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It now seems almost impossible to imagine that, on 12 March 2020, the total cases of COVID-19 in the UK was reported to be 590. Eleven days later Prime Minister Boris Johnson appeared on television urging us to Stay Home, Protect the NHS and Save Lives.
Health and care staff and other essential keyworkers have played a vital role in tackling COVID-19 and we thank them for their amazing commitment, and remember those who have died.
While at the time of writing restrictions have been eased a little, we are still in the midst of the pandemic with more than 163,000 confirmed cases in England.
Looking back to 12 March we can see that the health and care system has experienced a period of rapid change, with new ways of working and approaches adapted almost overnight to keep pace with the ever changing COVID-19 challenge.
Within recent weeks we’ve seen the launch of NHS Reset – a campaign led by NHS Confederation to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.
The campaign has ten themes, and the AHSN Network, together with the Health Foundation, are working with NHS Confederation to lead the “best practice and innovation” theme.
And in Kent, Surrey and Sussex we have our own reset agenda – there is a whole host of lessons to be learned, new ways of working to keep and embrace, and old approaches to retire.
Relationships are key
From speaking with our stakeholders it’s clear that there are still challenges to be met, as the other articles in this edition of Innovate show. However, one of the biggest positive factors during COVID-19 has been the change in relationships at local level.
Anne Tidmarsh, SRO for Workforce and Innovation for Kent and Medway, and the Design and Learning Centre, said that once COVID-19 started to emerge people started to work in a very different way.
“In Kent and Medway we’ve been extremely impressed with all the district, local and parish councils, Adult Social Care and NHS with their volunteering response,” she said.
“They’ve worked together with the voluntary sector, setting up volunteering hubs across Kent and Medway. We all really thought through how we could make sure that people could stay in their own home and get all the basics that they needed while not being able to go out and shop, and keeping the needs of the person key to delivery. This is reflected in the ESTHER work in Kent and Medway.
“Everybody was prepared to drop their organisational boundaries or bureaucracies and said, ‘we’ve got to get in here, we’ve got to help people’.
“I’ve been around the system for a long time, and have been working on integration of health and social care for a very long time, and we’ve never quite managed to do it. So it is very interesting that if there is an emergency that it does somehow seem possible to do it.”
The role of research
The need to rapidly adapt and re-think priorities has affected organisations right across the board.
At the start of the pandemic the National Institute for Health Research (NIHR) Clinical Research Network (CRN) paused the site set up of any new or ongoing studies at NHS and social care sites, with the exception of Urgent Public Health (UPH) COVD-19 research.
The NIHR portfolio, which ordinarily includes research in more than 30 specialities, was immediately streamlined to the single priority of COVID-19.
CRN Kent, Surrey and Sussex restructured its services in line with the national approach. Its Study Support Services team was reconfigured, with the delivery team of research nurses deployed into trusts to assist with the UPH COVID-19 research.
The remaining staff were formed into five mini-teams and as studies were approved onto the UPH COVID-19 lists, the teams managed the set-up, roll out and management across the region.
Kate Jones, CRN Kent, Surrey and Sussex Chief Operating Officer, said she was proud of how the research community has responded to the COVID-19 pandemic.
“We have demonstrated that as a region we can step-up and deliver world-leading research rapidly and at scale,” she said.
“The pandemic has also shown the importance of clinical research and the benefits it brings to our local population; this is very important for members of our black, asian and minority ethnic communities who have been disproportionately affected by COVID-19.”
Thirty-three UPH studies are now being delivered by NHS trusts and GP practices across Kent, Surrey and Sussex. Additionally one Research Delivery Manager and a small team was designated for the management of essential non COVID-19 essential research, such as trials where clinical care is research protocol dependent.
As we move on from the initial stages of the pandemic, the system is looking at how we will collectively move on and build out from the aftermath of COVID-19.
NIHR Applied Research Collaboration Kent Surrey Sussex (ARC KSS), hosted by Sussex Partnership NHS Foundation Trust, was able to act quickly to identify and set up nine much needed COVID -19 Rapid Response studies across Kent, Surrey and Sussex.
Commenting on the studies Professor Stephen Peckham, ARC KSS Director, said: “We were really pleased to have been able to act quickly and flexibly to support these projects. It’s important to remember that, without the support of the ARC, these much needed research projects, in response to the pandemic, would not have been possible.
“Over the next six months researchers supported by the ARC will be listening and speaking with selected people across Kent, Surrey and Sussex, including those caring for people with dementia, young people and families with mental health conditions and other vulnerable communities including Black Asian and minority ethnic (BAME) and those in high-risk groups such as the elderly people living in care homes, to help us comprehend what life has been like during the lockdown and what could be done to better improve health and care services in their area.”
The scale and urgency of many of the challenges during COVID-19 has not always been easy to manage. Issues around availability of PPE equipment, testing and the sheer volume of available advice has at times been overwhelming.
To support health and social care services, Health Education England (HEE) and eIntegrity made available a dedicated, free COVID-19 Coronavirus e-learning programme to the health and care workforce worldwide.
The Coronavirus e-learning resources continues to be developed and has been accessed over 1.5million times on the e-Learning for Healthcare (e-LfH) Hub since its launch in March 2020, supporting healthcare professionals, students, trainees, volunteers, and those returning to the health and care workforce.
Lauren Smith, a newly appointed Workforce Transformation Manager at HEE, was involved in collating and peer-reviewing these Coronavirus resources.
“Given the significant pressures on services we’ve all had to learn and adapt rapidly,” she said.
“To support services and the workforce, HEE’s Technology Enhanced Learning team led a group of diverse experts who gathered and peer-reviewed resources for the Coronavirus e-learning programme. This work ensured the workforce had access to digital learning resources they needed to deliver high-quality patient care in various and sometimes unfamiliar settings”.
HEE’s Technology Enhanced Learning team has also recently launched the Learning Hub, a digital platform enabling the health and care workforce to contribute and share a wide variety of learning resources for other learners to use.
The role of leadership
With the fast moving, multi-levelled changes and developments taking place as COVID-19, and our response to it, develops, Anne Tidmarsh said that strong leadership has played an essential part in helping teams and systems to deal with the pressures.
“With my workforce role in mind, I’ve been really interested in leadership during COVID-19, and what I’ve seen is that leaders in the system have been able to drop their professional clinical roles and have picked up completely different things that were needed and that they needed to do,” she said.
“So taking on leadership for the digital or volunteering cells, and not necessarily that being somebody from social care or for the NHS, but perhaps somebody from highways in Kent County Council.
“I have been really impressed with the leadership that has been shown, both practical leadership on the ground and also, for instance, the Chief Nurse leading the whole care home cell and directing it and moving it forward with the help of everybody else.
“It’s been really heartening to see that everybody was prepared to drop organisational boundaries and do what was needed, and give leadership and not being hesitant. That has been a very positive experience.”
Time to reset
The importance of the dismantling of organisational boundaries is reflected in the integration strand of NHS Confed’s Reset campaign. The campaign aims to recognise the sacrifice and achievements of the health and care sector’s response to COVID-19, rebuild local service provision to meet the physical, mental and social needs of communities, and reset our ambitions for what the health and care system of the future should look like, including its relationship with the public and public services.
Looking to the future
Guy Boersma, Managing Director of KSS AHSN, said that this is a key discussion for the region – as it is nationally – and that digital solutions will form an integral part of that new approach.
“Both in our region and across England, AHSNs have played a key role in accelerating the spread and adoption of technology into the system, with a direct focus on innovations that had a direct support to the current pandemic.
“Additionally, by contributing to the work of NHS X we’ve been able to ensure that proven technologies can have the strongest possible impact on the health and care system.
“And collectively the system has responded really well so far. For example online and video consultations are now available in the vast majority of GP settings across the south-east, and what would have been a two year programme was introduced in a matter of weeks because of COVID-19.
“But it’s not just about replacing existing systems with digital alternatives – we need to look to see where digital can enhance the offering so that our citizens, and the health and social care as a whole, can emerge strongly and confidently from COVID-19.
“These are challenging but interesting times, and we all have a key role to play in transforming lives through innovation and resetting NHS services for the future.”