The response to the COVID-19 pandemic has seen dramatic changes in how health and care services are delivered and used. These changes – or ‘service shifts’ – have in many instances incorporated a fundamental redesign of services, with profound implications for both staff and patients.

Key points:

• Service shifts have affected the whole care pathway. This includes changes to health promotion and support for vulnerable people in the community; remote consultations in primary and hospital care; new ways of receiving emergency acute and mental health services; and new collaborations across the health and care system.
• A number of ‘enablers’ made these changes possible despite the huge strain on the system. These included local freedoms to implement changes within national guidelines, more time for clinicians to innovate and permissive ‘air cover’ from regulators to do so.
• Barriers to sustaining these ‘service shifts’ include fears of digital exclusion for some patients, challenges arising from collaboration across organisations and the potential fragility of the new community support networks because of financial pressure on the voluntary sector and future loss of volunteers.
• As the NHS moves into the recovery phase and starts to address the backlog of care and unmet need, it will need to maintain openness to radical innovation and learn from what made such a response possible. The need to improvise and adapt will continue for the foreseeable future.
• A model for sustainable change will need to bring together different factors to maintain new ways of working. These factors include having the backing and confidence of both clinicians and patients in service shifts forged during the crisis period, the availability of tools and resources and the alignment of systems of regulation and incentives.