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NHS Reset: Helping our Integrated Care Systems to evaluate innovations during the pandemic

Posted: - 16th September 2020

The challenge

The COVID-19 pandemic has had a significant operational impact upon England’s health and care system, leading to unprecedented rapid innovation and transformation across a wide range of services.

We have been working closely with three Integrated Care Systems across Yorkshire and Humber (West Yorkshire and Harrogate Health and Care Partnership, Humber Coast and Vale,  South Yorkshire and Bassetlaw) and with North England and North Cumbria AHSN and their ICS, to understand what changes have worked and which haven’t during the pandemic and identify specific innovations to embrace as we enter a ‘new normal’ and look to improve our health and care system for the future.

We worked together to evaluate the innovations and changes taking place in each area as a result of the pandemic.

Action taken

In the first stage of analysis, we produced a rapid insights survey, which was completed by a large range of people from each region detailing the changes they had been involved in. This provided qualitative data on what had occurred, how this differed from what they had been doing previously and outlined what they perceived as the successes and challenges. From this, we produced a shortlist of innovative new ways of working and key learning to take forward.

From these responses, we selected some of the most important innovations and worked with systems to create more in-depth case studies, interviewing individuals and teams to explore further insights into the benefits, challenges and recommendations for their change.

Alongside this, we worked closely with patient and public representation groups across the region to understand how the pandemic and changes to healthcare had affected the population. Insights have been gathered from a broad range of groups, including cancer patients, Black, Asian and Minority Ethnic (BAME) communities and Healthwatch.

The learning from the surveys and case studies was then aggregated, analysed and brought together in a system-specific summary report, which drew on the learning and knowledge gained. This report presented the initial intelligence on what has been done – both changes in practice, innovation adoption and behaviour change – alongside recommendations for the ICS to consider and develop further.

Harnessing the learning from the outbreak of COVID-19 has been crucial to ensure that the rapidly expedited improved ways of working can be properly evaluated, sustained and spread for future benefit.

Early in the pandemic NHS England and NHS Improvement in the North East and Yorkshire identified that collaboration with partners and stakeholders would be key to ensuring a systematic and structured approach to the learning was devised and implemented – to eliminate duplication, avoid repetition and support the dissemination of approaches which could aid redesign efforts in the future.

Lessons learned

Here are some of the key findings from this evaluation work to date:

  • The use of technology was well received by patients because it ensured continuity of care, more flexibility in service provision and improved accessibility. It was also well received by healthcare staff, as it provided new ways to support their patients. However, some patients did not have access to the necessary technology, and IT equipment sometimes took time to fully embed.
  • Virtual working has been regarded as a positive due to its flexibility and benefits on wellbeing, along with the reduced cost, time and environmental impact. Some of the challenges included a blurred work/life balance, inconsistent performance of technology and inefficient meetings.
  • COVID-19 has led to greater collaborative working across the region, which has increased trust between partners, improved communications and greater recognition of the role of each team within the system.
  • Positive behaviours that came out of COVID-19 included the willingness to be flexible across the workforce, better communications, more – resilience, a greater appetite for change and more connectivity between partners.
  • COVID-19 has had a negative effect on the wellbeing of some patients. Postponed or cancelled services have caused increased distress. Of particular concern are older people, deprived communities, those at risk of domestic abuse and violence, and protected groups.

Next steps

The next stage of our reset and evaluation work is to conduct a deeper evaluation using the Quality Improvement (QI) Sustainability Model to develop action plans for critical priorities and sustainability in the ICS. This will consider any risks and mitigations, issues and gaps for each priority and programme, such as capacity, workforce, and resources.

Following this, a more academic evaluation will focus on the methodology of spread and adoption of the Rapid Insights and QI Sustainability work. This will also feed into the AHSN Network’s national evaluation insights work.

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