A constant focus on innovation and quality improvement is necessary in any health care system. But the pandemic brought this need into even sharper focus. Health care teams everywhere were forced to adapt, innovate and adopt new ways of working to meet the challenges presented by COVID-19. Those already working with an improvement mindset were best placed to respond.
The pandemic continues to create unprecedented demands on the health service. Time and support are needed to help sustain and develop the new ways of working developed over the last few years, and to find new ways to respond to the challenges ahead. Improvement approaches will continue to play an important role in this. Or as Penny Pereira, Managing Director of Q, put it in a recent blog, improvement principles need to run through the core of recovery, and ‘can help the system find a path to sustainable recovery and reset’.
The Health Foundation has a strong history of supporting improvement in the NHS and social care, helping to identify and fast track many promising ideas to improve care quality and efficiency. Over the last 15 years we’ve learned a great deal about how to make change happen in health care, investing over £200m in grants and research, and connecting over 4,500 people through our Q community.
Here we give a quick overview of four of our current improvement programmes and look at how their work is also finding ways to support the health service to recover from the pandemic.
1. Continuity of Care programme
In 2019 the Health Foundation awarded five large-scale GP practices and federations grants of up to £250,000 to increase continuity of care (how often patients see the same primary care professional).
Given the existing research and evidence on the benefits of continuity of care, we wanted to understand how continuity could be improved in practice. The programme was designed and delivered with support from the Royal College of GPs (RCGP).
The five sites introduced a range of practical approaches to improving continuity of care. One project, run by the Valentine Health Partnership, used practice data to identify usually healthy patients who were experiencing new or changing symptoms, having seen many different doctors in a short space of time. They found that allocating one lead GP to those patients helped to reduce their use of A&E and urgent care. In another part of the programme, Morecambe Bay Primary Care Collaborative and One Care collaborated to produce the Continuity of Care Toolkit, an in-depth, practical guide to improving continuity which is now being shared by RCGP.
General practice is facing big challenges around workforce and demand. Continuity of care isn’t the only solution to these problems, but the programme findings clearly indicate that it can play a role in supporting more efficient consultations, enabling patients to play a greater role in their own care and providing quality of access.
A soon-to-be-published mixed-methods evaluation of the programme, commissioned by the Health Foundation, found that continuity of care can be achieved without detriment to patient access (only 15% of patients weren't willing to wait longer to see their preferred GP), and that implementing continuity of care interventions can lead to efficiency and quality gains.
Mark Rickenbach worked on the programme on behalf of RCGP as a clinical champion across all the projects. He says:
'The paradox is that as workload increases for our GPs, continuity of care tends to decrease. Instead we should actively focus on continuity of care as a solution – to help reduce costs, urgent care needs and workload. The work of the Continuity of Care programme shows this can be done without necessarily having to make huge changes, and that it leads to definite benefits, for patients, for staff and for the system overall. The toolkit provides a really useful resource. Anyone wanting to improve continuity of care can dip in and out of this to pick a few things to adapt to their local practice.'
2. Common Ambition programme
The Health Foundation’s £2.6m Common Ambition programme is supporting four ambitious UK teams to build sustainable change across health care through collaboration between those who use services and those who deliver them.
Each partnership project is developing a collaborative community where people, families, health care professionals and researchers work together to improve health care. The projects focus on four very different areas: improving health services for homeless people; reducing HIV health inequalities; putting people with inflammatory bowel disease in control of their care; and redesigning services for people with learning disabilities or autism.
One year into the 3-year programme, the partnerships are already producing learning about the value of collaboration between the voluntary and community sector and the NHS in supporting recovery from the pandemic. For example, Common Ambition Brighton and Hove is showing how local voluntary and community sector organisations can support transitions between NHS services for homeless people.
Health inequalities have widened during the pandemic and addressing this will be an important part of health and care system recovery. The partnerships are involving their communities to make sure service improvements focus on those with the greatest need, and those with the poorest outcomes and experiences.
Common Ambition Bristol is working with local African and Caribbean heritage communities to increase the uptake of HIV testing and broader sexual health services, and to reduce late HIV diagnosis and stigma. The partnership is beginning to test a range of coproduced interventions, including a monthly dedicated sexual health clinic for African and Caribbean heritage communities and a community engagement programme with local barber shops.
The Common Ambition programme is supporting health systems to align the goals of patients and clinicians, and generating a better understanding of how communities can contribute to service improvement.
3. Anchors programme
Anchor institutions are large public sector organisations (such as universities, local authorities and hospitals) which are rooted in place and connected to their communities. These organisations have significant assets and spending power and can consciously use these resources to benefit their communities.
Working in partnership with NHS England and NHS Improvement, we launched the Health Anchors Learning Network (HALN) in March 2021 for people across the UK who are interested in, or responsible for, anchor approaches.
Inspired by our report on the role of the NHS as an anchor institution, and delivered by the Innovation Unit, the HALN has over 1,200 participants. The network aims to support health care organisations and systems to improve (or get started on) their anchor work through connecting people, sharing learning and developing practical tools and resources.
‘Some excellent anchor action was already happening’, says Health Foundation Programme Manager Jenna Collins. ‘But the HALN has given a forum for participants to share learning and connect with others, enabling them to further progress their anchor ambitions and adopt new approaches in their own contexts. This is particularly important in the light of the challenges facing the health and care system in the recovery from the impact of the pandemic.’
Our research into how anchor institutions responded during the pandemic demonstrated how COVID-19 galvanised the NHS into more purposeful action in its role as an anchor. Intentionally using its wider resources and influence on areas such as employment, procurement and environmental sustainability can help reduce local health inequalities and develop thriving communities during the COVID-19 recovery period and beyond.
In March 2022, we awarded Test and Learn funding for six NHS organisations to test innovative anchor approaches and generate new and valuable learning for the HALN. For example, three projects are focusing on how the NHS can widen access to quality work for local people. Projects in Doncaster and Essex are specifically looking at supporting young people’s employment opportunities. A project in Kings Lynn is developing a shared local plan between health and care partners for enabling the most deprived local communities to access employment opportunities across the local workforce.
4. Adopting Innovation programme
Health and care improvement is not only about identifying innovative solutions to the challenges facing the health and care service, but ensuring those solutions are successfully adopted and adapted in new settings. However, overcoming this spread challenge is a continuing endeavour.
The Adopting Innovation programme is funding the set up and implementation of four innovation hubs within NHS provider organisations across the UK to help them become better adopters of innovation. These centres of expertise and support have formed partnerships with other organisations in their networks, for example Academic Health Science Networks. Each hub is receiving up to £475,000 in funding over 2.5 years, plus a package of specialist guidance and support.
The programme is at an early stage, with the newly established hubs still getting teams in place, formalising plans and prioritising which innovations to focus on locally. The aim is for the hubs to build knowledge, skills and confidence in their local systems, and to share wider learning of the conditions and enablers that need to be in place to better support the effective uptake of innovations.
Health Foundation Programme Manager Gill Clayton says:
‘This is a unique opportunity to create change to improve patient care. It comes at a time when the NHS needs to accelerate effective uptake of new ideas to meet the challenges it faces and in the context of pandemic recovery.
‘All of the local systems are seeing their hub as an opportunity to better adopt innovation in order to address local challenges stemming from the pandemic. There are already some themes emerging through the set-up stage, including the need to contextualise plans within local systems, create a shared vision around innovation adoption and the importance of docking in with local Integrated Care System priorities.’
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.