A great many Trusts are feeling daunted by the mammoth task of restoring normal services. We drew together some of the UK’s preeminent Healthcare Service experts for a comprehensive round-table discussion on Healthcare Service Restoration.

During the course of this expert discussion, they explored the unprecedented challenges of restoring normal healthcare services in the wake of COVID, as well as some of the most important and concerning issues, from struggling with resources constraints to the difficulties of planning a restoration of services action plan. Here are some of the most important lessons that were revealed as part of that eye-opening session...

1. Service Restoration Will Change the Healthcare Landscape.

The main focus on the topic of service restoration has rightfully been around the waiting times and re-prioritisation of elective care pathways. But hidden within this very complex topic are other subtle complexities.

Frontline caregivers have been considerably stretched over the last year, and as they are returned to normal duties, care needs to be taken to ensure their health and wellbeing. Resuming normal duties after being reassigned to COVID wards for such a long time will entail re-training, re-assessments, and ongoing support - all of which will need to be tracked and monitored for quality and safety.

Healthcare providers also need to be mindful of their equality of services as they tackle the backlog, and ensure that pathways for the frail and elderly are prioritised alongside other more high profile services.

As trusts “rewind” the changes they have been forced to make, they need to ensure that they follow a new, cohesive way of working. Central management teams and specialist departments will need accurate, up-to-date data on performance, governance and quality assurance to be able to support a more agile decision-making process than was previously required.

2. Recovery Needs to Look Forward, not Backward

Going back to a “pre-pandemic normal” is not what is required, nor is it a measure of success. During the last year, new services and requirements have been added to the workload and these need to be taken into consideration as services are resumed.

With the introduction of new ways of accessing services, such as tele-medicine and tele-health platforms, recovery needs to be a forward-looking process rather than an aim to return to pre-pandemic levels of performance. With NHSE focusing on moving forward with the core six specialised areas of treatment (Neurosurgery, Neurology, Cardiology, Cardiac Surgery, Vascular Surgery and Solid Organ Transplant), individual trust and regional co-ordination will become even more critical.

The links between specialised care and the support services around them must become more robust and co-ordinated, and as these services are stood up, operational management needs to ensure that the right workforce is in the right place, and that staff are healthy and able to perform the services required. They also need to fully understand how different elements impact each other, and the planning process needs to incorporate and track real-life data to ensure that they have a constant feedback loop as services are resumed, so they can make operational changes quickly, based on factual information.

3. Quality and Compliance will Change to Accommodate new SOPs

Compliance is not separate from quality, but at least in the near future, some level of infection control will have to be inherent in almost everything that is done. This will result in a balance being struck between service restoration and the right safeguarding measures being put in place.

The challenge now is to knit the clinical and nursing leaders into the whole senior management team - and the operational leadership in particular - so this challenge is collectively owned by the organisation rather than by individuals. This is the only way to ensure a safe route to service restoration.

An added complexity to this process is that for many of the things that are currently being done, there is no baseline from which to measure “success”. As new ways have been introduced for patients to access care and services, Trusts are not yet at the point in the treatment cycle where they can assess whether the results are what would have been expected if these had been done face-to-face.

Quality measurements have become an evolving picture, where existing measures are being used to assess the current performance. However, many SOPs and policies are still not up-to-date with the new ways of working and as these are amended, quality measurements will need to evolve with them. This changing environment will bring a fresh set of challenges to the compliance teams who will need to work in a more agile environment than previously.

4. Building on Fundamentals Introduced During the Pandemic

Trusts are now starting to build on the collaborative efforts that were put in place at the start of the pandemic. Many of the partnerships that began by sharing support services or a with the collective pooling of PPE have begun to form the basis of a more cohesive approach to healthcare.

Trusts have aspired to many of these relationships for some time but got snarled up in bureaucracy. However, through necessity, we are now seeing shared workforces, with staff being deployed to Nightingale hospitals and regional vaccination hubs. There is a real appetite for ongoing collaboration, but the challenge remains - how do you get all of the people involved talking at the same time?

The ability to capture information, analyse it and then share it across multiple systems and trusts is now a “must have”, not a “wish list” item. To share theatre space, there is a need to ensure that not only is the theatre available, but that the support specialists are available too, and that the estate can accommodate those additional requests.

Co-ordinated performance and planning tools are going to be an essential part of assembling these partnerships to ensure they are working and making a difference, rather than adding a further challenge. Traditional paper-based or spreadsheet tracking processes will no longer be fit for purpose.

5. Service Restoration Presents Different Challenges Than Those Seen Pre-Pandemic

With referral levels from GPs being at a ten-year low and a population that has been reluctant to come forward for treatment, illnesses will be more advanced than would previously have been seen. As more referrals are seen and the situation assessed, these findings need to be incorporated into the planning loop and distributed among multiple departments and trusts - all whilst protecting patient data and adhering to the Caldicott Guardian principles. This feedback loop is essential to avoid setting unrealistic targets.

These lessons will form the basis for care, not just over the next three months, but for years ahead. Technology and shared data will be the enablers that allow this to happen. As NHSE introduce the Integrated Care Services and effectively devolve a level of care to the regions, there will be an increased expectation for reporting on performance and quality metrics to be returned to avoid regional variation in care.

This requirement reinforces the need for trusts to have quality, governance and assurance information available in real time, and to have an accessible platform to streamline reporting without consuming resources.

6. Information Sharing is the ‘Ace Card’ But Also the Challenge

As the pandemic progressed and new requirements were introduced, lots of new data sets were created and accessibility to this information will be key to the recovery efforts. Whilst information sharing still needs to protect patient confidentially, rapid decision-making and the ability to work through competing resource requirements will require operational, management and clinical teams to have information at their fingertips.

The challenge trusts face is in getting this data to the nursing leaders so that they can make balanced decisions on performance, risk, and assurance in a way that they have never been able to do before. As SOPs change to accommodate environmental changes, it is essential that performance outcomes are being measured to ensure that the new ways of working are truly making a difference.

The value of technology for performance tracking and governance has really been embraced throughout the pandemic. The speed with which COIVD took hold made real time data analysis paramount in tracking the fight against it.

Technology will play just as vital a role for the recovery. Trajectory models of how the recovery will take place are becoming more common, but as these are implemented, performance and quality assurance measures need to be constantly reviewed to see whether trusts are achieving the results they expected. It will be paramount that risk assessment and analysis relating to the new SOPs and new pressures are included in the board assurance framework.

7. Analyse, Plan, Act, Monitor…then Repeat

Technology underpins each of these steps and needs to be put in the hands of the front line so that they can use it operationally. Additionally, with most historical data being fed back to NHSE having been driven by contracts and finance in the past but now moving more towards patient pathways and understanding performance outcomes and equity of service, performance measurement technology is becoming essential.

There will be an increasing need for up-to-date information as providers work collaboratively on the backlog. Getting the necessary rapid feedback loop built into these systems is essential to understand demand, capacity, quality and safety in real time and to ensure that the results are as expected and having a positive impact.

It is vital to triangulate this information in a dashboard for nursing leaders so their decisions can be made based on the current situation. This capacity and delivery information also needs to incorporate the outcomes performance results to check whether the benefits are actually being realized.

What will have a massive impact is assurance around actions. Are the agreed actions being carried out - and to a high standard? Results will vary if actions are not implemented but if they are also not implemented consistently, this will affect the results too and could lead to the wrong outcomes from taking the next steps.

Each Trust and specialism needs to establish the plan quickly, then decide upon the actions that are necessary for the plan and track that the actions are being taken and to a high standard. They then need to monitor the results of the actions and their affect upon performance, analyse the results and check whether the actions worked. Question, review and then decide on what you plan to do next.

Performance and assurance information is the “ace card” in the recovery, but that needs to be carried through to why it is the ace card. And the reason why is because we can see what actions we took, how they were carried out, whether they worked, and what needs to be done next.

Watch the full recorded session on demand.