Clinical trials conducted in weeks, not years. A huge shift to tele-medicine for those who want it, saving time and increasing access to appointments with the doctor. Greater use of remote health devices. A halving of ambulance call-outs in London to take someone to the emergency department.
These are just a few of the changes in health practices that have come about in the UK as a result of the emergency response to Covid-19. The pandemic brought together the entire health and social care system. It forged new partnerships, accelerated research and quickened the take-up of innovations.
As the disease is brought under control, it is not too early to incorporate lessons learned from the handling of the crisis into everyday practice.
To that end, the Accelerated Access Collaborative (AAC) and the Beneficial Changes Network (BCN) teams at NHS England and NHS Improvement commissioned Frontier Economics, along with Kaleidoscope Health and Care and Rand Europe, to identify which potentially beneficial interventions, technologies and tools deployed during the pandemic could yield lasting benefits in future.
Innovation, research, collaboration
Our analysis focused on three particular aspects of the UK’s response: its impact on innovation (particularly in service delivery), research (particularly clinical research) and collaboration (especially place-based networks and other new partnerships). We paid especial attention throughout to understanding health inequalities and how to reduce them.
After conducting a series of deep dives into selected topics, interviewing stakeholders and conducting online workshops to review the evidence, we came up with six core findings:
- Clarity of purpose - A system-wide shared understanding of the need for action mobilises partners quickly and breaks down barriers to collaboration
- Leadership and agency - Beneficial change is accelerated by leadership that supports appropriate agency across organisational levels, and supports innovation and collaboration
- Inclusion and personalisation - Addressing health inequalities requires greater inclusion and involvement of diverse perspectives, and the better personalisation of services to different populations
- Skills and capability - Change was enabled by those who had appropriate skills to solve problems, then adapt to new ways of working
- Data and technology infrastructure - Critical enablers of rapid change include the safe and timely sharing of data, and appropriate and resilient technology infrastructure
- Evidence-based decision making - For the impacts over time to be fully understood, there is a continuing need for robust evaluation evidence to understand what works, for whom and under what circumstances
Building on these findings, we drew up a list of 12 recommendations to inform the future priorities of the AAC and BCN and the wider health system. We grouped them into four categories.
Critical ingredients for change
Covid was the worst health crisis in a century. The common national priority of containing the disease swept aside obstacles to cooperation. New treatments were tested at unprecedented speed; more efficient ways of reaching and treating patients were quickly rolled-out. The task for all relevant organisations now is to achieve that same sense of purpose by setting clear priorities and putting partnerships at the heart of how the health system embraces change.
One concrete change, we recommend, is to adopt new models of delivering services, such as blended service delivery. For instance, patients with long-term conditions can use smart home assistance devices and apps that allow them to share information with clinicians remotely, as has been happening in Torbay and South Devon. Use of a system for people with diabetes to self-monitor glucose levels is just one example of a technology that was also stepped up significantly during the pandemic.
Leadership based on trust – with appropriate accountability – is a precondition for promoting rapid change and agile service delivery. Practically, that means staff with operational knowledge should be encouraged to take the initiative to innovate.
The swift, safe sharing of data and evidence is crucial for the adoption of new models of service delivery, as is the timely communication of information. During the pandemic, the accelerated roll-out of digital methods, such as remote triage and the remote monitoring mentioned above, benefited many people. But this is not for everyone. More must be done to counter digital exclusion. Designing services to meet the needs both of those for whom technology works well, and for those who must have more tailored and personalised services is essential.
To design services well, integrating lived experience and co-producing guidance, training and other materials is essential. As is tailoring communication channels and styles to meet the needs across communities.
We make three recommendations. First, work is needed to address the under-representation of some groups in research. Second, the UK should be more actively involved in international clinical research projects. And third, the use of digital technologies that facilitate collaborative research should be explored further.
A striking feature of the response to Covid-19 was the way in which diverse organisations including the NHS, local authorities, university researchers, community support groups and even the military cooperated to tackle the pandemic across multiple sectors.
The health system needs to learn from this experience by ensuring that local areas have the capacity to focus on their own chosen multi-sector priorities. Representative national, regional and local voices must come together to map out collaborative strategies for addressing local health inequalities.
Covid-19 has provided pointers for how innovation can be embedded in the health system for the benefit of people who both use and provide its services. Innovation can be supported by ensuring the complex system by which health is paid for facilitates collaboration and appropriate risk-taking.
It has also shone a light on the pace at which change can be implemented through working together with a common purpose. Such change provides important opportunities to develop much needed and robust evaluation evidence on what works, for whom and in what circumstances. Not only does this information allow continued adjustments to improve services, but it also means budget-holders can make informed decisions about what delivers better outcomes from their budgets.
Furthermore, our work has shown the value of working with people with lived experience to design services along with the guidance, training and other materials. For many, using technologies to support service delivery can be highly effective. But this is not for everyone – others need more personalised attention. Evaluating and learning what the best approaches are for personalisation and enhancing inclusion are vital activities to address the inequalities experienced across communities.
This all makes it vital to learn the lessons of our handling of the pandemic to build a more robust, agile health and social care system.