Values must lead us through the Covid crisis

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

Sometimes the last few weeks and months feel like an endless stream of digitally enabled conversation. It can all become a bit of a blur. When did we expect the world-beating app to happen? Did we really find out that guidance on shielding was changing the next day through a paywalled Telegraph article tweeted by the Secretary of State for Health one weekend morning?

Some conversations stand out – with one being a roundtable organised by the Nuffield Trust and chaired by Nigel Edwards. The aim was to begin to figure out why the UK, and England in particular, had done so badly during the crisis: high morbidity and mortality, problems with PPE, testing, care homes, inequality, over-centralisation.

Complexity

One recurring theme we discussed was that of complexity. It is hard to imagine a more complex situation than the one we have just experienced. We must not expect decision-makers to get everything right in these circumstances.

But also how can scientific advice do justice to uncertainty without making action harder, and how can we encourage and enable decisive action at moments of great uncertainty, when all the consequences of our actions simply cannot be known?

Some participants seemed to favour approaches that explore every complicated aspect of the situation, but is it useful to get distracted from the devastating and unprecedented spread of illness by less pressing issues, such as those that affected our sewage system when people began flushing ‘unflushables’ during the toilet paper ‘crisis’ of early lockdown?

It seems to me that when confronted with an endlessly complex set of hard-to-predict consequences, the aim cannot be to try to understand all of them in detail. If we want decision-makers to worry about the sewage system at the same time as they are considering banning people from shopping trips, we will paralyse everyone into inaction. Maybe the only way to deal with the complexity of taking unprecedented action (no one had locked down a whole 21^st century economy before) is to go ‘back to basics’, and simplify.

Back to basics

I was reminded of this when I saw Dr Michael Ryan, executive director of the WHO Health Emergencies Programme, speak in May. Discussing whether it wouldn’t be better to just let this disease run its course, he simply stated this: “Humans are not herds”. Any strategy that does not “put humans and their suffering at the centre of the equation” is a “dangerous, dangerous calculation – we need to get our priorities right”.

Listening to Dr Ryan, I could feel this enormous sense of longing – what if we had leaders who spoke with this clear sense of moral certainty? Who spelled out clearly what values need to inform our response? No, we cannot know all the things that will happen. But we do know what values we care about: dignity, equality, inclusion, minimising human suffering.

At National Voices, we had a strong sense of needing to remind people of those shared values early on during this crisis. Maybe that is because we do not have access to the stellar expert advice available to government, we cannot model the impacts of early or late lockdowns, or the point at which NHS facilities might get overwhelmed.

So we are even more aware that the only thing that can guide our way through this crisis is our values – staying close to the experiences of those who needed health and care services before Covid-19 and who still have those needs, focusing on those whose needs are greatest and who are most likely to be impacted by the inverse care law.

So as early as April, we responded to the reported decision about who should have access to critical care if demand outstripped supply by publishing a shared value statement of over 80 charities.

A principled approach

More recently, we expanded our thinking on the values that should shape the ongoing Covid-19 management in this country. Our statement of five principles is supported by over 90 organisations, and has led to important discussions with system partners and professionals:

• Actively engage with those most impacted by the change
• Make everyone matter, leave no one behind
• Confront inequality head on
• Recognise people, not categories, by strengthening personalised care
• Value health, care and support equally.

As we move out of lockdown and try to restart NHS services, complexity is only going to increase. We will be lost if we don’t hang onto the values we need to defend and promote in difficult circumstances. We won’t get every decision right regardless, but we can weigh up competing interests by getting our priorities right and putting humans and their suffering at the centre of the equation.

Charlotte Augst is Chief Executive of National Voices, the umbrella organisation for health and care charities in England.

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.