Coronavirus (COVID-19) initial health and social care response: lessons identified

3. Approach Taken

Insights produced in this report have been generated following four key areas of activity:

a. A synthesis of lessons identified documentation – a review and synthesis of the health, Social Care and central government lessons identified work undertaken during the first six months of the pandemic response in Scotland drawing out key themes.

b. Options for further resilience not already documented in lessons identified – where lessons identified have not been identified in the review of documentation provided, one-to-one interviews have been held with key senior leaders and individuals to seek their views on the most critical lessons identified – for example, within the Scottish Government Health and Social Care Directorate.

c. Follow up review of key areas for additional focus – alongside the two steps above, a targeted follow-up of three additional areas outlined in the executive summary (Acute response, Social Care and Public Health) to gain deeper insight through further stakeholder engagement and document review.

d. International lessons identified – we have drawn on international lessons identified through engagement with international teams facing similar problems across the globe to understand how they have approached the pandemic and where lessons could be identified to form part of the ongoing Scottish response.

The two graphics below summarise the process by which documents reviewed were developed into the ten key themes. The ten themes have then been defined more narrowly in the darker blue boxes below, which become the sixteen sub-categories into which this report is organised. These categories were presented in a number of meetings with SG colleagues and wider stakeholders for early testing and confirmation.

This report distinguishes between 'areas of good practice' and 'opportunities for improved resilience' considering both of these categories as lessons to be learned. The 'areas of good practice' are exclusively drawn from documents reviewed and stakeholder engagement within Scottish organisations. These are being showcased in this report to provide NHS Boards and other organisations within the scope of this work with suggestions for what is currently being done across other Scottish teams. The opportunities for improved resilience are drawn from suggestions from the outputs reviewed and interviews held, as well as independent research carried out using publicly available data and the interactions with international organisations. Due to the timeframe of this scope of work it is noted that there may be instances where these opportunities for improvement have been implemented and the learning from the first six months of the pandemic has already been acted upon.

1.Source and review document
During the first eight weeks of this review (October and November 2020), 161 documents were reviewed from 30 organisations.

2. Identify lessons identified from literature
Following the review of documentation, findings and comments were collated. 340 such findings were noted, which were combined into 97 lessons across sixteen themes.

3. Group each lesson by theme
Themes were created based upon a combination of previous Scottish Government reporting and global research. Themes were changed iteratively based on the analysis of lessons identified.

4. Assess themes to similar global exercises
Themes were assessed in parallel to similar exercises, utilising global research and overlapping features/gaps of lessons identified were then identified.

5. Capture importance of lessons/gaps
To provide stakeholders with guidance on areas for further focus, we have sought to prioritise the key takeaways and lessons from within the sixteen categories based on the frequency with which they were referenced in documents provided and comparisons with wider literature.

6. Identify case study for lessons/gap
Where information provided permits, we have sought to provide a deeper insight into the Scottish response through case studies. International case studies highlight what has been put in place elsewhere. These are not cited as best practice; these are to provide insight into ‘Lessons learnt’.

7. Identify organisations for focus groups
Further gathering of lessons identified based on gaps identified has been undertaken in the form of focus groups and one-to-one interviews to provide further insight.

8. Guided follow up work through additional chapters
Additional targeted follow-up on three chapters (further detail on approach on the next page) across April and May 2021.

Follow Up Approach:

In the follow up phase of work, the Scottish Government's Health and Social Care Management Board requested a further follow-up into three additional areas given their prominence and contribution to the response in the first wave response to the pandemic:

1. The Public Health response

2. The Acute response

3. The Social Care response

This second phase of work was carried out over April and May 2021 but still focused only on the initial six months of the Covid-19 pandemic in Scotland. Scoping conversations were held with lead directors and identified stakeholders across each of the three areas as defined by the Health and Social Care Management Board to define the focus of each chapter. Due to the short timescales of this work coinciding with the pre-election period, there was a limit on the extent to which external stakeholders were able to be consulted.

The approach to each chapter was shaped in conjunction with lead directors for each of the areas. The Public Health response was devised through a series of workshops that built on shared reflections from Public Health Scotland, Scottish Directors of Public Health, and the Covid-19 Public Health team within Scottish Government. These workshops agreed key areas of focus, and follow-ups and further information were used to provide some of the detail that is shown in this chapter of the report.

The Acute response chapter was defined in response to three key questions set by the NHS Scotland Chief Operating Officer:

1. How well was the NHS set up to respond to the pandemic?;

2. How well were services stood back up after the first wave through the remobilisation of the NHS?; and

3. How well were services adapted or changed to respond to both the challenges and opportunites of Covid-19?

A series of individual and group interviews were held with identified members of NHS Scotland, Scottish Government, and territorial and special Boards to answer these questions and identify the key lessons from the first six months of the pandemic. The chapter sets out these lessons including examples where provided.

The Social Care chapter scope was defined as focussing in particular around care homes. This was agreed with the lead director during early mobilisation as it was felt that a major element of the Covid-19 response was the enhanced support provided to the sector through the enhanced professional oversight of care homes. Key themes were collated on the basis of targeted document review, and these were then tested in a series of sessions with Scottish Government leads who idnetified lessons from ongoing engagment with stakeholders through the pandemic groups established to support the pandemic response in care homes and social care, and examples provided to inform the drafting of this chapter. By focusing on care homes in particular, it is still expected that identified lessons will be applicable more widely to social care with care homes serving as a case study for the pandemic response.

Relationship between the sixteen overview chapters for lessons identified and follow-up chapters:

The follow up work in Section 5 provides an increased level of detail compared to the initial sixteen chapters in section 4 of this report.

Where relevant, information provided during the second phase of work draws on that provided in the first phase of work and brings this up to date. However, very limited changes have been made to the information included in the sixteen high-level summaries as this was not deemed to be in scope, and would have created inconsistencies between those areas followed-up and those that were not. Where there are overlaps between the three updated chapters, Section 5 of this report contains more updated information and should be used for reference.

We recommend that colleagues review the first sixteen chapters for a higher-level distillation of early lessons identified activity before reviewing the additional follow-up chapters for further detail if desired.