As system recovery planning sits at the centre of healthcare services post-COVID, experts look to create foundations of support to tackle the growing demand, including setting realistic targets, working within communities to utilise resources, and ensure staff wellbeing is at the forefront of initiatives.
In Connect Health’s latest Change webinar, leading healthcare experts explored the future of healthcare services, looking at how system recovery can support patients, staff, communities, and the wider system.
The event was chaired by Dr Graeme Wilkes, Chief Medical Officer at Connect Health. Providing opening remarks, Dr Wilkes said:
We have an expert panel, but in reality none of us are truly expert in how to come out from a pandemic. We’re using our past experiences to deal with a new situation of uncertainty. The key principles of uncertainty are, tell the truth and give people hope.
He welcomed guest speaker, Ken Bremner MBE, Chief Executive at South Tyneside and Sunderland NHS Foundation Trust, who explored supporting staff during system recovery.
Collaboration is the watchword for system recovery – and that’s collaboration at all levels. In the North East and North Cumbria (NENC) we have around 18,200 people waiting over 52 weeks for surgery and almost half of these fall into either Ophthalmology or Trauma and Orthopaedics. They are therefore a big focus for us along with those Priority(P)2 cases that have been waiting over a month for treatment. The total waiting list for the ICS is now around 260,000 but we are aiming to get back to a position as soon as possible where we have a sustainable and manageable waiting list.
We’ll do this by extending some of the activity we introduced during the pandemic, including extending our weekend and evening working, looking at making better use of our operating capacity, and expanding rapidly where we can.
Considering the impact the growing service demand is having on staff, Bremner continued:
You might say this is the most important thing we need to get right as an organisation. We need to make sure our staff are fit and on the road to recovery themselves.
At one point, we had about 400 of our workforce shielding. They’ve been coming back to work since April and health and safety is never far from our minds. We’ve been doing all the dedicated risk assessments and taking appropriate occupational health advice. Things like trying to redeploy staff into lower risk areas and adapting their way of working, such as changes to their start and finish times to help them get back into routine.
When asked about the immediate ‘quick wins’ planned to address the most pressing issues, Bremner said:
There isn’t a quick fix. Transparently sharing data across the region will hopefully help to find solutions to challenges that lead to wider recovery.
Providing a patient viewpoint, discussing what support and resources would help patients with arthritis and musculoskeletal (MSK) conditions, was Jonathan Canty, Policy Officer at Versus Arthritis.
We recognise that global health services face a whole range of different challenges when it comes to recovering services, including MSK and orthopaedic services. Towards the end of last year, we ran a survey to understand more about the experiences of people waiting for joint replacement surgery across the UK, which revealed worsening levels of mobility and independence, and a decline in physical and mental health.
Considering what resources would be beneficial for patients waiting for treatment, Canty said:
The survey highlighted to us that better support is needed for patients on waiting lists and it gave us a strong sense that the priorities should be clear communication, self-management support, access to physical activity programmes, mental health support and signposting to financial support and advice.
Posed with the idea of working collaboratively with other organisations across the country, Canty said:
Versus Arthritis has recently published a report calling on Integrated Care Systems and other local health bodies to take a number of actions to support people waiting for joint replacement surgery. The full report can be accessed here: https://www.versusarthritis.org/campaign-with-us/joint-replacement-support-package/.
Emma Challans, Executive Director of Culture and Improvement at Sherwood Forest Hospitals FT, and Founder of Proud2bOps, addressed the backlog and opportunities to restore services.
Exploring the hot topics of discussion within planning sessions, Challans said:
There has been quite a lot of discussion around resilience and what resilience means for the healthcare professional, for a team, and for patients. There’s also then the element of restoration, but with a very clear line of sight of what the future might look like. We’re thinking about collaborative working and what the future asks are around system shaping, planning, and delivering.
Much has been socialised from a personal leadership perspective in terms of your own values and morals, the process of asking colleagues to keep going above and beyond. The title of this discussion is ‘Now the hard work begins’, but many colleagues will probably say ‘what have we been doing for the past 12-15 months?’ Is that not hard work?
Discussing the need for increased activity, Challans considered the safety of staff, saying:
We’re having to recover services and get activity levels back up to a threshold similar to the previous year before COVID, but we’re learning how to do that in a safe, supported and transparent way. Some of the conversations we’re having, and particularly in Sherwood, are open and honest about being realistic in terms of what we can achieve and what we can’t.
Questioned on what roles are essential within a team to help recover systems, Challans said:
I would certainly have key specialists in welfare and well-being at the centre of conversations around responding, planning, and delivery – and couple that with psychological support. Before COVID, would we have gone straight for welfare and well-being? Maybe, maybe not. These are some really key things to think about.
Agreeing with the idea of changes to the way teams work, discussion-lead Dr Wilkes said:
It’s interesting how nature has a way of resetting things and to hear these points around welfare and support for patients from a holistic point of view.
Discussing integrating services within the community was Mo Taylor, Director of Business Development and Communities at Northumberland Council.
Local authorities take a significant role in emergency planning and responses, so when the health system at the very beginning of the pandemic needed to limit attendance and protect its systems, social care, community services, and home care had to continue with that community provision under immense pressure. We needed to support residents to make sure we could keep people out of the hospital system, which was protecting those that desperately needed medical support.
Addressing the challenges within the county, Taylor said:
We developed some significant new relationships within our community. There is an enormous amount of support in the voluntary sector and communities that we hadn’t harnessed on this scale before. We have more than 300 community groups across the County that have energy and innovation – we captured these and pulled them together to mobilise that kind of support. We started to understand what social prescribing and support planning actually meant in practice.
When asked about the role of local authorities in system recovery and capacity to support, Taylor said:
It’s about being more aware of what a local authority can do when it puts its mind to it and being a bit more aware of where the local authority sits in the system. It’s not just about emptying bins, maintaining parks, and managing social care, its so much more than that. It’s about harnessing what’s available in the communities and putting that to really good productive use.
Chris Lyon, Head of Operations at Cross Counties and North Blaby Primary Care Networks, and Director of East Leicestershire & Rutland (ELR) GP Federation, provided the primary care perspective on managing demand.
There are concerns about resilience with small and large practices. You would perhaps expect these concerns from small practices, but some of the larger ones have also struggled. We’ve seen a real increase in mental health contact, with some GPs reporting 70% of their daily workload is low level mental health support.
Considering some of the positive things to come from changes to services, Lyon said:
The shift towards the technological solutions that we’ve implemented has been really rapid, and in most cases really very effective. Primary care now has to work out what ‘normal’ is. That could be a return to what normal was, but I think everyone can recognise that this is a golden opportunity for primary care to change what it is – I think it will be a mix of face-to-face and virtual appointments.
We need to work on pathways that allow primary care to keep patients away from secondary care. For the future, I think local collaboration and working within the community and with voluntary sectors, is key to getting ourselves out of this and getting ourselves back on an even keel.
Questioned on staff morale and job retention within primary care, Lyon said:
There isn’t a consistent picture across the region. Morale is patchy in some practices, others are struggling with staff leaving, whilst some seem to be doing ok. The issues are magnified in the city, but we’re looking at system recovery as a whole.
During a panel discussion led by Dr Wilkes, all participants were asked to consider one thought or action that is really important to assisting in recovery.
Ken Bremner MBE, Chief Executive at South Tyneside and Sunderland NHS Foundation Trust:
- Let me turn it around and tell you the one question I’m asking every single member of our team at the moment: Why has it taken a pandemic for us to fundamentally change the way we work?
Jonathan Canty, Policy Officer at Versus Arthritis:
- We recognise that it’s going to be a long road to tackling the backlog of surgeries, so please work with patient groups like us to support patients to ‘wait well’ over the coming months and years.”
Emma Challans, Executive Director of Culture and Improvement at Sherwood Forest Hospitals FT, and Founder of Proud2bOps,:
- Changing the way that we performance manage systems in relation to the ask of delivery.”
Mo Taylor, Director of Business Development and Communities at Northumberland Council:
- We need to share what we now know. I think there are some blind spots for different organisations and we should share what we know now about residents, resident behaviours, patient behaviours, and workforce issues. We need to have a huge collective understanding of those pressures.”
Chris Lyon, Head of Operations at Cross Counties and North Blaby Primary Care Networks, and Director of East Leicestershire & Rutland (ELR) GP Federation:
- I think Primary Care needs to work through networks, federations, and other similar bodies to play an active role in the health economy as a whole. The advent of ICS’s will help that. Primary care needs to stop seeing itself as just a GP practice – it’s much more than that.”