Innovation and the speed of change

The speed and scale of the pandemic required health and care providers to respond in new ways. The enormity of the challenges they faced meant that, at very short notice, services developed new procedures and ways of working.

In June we published more than 300 examples from the front line of changes that providers had made, so that they could quickly learn from each other and consider whether innovations brought about by the crisis could help shape services in the future.

The examples, from small home care agencies to large acute hospitals, are a celebration of the dedication and resourcefulness of health and care providers and staff. They illustrate their tremendous resilience and imagination, and their determination to think differently to meet the needs of people who use services and keep people safe in a time of crisis.

They included:

• A GP who carried out a virtual ward round to two care homes by video call. She saw every patient in the homes registered on the practice list. She then telephoned the next of kin for each patient to reassure them that their loved ones were being supported.
• Another GP surgery pledged that each member of staff would ring one potentially isolated patient for a chat every day during the pandemic. This good practice was followed by all GP practices in the primary care network.
• A homecare provider has been using tablet computers to record baseline observations of people using its service. Monitoring temperatures and vital signs has helped to identify early signs of infection, enabling them to apply additional social distancing measures and to use consistent care teams to help limit any potential spread of the virus.
• A service for people with a learning disability contacted their favourite local pub to help them create their own pub, while observing social distancing guidelines. The local pub kindly donated items to help make it as authentic as possible.
• An NHS trust introduced a new role of family liaison officer to support patients, their families and loved ones, as well as staff teams. The trust also set up a drop-off and collection station so that people could send items to their loved ones on the wards through the officer.
• A mental health NHS trust set up a 24/7 mental health emergency department with a dedicated phone line for patients in crisis, so that they could avoid acute hospital emergency departments.

The provision of health and care services was already changing, but the pandemic has sped up that change. This has happened when groups of people have come together to solve an urgent problem, such as the development of the Nightingale hospitals.

The crisis has also accelerated innovation that had previously proved difficult to mainstream, such as GP practices moving rapidly to remote consultations following the requirement to move to a remote triage-first model of care. In the week beginning Sunday 1 March, 14% of appointments reported to NHS Digital were recorded as being by phone. By the week beginning Sunday 29 March, a week after the lockdown, this had jumped to 46%. It has remained around this figure every week since then (figure 14).

NHSX reported that, by 1 June 2020, 87% of general practices were live with technology to enable online consultations, a figure that has increased markedly during the COVID-19 period. NHSX has also reported that more than two-thirds of practices saw appointments booked online using GP Connect.

GPs have told us they have received positive feedback from patients, and this is generally supported in the surveys we have carried out with people who use services during the pandemic. Most of those who responded to us wanted the access routes available during the pandemic, such as online appointments and telephone and video consultations, to remain available in the future.

However, these remote forms of access were less popular with certain groups, such as people in low-income households, and face-to-face appointments remain important. Healthwatch England heard concerns from people about the accessibility of remote care for people with additional communication needs, as well as people who do not use the internet. They highlighted how digital or telephone appointments and assessments are not always suitable for people living with dementia, autistic people, and those with a learning disability. A recent report from Healthwatch England, National Voices and Traverse, The Doctor Will Zoom You Now, said that, “Key to a successful shift to remote consultations will be understanding which approach is the right one based on individual need and circumstance. A blended offer, including text, phone, video, email and in person would provide the best solution.”

In initial feedback from conversations we had with GP practices during the pandemic, they said that practice teams have been working well together and more closely in response to the challenges they have faced, which has enhanced people’s working relationships. Practices also indicated that they had received good support and engagement from others to help them manage the pandemic, including clinical commissioning groups and primary care networks.

In terms of the challenges they have faced, a common theme in early feedback was one of information overload, particularly practices struggling with guidance from different sources that was changing or conflicting. Practices have said that going forward, guidance needs to be much better coordinated and streamlined.

Some of the rapid innovations we have seen since the emergence of COVID-19 have been positive for people with protected characteristics. The Think Local Act Personal group has published a number of encouraging case studies of positive responses to the pandemic, available on their website. They include examples from different parts of the health and social care system, aimed at different groups including yoga for disabled people, inclusive digital innovations for people with a learning disability, and new support systems for Black and minority ethnic staff at an NHS trust.

Some innovations, though, have brought to light the need for equality impact assessments to become an integral part of developments in health and social care, even in emergency situations. For example, we were unable to register two proposed Nightingale-style step-down centres for people recovering from COVID-19 because they were unsuitable for many physically disabled people and older people.

It was clear even before the pandemic that digital solutions such as online consultations and triage apps work well for many. However, many of these innovations exclude people who do not have access to a smartphone or computer, and some have been rushed into place during the pandemic. Arrangements and planning for people who are vulnerable to digital exclusion must not be lost in the rush to prioritise innovative and resource-saving online options.

We have worked with other health and care organisations to identify a set of principles that can help enable innovation in health and social care providers. This work was funded by a grant from the £10 million Regulators’ Pioneer Fund launched by the Department for Business, Energy and Industrial Strategy (BEIS) and administered by Innovate UK. These principles will be published in a report in the autumn.

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