Introduction from David Somekh EHFF Network Director:
We’re publishing this month’s bulletin a bit earlier, because of upcoming holidays. Again, we have four diverse contributions.
1. Dr Dan Alton’s blog from the UK’s NHS Confederation is reprinted with permission and deals with the benefits of implementing the NHS Population Health Management strategy to tackle COVID-19 in his practice community.
2. Also from primary care, one of our partners, the European Forum for Primary Care (EFPC) have issued a highly relevant statement on reducing the impact of the pandemic on specific vulnerable groups in the community.
3. We’ve commented previously on the role of tele-medicine during the pandemic; here we reprint from the HIMMS.org media digital newsletter “Mobihealthnews”, a further opinion piece on the future of tele-medicine post-COVID-19.
4. Finally, also from the UK, another partner GGI (the Good Governance Institute) provide regular COVID-19 related blogs. Here they offer a piece from Lawrence Tallon on the challenge to Boards of the kind of uncertainty and turbulence that the pandemic has highlighted. EHFF has long highlighted the challenge that turbulent (rapidly changing) environments pose to public services and what it implies for leadership training.
NHS Reset: A running start – using population health management to rapidly respond to the challenge of COVID-19 | Dr Dan Alton
NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.
In this blog, part of a series of comment pieces from NHS Confederation members and partners, Dr Dan Alton, a GP in Wargrave, Berkshire, explains how his clinical commissioning group has used population health management (PHM) tools to help address the challenges of COVID-19. He also considers the opportunities it could present to redesign systems in the aftermath of the pandemic.
Human interactions are one of the linchpins of any PHM approach. When we want to make any cultural change or improvement, it’s 10 per cent about data and 90 per cent about change management. It is about talking to people – your colleagues, your patients – and identifying ways to make positive change happen.
Before COVID-19, Berkshire West Clinical Commissioning Group was an NHS England and NHS Improvement development programme site for PHM, participating in wave one of the organisation’s PHM development programme in 2018/2019. This meant that when faced with the immense challenges created by the pandemic, we already had a strong whole-system data infrastructure and analytical support in place that we could draw on. Most importantly, we had a strong network of partnerships and working relationships in place across the medical system, social care, councils, community services and the voluntary sector.
We already know the impact that wider determinants of health can have, with potentially 80 per cent of our population’s health outcomes determined by their social and economic situation, home environment and other key inequalities. The pressures created by COVID-19 have brought all of this into sharp focus, magnifying the health, social and economic disadvantages suffered by many people.
Focusing on responsiveness not perfection
Within hours of lock-down, we began reaching out to our networks across the Wokingham locality to plan our approach. We knew that we needed to act quickly to identify our most vulnerable groups and find out what support and care they required. This, of course, included those shielded patients, but we also worked with our analyst huddles, using key data such as residents needing assisted bin collections, sheltered housing, care needs or food and medical supplies, and identified around 2,500 residents in this first wave.
Within days, they received phone calls from our health and social care teams to ask them what they needed. One of the biggest concerns raised was the fear of loneliness, and thanks to our voluntary and social sector members, we were able to rapidly put into place befriending services and checking calls.
One of the things we said from the start was that we would not let ‘perfection be the enemy of good’. We identified where we were able to make an immediate impact, rather than needing to perfect our cohort of identified patients first. We used a rapid implementation model, using PDSA cycles (Plan. Do. Study. Act) to learn and make improvements, and having a PHM framework already gave us permission to think outside of our individual silos, and to act rapidly as a single team with a shared purpose. This fleet-footed approach has helped us to quickly identify and offer support to other high-risk cohorts, including those particularly struggling to cope with the impact of lockdown.
For example, using very simple datasets we were able to identify and reach out to families with newborn babies. Most new parents had lost their support network as a result of the pandemic – they had no family around them, there were fewer new parent support groups, and health visitor calls were all online. We rang them and asked them about their mood and how they were coping. It was a simple search-and-respond approach to finding a cohort where we could manageably do something, and then doing it. On a number of occasions, this has also enabled us to actively intervene when urgent support was required.
We are now working with other available data, such as joining up more council held data, to further segment our population according to risk. We are doing this with support from the commissioning support unit and using the integrated population analytics (IPA) tools, particularly as more information on risk factors for the infection become available.
The huge range of resources from the NHS England PHM Academy has been immensely helpful, both in terms of information and connectivity to the other 2,300 members. We continue to need to understand who is vulnerable and to what. Not just the older person living alone, but perhaps a younger person, a single parent, a carer or someone with a mental health background. And of course new challenges are now developing. For example, from people who have not been seeing their GP or other healthcare professional as regularly or rapidly as they should have during this period. We now urgently need to find ways to identify this specific group of patients and offer the proactive care that they need.
Recognising and adapting to the changing landscape
We also need to think about what we do next, now that the first groundswell of infections is beginning to pass and health systems can start to focus on other health priorities. If this time has taught us anything it is that we can think differently, and this is our opportunity to redesign our systems.
For example, how can we deal with our backlog of patients most effectively? And most importantly, how can we make sure that we are seeing patients based on need and not on demand? Can we use the tools of PHM much more widely during this reset, enabling us to move towards a prevention agenda? Can we actively address the exposed health inequalities and overcome the educational, cultural and confidence barriers experienced by many of our residents? Can we act on what different segments of our population really need and take the interventions and solutions to them, rather than just expecting them to come to us?
I really believe that we can – this is our chance to redefine how we ‘do healthcare.’
Dr Dan Alton is a GP at the Wargrave Surgery Berkshire, and Berkshire West CCG chief clinical information officer and population health management clinical lead.
Follow him on Twitter @DrDanAlton
(reprinted courtesy of the NHS Confederation and NHS Population Health Management))
Statement on COVID-19 from the
European Forum for Primary Care: Reducing the Impacts to Vulnerable Groups
On behalf of its members and partnering institutions the European Forum for Primary Care (EFPC) has prepared this brief statement based upon four focus groups and a two-part survey.
It is our intention that this statement draws attention to the impacts that the current COVID-19 pandemic will have on two vulnerable groups of society; within the field of mental health and elderly populations. Furthermore, we wish to highlight the collateral damage as a result of health systems operating within ‘COVID-19 Mode’.
Based upon this statement, the EFPC has also created several messages for health policy which can be used as a rough guidance when implementing and/or creating policy.
Given the far-reaching impacts of the current crisis, it is vital that populations who are most vulnerable to its impacts should not be ignored. The field of mental health for example, has already seen a significant rise in potential cases of suicide, depression and chronic conditions. “Everything is coming second to the coronavirus”. Given the adjustments made by governments and/or organisations to limit non-essential treatments or appointments, the increasing lack of availability of vital treatment regimens and/or care, consultations with health professionals and reduced social contact, has undoubtedly exacerbated the situation: “People are coming forward with problems so much, but there are so many delays in the system; they cannot cope. Those with suicidal thoughts are intensifying and having to wait two or even three weeks before their case is brought forward for a decision on whether or not they need support”.
Those we rely upon most on the frontline of care; doctors, nurses, care workers etc. are being hailed as heroes. Whilst this is not far from the truth, this can place enormous pressure on those working within such sectors, encouraging feelings of immense responsibility. “There are huge worries on the frontline. You know on overwhelming risk of getting the virus”. Protecting those – whether it is through mental support or protective equipment/procedures – who care for the population that is suffering from COVID-19 is vital, and it is imperative that we maintain their health and happiness. “There is a huge amount of stress on very young doctors, especially when breaking bad news to relatives”.
Uncertainty is an overarching theme throughout the entirety of this crisis and has already impacted mental health, not only those with existing mental health problems, but also the general population. Worries about employment, the economy, family and friends, and how the future might look, puts a huge strain on the day-to-day lives of citizens. Social isolation rules have also drastically reduced physical contact between family and friends. It is already widely accepted that the elderly are a significantly high-risk group. Those living alone are forced to isolate and many go without contact with others for extended periods of time. On top of this, being unable to carry out day-to-day tasks such as shopping increases their vulnerability to mental issues: “This loneliness, for all people but especially for elderly people, it is a big problem”.
Elderly people with existing mental health conditions face a risk of a lack of sufficient care and/or treatment, further spreading of the virus via ineffective advice given to their carers, and an overall sense of abandonment. It is also becoming increasingly common that caregivers are not allowed to visit anymore: “They receive care, but the bare minimum. People haven’t been receiving their regular home care, they just get some food. So mentally and physically they get very distressed indeed”.
The shared-living environments in which many reside; nursing homes, assisted living etc. are also at increased risk. The actions taken to reduce this, for example by banning all visits from friends and family can help to alleviate transmission, but at the same time is incredibly de-motivating. Existing data already shows alarming incidence rates of death and diagnosed cases; therefore, a careful balance of support and appropriate safety measures needs to be struck.
The extent to which these impacts will take hold in the near-future is unknown, however, taking into consideration the already existing vulnerabilities provides a solid basis by which to mitigate to such impacts. Below are several considerations based upon the above statement.
– Telemedical services implicate the potential to overcome distances and maintain health care services as well as to increase additional worries in this burdensome time.
– It is vital to avoid the exclusion of existing vulnerable groups from health care and social services caused by technology and access as well as of supposed healthy population.
– Collateral damage – especially in terms of mental health and the elderly – caused by physical isolation as well as reduction of contact and access by (technical) barriers to health and social care, have to be considered in policy decision making process.
– Creative processes to overcome barriers and allow greater access to health and social services have to be appreciated and adopted for sustainable implementation.
– Maintenance/Care for the mental health of those who care for others during the COVID-19 pandemic must be an essential, first-priority concern of policy makers in all countries.
– The COVID-19 pandemic provides fantastic momentum to promote social association during physical isolation all over the world and is independent from age, gender, race and social status.
– Strengthen the connection between practice and research
COVID-19: The rise and rise of tele-medicine
“Tele-medicine is not new, but people have been reluctant to use it for many reasons including technical barriers, security concerns, and a lack of availability or access.But tele-medicine has evolved significantly – platforms are increasingly secure and provide higher quality images, connectivity and sound that make the virtual consultation comparable to a face-to-face visit. Furthermore, remote devices are helping to bring patients and healthcare professionals closer and ensure a more accurate remote diagnosis.
Tytocare was one of the first companies to develop a device that the patient could use at home during a tele-consultation to measure vital signs. The doctor would guide the patient in taking those vital signs using the device, gathering real-time data to establish a better diagnosis.
Wearables are also playing a key role in telemedicine. Many patients are monitoring themselves on a regular basis. “The use of wearables has the potential to increase the health information gathered by a patient to improve the breadth of care one can perform at home,” says Dr Aditi Joshi, medical director of JeffConnect telehealth, Jefferson Hospital, US…..”
Read the rest of the article in mobihealthnews via the link below:
Living in a VUCA world
GGI’s 2019 Festival Review featured an article entitled Strategy for a VUCA world by Lawrence Tallon, who is now Deputy Chief Executive at Guy’s and St Thomas’s Hospital but at the time was Director of Strategy, University Hospitals Birmingham (UHB) NHS Foundation Trust.
VUCA is an abbreviation of volatility, uncertainty, complexity and ambiguity – all characteristics that have been in plentiful supply since the start of the COVID-19 pandemic.
At the heart of Tallon’s article was the idea that, to facilitate rather than hinder the radical innovation required to navigate the profound changes lying ahead for the health service, governance would need to be more adaptive than ever before. It’s a thesis that bears revisiting in the wake of everything that has happened since March this year.
During the NHS 70th anniversary celebrations in June 2018, as the UK obsessed about Brexit and the World Cup, thoughts inevitably turned to what the health service would look like in another 70 years, to which the only sensible answer was, of course, that no one could possibly know.Tallon wrote: “How many people 40 years ago would have predicted the internet, or 20 years ago, the rise of the smartphone – and how both have changed our lives so much in that time? The only thing we can say with confidence is that the practice and delivery of healthcare will be dramatically different in 70 years’ time – in some ways that we can imagine and others that we perhaps cannot.”