Healthcare after crisis: lessons from Christchurch

In the last few months we have all made huge changes to our lives and work in response to Covid-19. Not just to protect ourselves, but to protect our community.

This is a real-life example of collective responsibility.

I visited Christchurch, New Zealand in early 2020 as part of my Churchill Fellowship to discuss how the health system in Christchurch coped after the disasters it has suffered in the last decade. Collective responsibility was a key principle that senior leaders and clinicians emphasized.

Since spending time with leaders in Christchurch, I think we can learn a lot from how other health systems have coped with such disasters and take great hope from their examples.

Christchurch

The city of Christchurch has had its fair share of crises, namely the Christchurch earthquakes in 2011 and the Christchurch terrorist attack in 2019.

There are similarities between the effects of the disasters Christchurch has experienced and the situation we find ourselves in through this Covid-19 pandemic.

In any crisis there can be a huge loss of life and high casualty numbers, there are also difficulties managing supplies and maintaining non-emergency services and the long term impacts of any crisis can impact the health system and society for many years.

It is this long-term impact, on our health care system, our citizens and our communities, which we need to be mindful of as services begin to reopen and we move into a rehabilitation and recovery phase of the pandemic.

Since spending time with leaders in Christchurch I think we can learn a lot from how other health systems have coped with such disasters and take great hope from their examples.

Planning for the long haul

Emergency plans tends to lack foresight of long-term impacts, especially psychological impacts.

In Christchurch they were dealing with the psychological and emotional effects for years post-earthquake including grief, loss, fear, low confidence and lack of self-determination.

This is likely to be similar for people who have experienced Covid-19. Survivors can suffer with extreme fatigue, muscle wastage and deconditioning. There are also mental health implications to prolonged intensive care needs such as high incidences of PTSD, anxiety and depression for years after discharge from hospital.

Although many health services are now turning their attention to the immediate rehabilitation needs of Covid-19 patients and restarting non-Covid services, we should be planning for the long-term - when the physical and mental recovery needs of our communities will become apparent.

In Christchurch, they suffered several aftershocks and also another crisis of a different kind during the 2019 Christchurch terrorist attack.

In thinking about the possible aftershocks of Covid-19 we need to think about a possible second wave, further crises such as the winter flu and other impacting issues such as financial hardship and widening inequalities. There will be other, possibly unforeseen, aftershocks and as a health system we need to stay mobile and adaptive to these.

Key Principles for ongoing success of health systems after crisis

In Christchurch clinicians and leaders repeatedly highlighted some key principles which they emphasised as successful elements of their health systems response:

1. Collective responsibility
2. Collaborating with other services
3. Citizen focused decisions

These are all principles which helped Christchurch through the toughest times of their crises but which they have also continued to rely on in the years post-crisis.

Collective responsibility ensures decisions and discussions take place beyond organisational boundaries, with the focus remaining upon the patient and their community rather than the individual priorities of competing organisations. This principle has allowed their health system to pivot quickly, with support from across different networks and patient groups.

Collaborating with others shows the importance of reaching out to services, organisations and individuals beyond the boundaries of traditional healthcare providers such as NHS Trusts and liaising with local government and private healthcare providers.

Maintaining a citizen focus ensures discussions remain focused on the end goal, which the Christchurch networks have defined as aiming not to waste the patients’ time. Citizens are present at meetings and on boards and assist leaders to stay grounded in their discussions.

I hope these key principles and lessons can remind us all to keep open dialogue, collaborate widely and hold each other to account. The crisis has been a huge challenge for healthcare systems around the world. But it can also be an opportunity for creating a more positive future.

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Hannah Morley is an RSA Fellow, an Advanced Physiotherapy Practitioner (APP) working in Gloucestershire as a First Contact Practitioner and Lead Physiotherapist for Gloucestershire Health and Care Foundation NHS Trust and Stroud Cotswold Primary Care Network.