Covid-19: Harnessing what we have learned to deliver services during the second wave

Winter pressures on the healthcare system are likely to be compounded this year by a resurgence of Coronavirus, making it of critical importance to draw on the lessons learned during the first wave of the pandemic as we get to grips with the current seasonal challenges.

Whilst there are numerous areas worthy of mention, here are some broad categories to focus on:

System working; responding to the first wave accelerated the maturation of many integrated care systems and put in place the building blocks for greater system resilience. Improved communication and coordination mechanisms were established between partnerships at place – including, PCNs, CCGs, acute and community hospitals, mental health, learning disabilities and social care.  This was particularly evident around the collaboration on Covid-19 assessment, the supply of PPE and the care arrangements for shielding and vulnerable patients. Viewing the health landscape through the lens of a holistic system caused some areas to adopt a single system-wide elective care waiting list and this has been referenced in an earlier insight piece authored by my colleague Ian Triplow: Elective Services: One System, One Waiting List

In some areas there has been a marked reduction in average length of stay in step-down beds with a focus on maximising community support for rehab and delivering a “home first” approach where clinically appropriate and available. The greater focus on working together across the systems on timely packages of care appears to have reduced DToCs in various areas; as the recovery of elective activity levels increases, it will be an area of interest to see if this can be sustained.

Decision-making and communication; locally, regionally and nationally decision-making processes were streamlined and the changes to clinical models, assessment processes, treatment thresholds, infection control procedures, equipment, locations and follow-up were captured within algorithmic or schematic diagrams as opposed to voluminous documents. Prioritisation methods also came to the fore and my colleague Vineeta Mann has outlined a robust prioritisation framework for elective surgery activity, which can be read here.

Infrastructure and technology; the rapid deployment and increased use of digital remote working was an undoubted success during wave one, enabling service delivery to continue and supporting efforts to maintain or increase capacity.  However, this change in practice may impact service users and staff in highly varying ways. The ability of some care professionals to pick up on non-verbal (diagnostic) signs may be affected when virtually assessing patients. In addition, some situations may result in an unexpected increase in the consulting time required to adequately convey / receive information during a remote (non-face-to-face) consultation.  A risk assessment around the novel introduction of virtual technology to an area of care is important especially in respect of vulnerable service users affected by a mental health problem or a learning disability and the staff caring for them.

The use of the healthcare estate has come into sharp focus during the pandemic and weaknesses around the flexibility and inadequacy of parts of the NHS infrastructure have been exposed.  There has been a requirement to reconfigure premises to support social distancing, implement hot / cold site patient segregation (infection control) measures and establish Covid-19 assessment units.  This is prompting an ongoing and continued review of the healthcare estate in many places as well as stimulating thinking around the development of more collaborative working arrangements from the standpoint of both location and skill-mix.

Workforce, Wellbeing and Inequalities; ensuring sufficient response capacity during the first wave of the Covid-19 pandemic necessitated efforts in carefully managing and acting on available workforce skill-mix, rostering and staff sickness information coupled with data on patient specific demand and the availability of diagnostic and other equipment.  A distinct area of concern as we respond to this second phase is the limited amount of ‘down-time’ some care sectors may have been afforded in recent months and the potential isolation some staff may have felt with the move to remote working, so special attention needs to be paid to staff health and wellbeing with a watchful eye on colleagues who might be experiencing burn-out.

Finally, the indirect consequences arising from the need to de-prioritise non-urgent care is yet to be fully understood.  Similarly, the wider social impact on mental health, drug abuse, suicides, debt and the associated strain on families and carers is only beginning to emerge.  However, it’s clear the Coronavirus pandemic is exacerbating already existing social and health inequalities and so extra attention is needed to ensure our second wave response plans are sensitive to this.

To find out how Attain can help you meet the challenges of winter pressures and the second wave of the Coronavirus pandemic please get in touch with Ore Okosi at ore.okosi@attain.co.uk

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