Using crises to leverage change and build resilience: Legacies and learnings from shocks

BACKGROUND: The economic crisis of 2008 and the Covid-19 pandemic acted as profound shocks on health systems around the world. During the financial crisis, Ireland was one of five European countries to receive a bailout from the Troika. The loss of sovereignty in governance and six austerity budgets created a huge challenge for the Irish health system and its ability to be resilient in the face of long-lasting shock. These constraints on resources and a shift in governance meant that Ireland's health infrastructure was weak going into the Covid-19 pandemic. Furthermore, the depletion of workforce numbers and low morale also presented challenges. METHODS: Semi-structured interviews were conducted with seven senior stakeholders as part of the wider RESTORE research project, following ethical approval from the research Institution. Nvivo software was used to conduct thematic analysis independently by three researchers. RESULTS: The financial crisis deeply impacted the Irish health system throughout the years of austerity. Due to these legacy issues, the system was in a relatively weak position when faced with the Covid-19 pandemic. Furthermore, a lack of long-term planning was evident during the recovery period and the system was unable to reverse many of the negative impacts brought on during austerity. However, the system proved adaptive and innovative in response to Covid-19, and the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding and a devolution in decision-making structures. CONCLUSIONS: The findings raise the question of whether health systems are entering a state of permacrisis and if so what can be done to promote resilience and prepare for future shocks. Furthermore, it asks whether health systems should put resources into acute shocks or everyday crises and explores the relationship between these two foci and resilience.