“Yorkshire & Humber AHSN colleagues have added immense value to our rapid insights learning and innovation work. From design and start-up, through to data capture, engagement and compilation of case studies, we’ve benefitted from the thought diversity, creativity and rigour of approaches and experience provided.”

Jo Farn, Programme Director for Systems & Leadership Development, West Yorkshire and Harrogate Health and Care Partnership

Rapid evaluation of what has worked during COVID-19 to inform tomorrow’s activity

Challenge / problem identified

The COVID-19 pandemic has significantly affected the lives of the Yorkshire and Humber population in many ways, both personally and professionally. It has required healthcare organisations to rethink what they do, to innovate, and to adapt quickly to respond to the crisis, by implementing at pace and at scale new approaches that have enabled essential patient care and services to continue during the crisis response.

Yorkshire & Humber AHSN worked together with three Integrated Care Systems (ICSs) across their region, and with North East and North Cumbria AHSN and their ICS, to identify the behavioural and cultural changes and the specific innovations to embrace as we move forward and reset our health and care system, so that it is enhanced for the future. The challenge was to reflect on the learnings from the COVID-19 crisis and determine what it means for the way health and care is delivered going forward.

“Every time you hear someone telling you it’s too complex, too difficult, in COVID time, you just did it. Crises create leverage… it’s a time of crisis, but also opportunity.”

Clinical Advisor, Local Care Direct

Actions taken

Yorkshire & Humber AHSN partnered with three ICSs across the region (South Yorkshire and Bassetlaw; West Yorkshire and Harrogate and Humber, Coast and Vale), and with North East and North Cumbria AHSN and their North East and North Cumbria ICS, and worked together to evaluate the innovations and changes taking place in each area as a result of the pandemic.

In the first stage of analysis, Yorkshire & Humber AHSN 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, the Yorkshire & Humber AHSN produced a shortlist of innovative new ways of working and key learning to take forward.

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

Impacts / outcomes

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.

Hannah Wall, NHS England and NHS Improvement’s System Improvement Lead for the North East & Yorkshire and North West Regions, explains further:

“We contacted the Yorkshire & Humber AHSN some months ago to understand how our two organisations could work together, to maximise the opportunities from this experience for everyone. The YH AHSN were already substantially ahead of us, having been commissioned to work with regional Integrated Care Systems on a process to capture and evaluate examples of changes in practice in organisations within localities since the pandemic began.

“From our very first discussion the staff at the YH AHSN were keen to collaborate and to offer their support to the recovery of the NHS in the region. They were eager to learn about the regional and national programmes of NHS work and have been willing to share openly the work that they are doing. They have facilitated introductions to key individuals and collaborated with us on solutions to problems as they arose. Thanks to their support in June we were able to issue a joint stakeholder publication of early learning/ case studies from the management of the pandemic and we are now able to look at how we can work together in the medium to long-term to take the COVID-19 beneficial changes forwards.

“Without their resource, input and expertise we would have much less to show and have progressed at a much slower pace.”

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.

“It is not enough to use the solution, you have to design the organisation around it and that is recognised by a lot of different providers, that you have to manage your urgent care in a certain way to maximise the number of people coming online.”

GP Partner, Haxby Group

“Don’t be afraid to stand up for what you believe in or challenge if you feel something won’t work in the best needs of the clients… Look at the value of working together for the benefit of the good, the synergy of the whole system approach rather than little pockets working differently and going down their own route.”

Principal Occupational Therapist, Kirklees Council 

Future plans / next steps

The next stage of Yorkshire & Humber AHSN’s 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.

“I worked with the Yorkshire & Humber AHSN to jointly lead the rapid insights research across WY&H. It has been an excellent example of joint & collaborative partnership working. Despite never meeting face to face I felt a great bond with the team and shared purpose. AHSN added some solid structure and expertise to the process. They were able to quickly build solutions and adapt when needed. The commitment from the team was excellent, everyone was prepared to jump in to deliver the work in a very short deadline. Overall, an excellent experience and a pleasure to work with.”

Peter Wyllie – System Leadership & Development Programme Manager, West Yorkshire & Harrogate H&CP – ICS