Over the last three months, the AHSN Network has been contributing to NHS Reset, the initiative led by NHS Confederation to stimulate public debate on what the health and care system should look like post COVID-19.
Galvanising partners across health and social care, the NHS Reset campaign aims to recognise the sacrifices and achievements of the COVID-19 period, rebuild local systems and reset the way we plan, commission and deliver health and care for patients and communities.
During the pandemic, we have witnessed an explosion of innovation. The AHSNs have been focused on uncovering, celebrating and spreading the innovations and new ways of working that have supported patients, staff and systems at a time of national emergency.
Richard Stubbs, CEO of Yorkshire and Humber AHSN, said: “AHSNs have played an important role in helping health systems across the country to rapidly change the way they deliver services, and increasingly, to learn from these changes and use them to inform the future. We’re pleased to partner with NHS Confederation and the Health Foundation around the best practice and innovation theme of the #NHSReset campaign. We see this collaboration as hugely complementary to our own AHSN Network Reset campaign and the work being undertaken by individual AHSNs across the country. By bringing together the collective reach and knowledge of these three organisations we see great potential to both identify novel and innovative opportunities to shape health systems of the future, but importantly, to also ensure our findings and recommendations live long into the future and are translated into meaningful improvements in patient care and the way we deliver services.”
The AHSN Network has identified 10 key areas that have benefitted as a result of this rapid change, presenting a valuable opportunity for us to learn and inform how we do things in the future.
- Changing healthcare system dynamics
- Building stronger relationships with industry and supporting innovators
- Implementing digital solutions
- Supporting primary care
- Improving patient safety
- Using lived experience in addressing inequalities
- Supporting volunteers
- Identifying and resolving issues in PPE supply
- Rapid insights and evaluation
- A cleaner, greener NHS.
Changing healthcare system dynamics
The response to the COVID-19 pandemic has been a wakeup call that should cause us to change some beliefs about our healthcare system and the behaviours of staff and citizens.
As Richard Barker (Chair of Health Innovation Network) and Guy Boersma (Chief Executive of Kent Surrey Sussex AHSN) reflected in their joint blog post back in May, four beliefs have been challenged:
- The belief that that our health is the NHS’ problem, not our own. Personal responsibility for maintaining strong health status and reducing health vulnerability must increase in the wake of COVID-19, and we should see a growth in demand from citizens and a response from innovators for tools to enable this.
- The belief that health workers – particularly domiciliary workers and health assistants – are doing low level work that merits low pay.
- The belief that the NHS is a super tanker that cannot move quickly. It can and it has. We must collectively learn from how this was achieved and how the NHS can continue to respond positively to population needs at a faster pace and scale.
- The belief that the NHS and private providers are ‘enemies’. In contrast, we have seen that agreements to work together and switch capacity reveal that they are on the same side in any health battle.
Building stronger relationships with industry and supporting innovators
This last point above is a thread that runs through much of AHSNs’ activity to support the COVID-19 response.
As AHSNs know from many years’ experience but which has become much clearer during the pandemic, it is possible for the NHS and industry to work in partnership. Through our support and discussions with innovators and companies, we have seen some remarkable transformations in the way care and services have been delivered for patients in recent months.
Ashish Chokshi is an ‘NHS Navigator’ with the DigitalHealth.London Accelerator and believes COVID-19 has acted as a trigger a new era of collaborative working between SMEs and the NHS with clinicians suddenly more willing to try out new technologies. Talking about the need to retain these new ways of working with industry, Ashish says, “The challenges are there, but not unsurmountable if culture continues its transition from ‘what are the issues with this’ to ‘how can we make this work’.” Read more here.
In July, we hosted a virtual round table with industry partners to explore their lessons learned and lived experiences, who shared examples of the challenges and opportunities COVID-19 presented to health companies. NHS colleagues also shared impressive insights into the ‘staggering’ rate of uptake and advancements, emphasising the need to maintain this momentum and appreciation of the benefits these innovations can bring. As Nicole, McGlennon, points out in her recent blog, the input of industry and the learnings we can take from innovators and their experiences of COVID-19 shouldn’t be underestimated.
One of the innovators involved in the round table was Chris Barker, CEO of Spirit Health Group. Chris commented: “The healthcare landscape has changed forever. Technology is here, it is evolving and we need to embrace it as part of the normal healthcare landscape. We need to work with healthcare professionals and commissioners to ensure that these advancements are regarded as part of normal care and not ‘digital healthcare’ only.” Read more from Chris in his blog post.
Beyond our round table, we’ve been capturing the insights of healthcare innovators during COVID-19.
At the start of the outbreak, NHSX, the AHSN Network, PUBLIC and the Ministry for Housing, Communities and Local Government launched #TechForce19 to find technology that could help vulnerable people during the pandemic. In this series of three podcasts, we talked to the companies who were selected to receive support and funding to take their innovations to the next level.
In this blog, Laura Boyd, Deputy Director of the NHS Innovation Accelerator (NIA) highlights that for many NIA Fellows the usual blockers to working with the NHS overnight have changed overnight.
For some, the start of the pandemic meant the phone ringing off the hook for their digital transformative innovations that enable remote ways of working. Others, who saw demand for their innovations grind to a halt when priorities had to focus elsewhere, the crisis offered an opportunity to pivot and adapt. “True to their entrepreneurial selves, we saw the NIA innovators use their knowledge and expertise to help the NHS,” says Laura.
The call for new NIA Fellows is now open, and one of the themes that applicants’ innovations need to address is the NHS response to COVID-19. Find out more here.
Many companies have welcomed a reduction in bureaucracy a major enabler during the response to COVID-19. “Our plea to the system as we ‘reset’, is to trust in your staff, empower them to get on with their jobs and allow them to make decisions themselves,” write Vicki Haworth and Charlie Bell, Founders of Isorropia Foundation. “Replacing bureaucracy with autonomy makes it easier for your team to develop resources and deliver the services needed by an innovative, agile NHS.” Read more in their blog here.
Implementing digital solutions
Much of our work in the last few months has highlighted the great potential of digital health innovation for NHS service restoration and reset.
The AHSN Network has carried out a research study to understand how digital and AI technologies have been an enabler in reducing the care burden and coping with the crisis, and to identify what should be sustained in the ‘new normal’ longer term.
Our new Digital and AI report explores a number of key findings and calls to action, including the need to reconfigure patient pathways to integrate NHS and social care around patient/citizen needs so that improved outcomes are the goal, with digital and data technologies utilised as enablers – the means to the end, rather than the end in itself.
Another recent report by the King’s Fund, commissioned by the AHSN Network, uses four unique case studies to outline and discuss common themes of effective implementation of digital innovation.
‘Technology and innovation for long-term health conditions’ considers the use of digital innovations in health services from the UK and overseas to demonstrate transformative potential and compare and contrast themes across geographies. The report also recognises the rapid uptake of digital innovation driven by the COVID-19 pandemic and outlines some of the questions services need to answer to sustain and implement digital technologies effectively going forward.
As Guy Boersma, Managing Director at KSS AHSN and Digital & AI Lead for The AHSN Network comments, this report is highly relevant to the Reset debate, as we attempt to hold on “to the digital gains of the last six months, working differently and unlocking the power of technology at much greater scale to reach many more patients. The case studies in the report are bang on in terms of relevance with their focus on Virtual Wards, Remote Monitoring and the benefits of Supported Self Care”. Read more in Guy’s blog here.
And as Dr Matt Kearney, GP and programme director at UCLPartners, says in his blog post, “A key message of the King’s Fund report is that just satisfying the understandable hunger for new technologies will not be enough to transform healthcare in the wake of COVID-19. Technology will be a key enabler, but clinical teams will need new pathways and new ways of working if we are to deliver high-quality proactive care to our patients with long-term conditions in this new world.” Read more here.
During the pandemic, AHSNs around the country have been supporting a number of companies to develop and/or spread their technologies that could aid the response.
For instance, Health Innovation Manchester worked with tech company Safe Steps to develop a UK-first digital tool to help care homes track COVID-19 and coordinate care with GP practices, social care and hospitals to optimally support vulnerable residents.
East London GP and UCLPartners’ Health Technology Advisor, Dr Nausheen Hameed has seen first-hand how increased adoption of digital technology has transformed maternity care during COVID-19. “Although face-to-face appointments with pregnant women and new mothers are important, apps like Mush and video consultations are valuable tools for GPs and certainly have a place in the longer term,” comments Nausheen in this blog post.
Supporting primary care
Perhaps the biggest shift in the use of digital technologies by the NHS during COVID-19 has been the use of remote consultations in primary care.
All AHSNs supported the rapid rollout of digital primary care, helping NHS England and NHS Improvement, NHSX and NHS Digital to achieve a near-total uptake of video and online consultation technologies in only two months across GP practices in England.
In April, the Digital Health and Care Alliance (DHACA) in partnership with the AHSN Network ran two webinars to explore how practices were implementing ‘total triage’ solutions during COVID-19. The webinars featured representatives from some of the companies supplying total triage systems, as well as patients, GPs and practice staff.
In addition to listing the many benefits of online and video consultations, participants in the webinars recognised that the move to total triage is not just about the technology and ‘turning on’ a system. This has to be an improvement journey. Read more here.
Not being able to see patients face-to-face has not been the only challenge faced by colleagues in primary care during COVID-19, and the AHSN Network has partnered with the Royal College of General Practitioners (RCGP) to offer support and advice through a series of webinars.
- Patient assessment and the role of physiology and oximetry: The assessment of patients who are unwell with COVID-19 or other causes presents a significant challenge for GPs and clinicians working in primary care. This webinar considered the role of oximetry and other physiology in that assessment.
- Primary care in care homes during COVID-19: This webinar shared examples of current good practice and collaboration between primary care and care homes, including resources to support virtual ward rounds.
- COVID-19 and children: what the busy clinician needs to know: This webinar considered how COVID-19 affects children, identifying and managing non-COVID-related illness, and a brief review of its wider impact.
Improving patient safety
The 15 Patient Safety Collaboratives (PSCs), commissioned by NHS England and NHS Improvement and hosted by the AHSNs, responded quickly to both the immediate crisis in March and to reprioritise their day-to-day work programmes. The safety of patients during COVID-19 meant PSCs had to adapt quickly to support local health and care systems to refocus support where it was most needed.
PSCs accelerated the spread and implementation of tools to spot seriously ill patients in care homes, who are at greater risk of deterioration, and took on the rapid mobilisation of a safer tracheostomy care programme to assist the high number of patients expected to need prolonged ventilator support in intensive care units.
“One of the things that I can reflect on is how quickly we have been able, as an AHSN Network, to mobilise our workstream leads from all 15 AHSNs, talk to them about their shared learning, get a baseline and workout how to share the information and toolkits to make the biggest difference locally and nationally,” comments Jay Hamilton, Associate Director of Health & Implementation and Patient Safety Collaborative Lead at Health Innovation Manchester. Read Jay’s blog on how AHSNs supported the rapid spread of the safe tracheostomy care response.
Looking forward, PSCs are rolling out virtual ward pilots to support patients in the community, generating evidence to support future waves and ways of working as part of the NHS At Home programme.
Natasha Swinscoe, national patient safety lead for The AHSN Network and CEO of the West of England AHSN, points to the importance of a common goal in being able to adapt so quickly, and a key lesson for the future. “Working together – keeping it simple, sharing widely, testing and learning – can increase the speed and impact of any innovation or change in practice,” says Tasha in her blog published this week.
Using lived experience in addressing inequalities
As we work towards ‘resetting’ our health and care services by learning practical lessons from our collective response, we must make sure that everyone who has a stake in the NHS has the opportunity to have their say on how we might do things in the future.
Many groups and communities such as Black, Asian and Minority Ethnic, older people, people living in care homes, people with disabilities and long term conditions, and carers have been affected disproportionately and more severely by COVID-19. It is important that we listen and understand these perspectives, so that we can learn and address inequality when we see it.
Dr Bina Rawal, a non-executive director of the Innovation Agency, argues that by laying bare ‘inconvenient truths’, the health service can reset to a healthier work environment for all employees.
As Nicole McGlennon, Managing Director of East Midlands AHSN, stresses in this blog, agencies like the AHSNs have the ability to engage and involve the public, and undertake processes such as equality analysis to assess and better understand if any potential innovations could exclude certain groups or make accessing services or information harder. AHSNs have also committed to a number of important diversity pledges to ensure our work, including the innovations and innovators we support, embed equality, diversity and inclusion.
Since the start of pandemic, thousands of people have volunteered to support the NHS and their local communities. AHSNs have been working with partner organisations to help coordinate opportunities for volunteers, helping to match them to the services most in need, and learning vital lessons and best practice to share with others.
Imperial College Health Partners (ICHP) helped to identify potential volunteering services in North West London able to support community/trust pharmacies and individual patients with their medicine deliveries, discovering extensive volunteering resources in the community that weren’t being fully utilised. Read more here.
The South West AHSN’s Institute for Social Prescribing supports innovative practice in social prescribing to help address a range of issues that impact people’s health and wellbeing. During lockdown, the Institute has been supporting community groups in Devon and Cornwall, whose work usually involves bringing people together, to find alternative ways to work with volunteers to provide support to the most vulnerable.
Identifying and resolving issues in PPE supply
During COVID-19, a priority area for health and social care has been to ensure a consistent supply of suitable Personal Protective Equipment (PPE).
At the start of the pandemic, there was an urgent need for additional sources of PPE to ensure trusts had appropriate levels of protection readily available for staff. There was an identified need to assist health and care organisations to ensure a reliable supply of suitable PPE and to explore options for more reusable PPE.
AHSNs have taken a lead role in sourcing additional supplies of PPE, supporting innovators producing new PPE products, and developing the potential of reusable PPE. We will continue to share best practice and opportunities to improve the resilience of the PPE supply chain, reducing environmental impact and support economic growth of UK manufacturers and support services. Read more in our case study.
Rapid insights and evaluation
Many AHSNs have conducted system-wide surveys to generate rapid insights into work at system, place and neighbourhood level in response to COVID-19. The insights are being used to draw out the positive elements of change that will support systems as they move to reset and to inform their work plans and business planning processes.
Read our case study on Yorkshire & Humber AHSN’s work to help the Integrated Care Systems (ICSs) in their region including the collaboration with the North Est and North Cumbria AHSN and their ICS to reflect on the learnings from the crisis and determine what it means for the way they deliver health and care going forward. Some of the common themes emerging from more than 450 examples of service changes and innovations in response to COVID-19 pandemic include:
- Increased collaboration between teams/specialities, organisations, and systems to develop solutions to shared issues and provide mutual aid.
- Rapid adoption of technology (including virtual consultations, remote monitoring devices, communication software and IT infrastructure) that has allowed to continue support patients and staff in a safe way.
Similarly, Wessex AHSN worked with local member organisations to create a rapid insight team to capture learning about the changes being implemented to support the NHS and to identify what should be adopted and developed in the longer term.
Jon Siddall, Chief Executive of South West AHSN, was one of the speakers on the recent workshop hosted by the Health Foundation’s Q Community in partnership with the AHSN Network and NHS Confederation on rapid learning and improvement during COVID-19. Jon shared an overview of the work they are doing to support learning during COVID-19 in Devon and Cornwall and gave practical examples of the work they have done in three areas to support learning:
- Shared purpose to reduce conflicting priorities and enabling focus, for example using video consultations in general practice and sharing rapid learning across the region.
- Permission (psychological safety) to try things out, fail, ‘get on with it’ and innovate.
- Cross-organisational systems, such as social prescribing sites sharing data with the voluntary sector.
UCLPartners rapidly gathered, synthesised and shared emerging insights and evidence on COVID-19 management in intensive care, working with the Intensive Care Society to facilitate national and international knowledge sharing events. This fed into the learning system at London Nightingale Hospital and the learning was also disseminated regionally, nationally and globally to support similar endeavours.
In this blog post, Sophie Bulmer, UCLPartners’ Network Development Lead, shares key learning points on how a learning system was built at Nightingale London to make agile changes for the benefit of staff, patients and their families.
A cleaner, greener NHS
Could the post-COVID-19 fresh start or ‘new normal’ that is widely under debate provide a golden opportunity to rethink the environmental path we in the NHS can take as we move into the reset phase of the pandemic? This was the question posed by Gideon Ben-Tovim OBE, Chair of the Innovation Agency, who puts forward a number of suggestions for a green and just Reset.
These include reviewing environmental policies for sustainable best practice on waste, recycling, transport, plastic use, water, energy, heat, power and buildings, and reinvigorating use of ‘social value’ legislation in commissioning decisions, so that they fully take into account social, economic and environmental benefits. Read more here.
Get involved in the NHS Reset debate
Working with the NHS Confederation and the Health Foundation through the NHS Reset campaign, we want to explore how the health and care sector can work with staff, patients, the public and industry to understand, translate and adapt the best of COVID-19 related innovations and initiatives into everyday practice – maintaining momentum, sharing what’s working and improving people’s care.