The domestic response to coronavirus has shown that, in times of crisis, the NHS and its staff can react and adapt in ways that are only possible through a centralised national service. Some changes, like the addition of the new Nightingale hospitals, will be transient. Others, such as video conference consultations, may remain long after this crisis is over. The initial focus has been on front line NHS services, but could the most profound legacy result from the volunteer efforts and wider community response to supporting those most vulnerable?
As a hospital doctor, I look after you only while you are in front of me. Your family, your carers, friends, and your community look after and support you 24-7 when you are back home. Adult social care and community support have a huge impact on improving people’s quality of life and reducing the burden of disease. Programmes such as meals on wheels reduce malnutrition and risk of other illnesses in the elderly, while day centres reduce loneliness and support the mental wellbeing of some of the most vulnerable in society.
During my time working for the NHS, I have looked after many people with severe mental illness, and have seen both extremes of community support provision. Some people live on their own, with little to no community involvement; isolated to the point of becoming what is effectively an asylum of one. At the other end of the spectrum are people supported by charities and community groups working hand-in-hand with statutory services, enabling them to flourish.
To stay well, people need a reason to be well. They need a reason to wake up in the morning and a sense of meaning and belonging. People with mental illness can be particularly at risk of being isolated and in need of community support. But all of us, regardless of health conditions, need to feel and be part of a community.
Across our society, we are seeing first hand the many people – often hidden in plain sight – who need a little help: those with limited social capital, without friends or family who can help with collecting their shopping and medication; people whose only social contact may have been going to the shops or seeing their GP, and for whom a chat on the phone once a week is a lifeline; those who, for all sorts of reasons, may be marginalised and living on the fringes of society. The crisis has activated our communities to step up and help like never before. Local support groups have sprung up all over the country and more than 750,000 people have joined the NHS volunteer programme. There is a can-do, action first approach to helping and it is truly inspirational.
The state is also playing a large role, and local authorities and central government have set up wide-ranging support for people including food parcels, medicine deliveries and welfare checks. It can be easy to focus on front line NHS services, but adult social care and other services provided by local authorities and charities are its backbone. We all know that the challenges around fixing social care services are legion, with no easy answers. But there are signs of change here, too, as carers are finally – rightfully – being recognised as critical workers in our society. Surely there is no better time than now for all politicians to step up to the plate, just like our communities have, and drive through improvement and change that builds on the back of our response to coronavirus.
Many of the care needs that people have now are not going to go away when the pandemic is over. Sadly, as a result of crisis, these may even get worse. There is already some evidence that people may be delaying attending healthcare services when they have suspected cancer symptoms or other serious illnesses, leading to worse outcomes. The impact on mental health may be even more profound as economic downturn is strongly associated with increasing mental health problems. This is yet another reason, if one was needed, as to why we must ensure the most rapid recovery of our economy as possible once lockdown starts to lift.
How will our community response change when we are on the other side of the pandemic and shielding lifts? Is it conceivable that volunteers, having met and supported people through this time, will abandon them and withdraw? Or could the legacy of coronavirus be a galvanising of all society to support and care for those who need it most? After the unequalled support we have provided to some of the most vulnerable during the pandemic, we must ensure that care from and in the community will be better than ever before. Look outside at the rainbows in windows and volunteers pushing offers of support through doors: our citizens are leading the way to change.
Ben Spencer is a psychiatrist and Conservative MP for Runnymede and Weybridge.
This article originally appeared in the New Statesman’s Spotlight report on mental health of May 2020. Click here for the full report.
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