System recovery – now the hard work begins! – Q&A Summary

As part of the Connect Health Change webinar series, we present the Q&A summary from our panel who discuss solutions and ideas on the best approaches for dealing with the growing backlog of demand for hospital care, and the need to tackle growing waiting times

Connect Health “Change” brings you the thirteenth in a series of webinars to make and embed transformation in healthcare. Aimed at system leaders and clinicians across the NHS, the webinars provide practical solutions to the challenging issues we are all grappling with.

This webinar was aimed at leaders who are seeking solutions and ideas on the best approaches for dealing with the growing backlog of demand for hospital care, and the need to tackle growing waiting times. In addition, community services and primary care face significant backlogs as much routine care was put on hold.

Inspirational and experienced speakers included leaders from ICSs, local authorities, primary care, community providers and those on the frontline delivering services.

The webinar covered:

  • The impact of waiting lists on every part of the system
  • Uncover innovations and techniques in order to inspire and educate
  • Examples from those who are well on their way to solving the backlog challenge
  • What changes to care pathways introduced during the pandemic should be retained
  • The best way to embed and accelerate digital change

Delegate feedback included:

  • That there was representation from pertinent sectors. It kept to time and was informative

Watch the Webinar in Full

 

 

Chaired by:

Dr Graeme WilkesChief Medical Officer, Connect Health

 

Q&A

 

Ken Bremner MBE, Chief Executive, South Tyneside and Sunderland NHS Foundation Trust

 

View a video of Ken’s talk

 Question 1: Trusts had to submit final recovery plans to NHSE on 03 June.  What are the quick wins in your plan?

 Answer: Like a lot of organisations we have made some significant changes on outpatients in particular and transforming the way that’s delivered as an organisation. About 40% of all our appointments are now via either telephone or some form of virtual means. In the meantime, there’s no doubt that we can go further with that.

We’ve also got some pilots running with patient-initiated follow-ups in three particular areas to see how much success we have with that. There’s also a big push on advice and guidance as well. We’ll also have a look at our capacity demand as an organisation, (which we do regularly anyway as part of the planning process) but that needs to be refreshed given that so many things have changed, not least of which of course are the IPC restrictions we’re all working with. We’re going to take a little bit of time to reflect on how we got the right capacity and demand. You’ll also see more sharing and transparency of data from amongst the trusts within the North East community so if there’s organisations that need help in a particular area and hopefully, we can come up with solution amongst ourselves to solve that or at least to recover in due course.

 

Question 2: What’s your sense of the current throughput consequences of IPC guidance and how close you are to getting back to pre-pandemic levels of productivity?

Answer: As of today, if I just look at how ‘open’ we are to where we were in 19-20, we’re running at about 85-86% of where we were inpatients and day cases compared to 19-20. If I look at outpatient activity, we’re probably running somewhere around 91-92% but in outpatients, I would make a distinction between new and follow-up, follow-up is fairly close to 100% but new, is probably running at just over 80%. We’ve got some internal issues to disentangle there as well, so don’t get me wrong opening up isn’t easy but it’s the easier bit of this in my view, the backlog and the unknown is the bit that’s the more difficult and challenging ask.

 

Question 3: How can you best use the help of the community and council and primary care?

Answer: We’re not completely separate organisations at the moment, a lot of our services are working very well on the ground and have done for years, but sometimes it’s the organisations that get in the way of progress rather than some of our staff actually delivering some of our services, so we’ve always worked well together. I don’t want to see a quick fix and I say that because I’ve had thousands of these quick fixes in my time in the NHS.

This is about embedding local partnerships and working for the long term, not for the short term and I think that comes back to some of your key themes at the start.  It’s less about an individual organisation’s success now, more about collectively what are we doing for our patients and our residents. This is the continuation of a transparent conversation about what each of us can do to support each other, because we equally need to listen to the problems that each of us have got to find some solutions collectively. I hope it’s not a quick fix but a start of a longer term, embedding of health and well-being, to put it in some reform of our residents and our patients. I would like to make a plea to some of our policy makers nationally to also start to take a little bit of a longer-term view. We are very hopeful the ICS in particular will now give us a little bit of a platform both at place level and at system level to do exactly that.

 

Question 4: What is the thing that will make the biggest difference in the context of recovery?

Answer: I would turn that around and let you know a question I’m asking every single member of our team at the moment, which is ‘why is it taking a pandemic for us to fundamentally change the way we work.’

 

 

Jonathan CantyPolicy Officer, Versus Arthritis

View a video of Jonathan’s talk

 

Question 1: How can Versus Arthritis work effectively with Integrated Care Systems to implement these recommendations?

Answer: We are certainly starting to make those connections. We deal with existing contacts through the commissioning services arrangements that we’ve had with CCGs etc. The challenge is trying to find that lead specifically to leading policy and services around arthritis and MSK conditions and I think that’s where we are still gathering intelligence and information.

 

Question 2: Where do you feel the public is in terms of expectation coming out of COVID, is there too much expectation, is it being appropriately set by; politicians, health leaders and the press?

Answer: The feedback that we’ve gathered throughout the pandemic, (at least among people with arthritis) is that people are incredibly pragmatic about where the NHS have had to prioritise its resources. That was clear, certainly in the opening months after the first lockdown. The challenge now, is that because people have obviously been waiting for longer periods of time, in various levels of pain and dealing with other symptoms, I think there is a greater desire now for clearer communication from local health services. There is a realism about the length of wait for operations and it may take a long time to be treated, but just to have some kind of communication and to be signposted to different levels of support that are out there, both within the communities from volunteer organisations or from local authorities for example, would make a big difference.

 

Question 3: What is the thing that will make the biggest difference in the context of recovery?

Answer: We recognised that it’s going to be a long road to tackling the backlog for surgery, so please work with patient groups like us to support patients, to wait well over the coming months and years.

 

 

Emma ChallansExecutive Director of Culture and Improvement, Sherwood Forest Hospitals FT, Founder/Chair of @Proud2bOps

View a video of Emma’s talk

 

Question 1: Who would you have on your recovery team Emma?

Answer: I would certainly have key specialist welfare and wellbeing leads at the centre of all conversations which are around responding, planning and delivery. I would certainly have coupled with that psychological support and credible trusted clinical leaders in that forum. Voluntary services without a shadow of a doubt and also primary care clinical leads involved in that team. The chief exec would be involved in every discussion, every meeting, to gain a true understanding. The final one I would choose in there is having that nursing infection control. Before COVID, would we have gone straight for welfare and well-being or informatics and business intelligence? What about voluntary? Some really key things to think about and there might only be 10-15% that might be different Also, I like to be in the centre of it at all times, both with different hats on and my role in terms of supporting people and the culture.

 

Question 2: How can you best use the help of the community and council and primary care?

Answer: I think the key thing is that some of the terminology being used is ‘COVID was a blessing in disguise because of the rapid change, partnership, working and improvements had’ but made many of us might think that COVID wasn’t the blessing in disguise for many reasons. This is the feeling of what it has released. For me, there’s something strong in that about power and our response to COVID almost moved power out of the equation to some degree and started to create much more shared power than let’s say single organisation power or single leader power. Ken made a good point that actually this is about leaders having a very different attitude, mentality and style to working collaboratively that is more sustainable in the future. That shift in power, I think has to be maintained and stretched to really test that. That also has to be supported at a regional level as well, in terms of allowing that to happen in a safe, supported way. It comes back to power, and shared power is certainly something that I think we need to really pay attention to going forward.

Question 3: What is the thing that will make the biggest difference in the context of recovery?

Answer: Changing the way that we performance manage systems, in relation to the ask of the delivery.

 

 

Mo TaylorDirector of Business Development and Communities, Northumberland Council

View a video of Mo’s talk

 

Question 1: What do you see is the council’s biggest role in system recovery?

Answer: There’s two key opportunities. One is within our integrated system about how we support those pathways with clinical and social care support. The other is the community side, which is the thing that we need to put a bit more of a spotlight on. There’s more we can do with the volunteer sector and community groups and to support their own well-being on the back of them understanding what their needs are. Some of the health needs and symptoms that come through, are from wider determinants. We’ve engaged with people in social care activities because they’ve been worried about; losing their jobs and/or managing their own health and they’ve ended up in primary care – they would have got into primary care pre-pandemic for all those issues, now we are trying to deal with those, quite rightly before they present in primary care because we can find the solutions to support them.

It’s about being a bit more aware of what a local authority can do and being a bit more aware about where the local authority sits in the system. It isn’t all about emptying bins and looking after parks and providing adult social care… it’s much more than that. It is about harnessing what’s available in the communities and putting that into good, productive use.

 

Question 2: What is the thing that will make the biggest difference in the context of recovery?

Answer: What we should do is share what we now know. There are some blind spots for different organisations and we should share what we know now about residents, resident’s behaviours, patient’s behaviours, workforce issues… we need to have a collective understanding of those pressures.

 

Chris Lyon, Head of Operations, Cross Counties and North Blaby Primary Care Networks and Director of East Leicestershire & Rutland (ELR) GP Federation 

View a video of Chris’ talk

 

Question 1: What’s happening with morale and recruitment and retention in primary care?

Answer: It’s probably very similar to other areas – morale is patchy across member practices. Some are more resilient than others, some are struggling with staff leaving, some are struggling with recruitment and others seem to be doing okay. It’s not a consistent picture across either of my two PCNs or across LLR as a whole. The issues are magnified for the PCNs that cover Leicester City; they’re struggling more than the county are. The county has different issues that we’re struggling with separate to that. We need to concentrate both on our own system recovery but also, whilst doing that we need to ensure that we play an active part in the recovery of the system as a whole.

 

Question 2: What is the thing that will make the biggest difference in the context of recovery?

Answer: I think primary care needs to work through Primary Care Networks, federations and other similar bodies, to play an active role in the health economy as a whole, the advent of ICS’ will help that. Primary care needs to stop seeing itself as just a GP practice, it’s much more than that.

 

 

Watch the webinar again, which includes further insight from the speakers including a full Q&A session, and read more about the speakers here:

Wednesday 23 Jun 2021

View our speakers’ biographies

 

Read more about transformation at Connect Health: 

Transformation