Covid-19 has already been a tragedy for hundreds of thousands of people in the UK. We need to ensure that we very quickly learn the lessons from these past nine months – and, even more, that we rapidly apply these emerging lessons, so that the next nine months are not so dreadful.
So, what are these lessons? First, there is the need to focus on local, rather than national approaches. In a recent publication (https://www.tandfonline.com/doi/full/10.1080/09540962.2020.1821445?src=recsys), we worked with Italian colleagues to compare the approaches in two Italian regions, which had very different experiences with Covid-10. Veneto experienced its first death the same day as Lombardy but subsequently had a much slower growth of infections – by mid-April, Veneto had registered a cumulative number of 1,087 deaths and Lombardy 10,511. This appears to have happened because Veneto implemented a very different strategy, including a focus on home diagnosis and care, based on its well-developed community health system at local levels and extensive tracing and isolation at home. Significantly, regional government guidelines emphasized strengthened collaboration between voluntary organizations and public institutions, with local operational centres created at local government level to identify needs and priority intervention areas to recruit, train and equip (with PPE) local volunteers. This system linked volunteers and local councils for delivery of food and masks, accompanying elderly people on urgent medical visits, staffing mobile units supporting the homeless and substance abusers, providing psychological support by telephone and helping to recruit and train new volunteers for lockdown activities. This local response, promoting user and community co-production, has been hugely different from the centralised approach in the UK, e.g. the inability for months to make effective use of the volunteering offers by 750,000 UK citizens.
Second, we need to get smarter in ensuring resilience in dealing with Covid-19 and its health and economic consequences. However, resilience does not come easily. System-wide resilience requires a connected series of responses:
- service users seek individual outcomes, which require user resilience;
- members of local communities seek collective outcomes, which require community resilience;
- service provider organisations seek favourable business outcomes (profits for private providers, social value-added for non-profit organisations), which require service resilience;
- public service commissioning organisations seek to protect their service users from harm caused by the failure of any specific provider, which requires market resilience.
Moreover, these different forms of resilience interact with each other, so that focusing on just one of them is inadequate – the overall system is only as strong as its weakest link. Yet current public service organisations are very narrow and partial in their understanding of and ability to influence resilience in other parts of the whole system resilience chain.
So the third lesson is that we need to find ways of creating and maintaining positive links between these key elements of system resilience. While all stakeholders can play a role in this, citizens have a unique contribution to make, since they have the most intensive interaction with communities and with service providers. Local councils, therefore, need to move to a strategic reliance on co-production with local communities, which by its very nature can make the resources of local people available for strengthening each of these links in the service network, and therefore the resilience of the overall system.
The different regional experiences in Italy suggest that a local approach covering community- and home-based assistance are more effective than a centralised approach focused on hospitals. We suggest that a wider set of community-based interventions is needed, involving co-production with local communities, not just healthcare, since suppressing contagion will have to rely on prolonged socially-responsible behaviour and self-control by citizens, something of which the healthcare system has little experience, or indeed understanding.
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Governance International is a non-profit organisation working across the UK and internationally to support citizens and public service organisations to co-produce better public services and outcomes. Currently, we are focusing on how co-production can increase resilience in coping with the COVID-19 crisis – see our website: https://www.govint.org. We have been an Affiliate Member of the Co-operative Councils’ Innovation Network for the past three years.