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

6. Conclusion and Next Steps

This report has found a series of specific, local learnings through reviews of existing documentation and follow-up interviews with identified stakeholders. There have been a number of instances of identified good practice from within individual organisations identified within Sections 4 and 5 of this report, as well as insights and learnings for areas of increased resilience from different groups which should inform the shape of the the Government's on-going response. Based on both Scottish and global perspectives, clear, common themes for successful and sustainable recovery for health systems and providers in Scotland are emerging. To return organisations to sustainable operations with high levels of preparedness for future potential waves of Covid-19, international insights suggest that there are eight key actions for health and care leaders to focus their resources on as pandemic response continues and remobilisation plans are refined.

Illustration 05 – Eight Key Actions to Consider Going Forward

Digital Delivery

1 Continued acceleration of digitally-enabled care transformation

2 Adopted solutions built care models to become sustainable alongside updated business models

Agile Workforce

3 Focus on tasks and competencies not roles and job titles, and revise existing workforce plans

4 Prevent staff attrition and burnout and improve support for remote and flexible working

Developing New Care Models

5 Build and adapt new models to deliver healthcare ourside of COVID-19 related care & address backlog

6 Increase virtual care, support care at home or in residental settings through remote

Operational Resilience

7 Command centres to embed ops mgmt. systems for monitoring & managing system capacity & perf.

8 Collaboration and continuity planning across organisations and systems to provide a centralised view

As part of these eight identified actions that remain important for all health and care organisations both within Scotland and internationally, this report outlines three high level findings that cut across all elements of NHS Boards' and Social Care organisations' responses to the on-going pandemic, as well as remobilisation plans. These three areas are:

1. A recognition of the importance of multiple stakeholders involved in any decision-making. This has been identified from the perspective of patient engagement and communication, working with primary care, community and Social Care, as well as governance and leadership. Diverse viewpoints and insights into key decisions mitigates the risk of unintended consequences, as well as increasing the pace at which integrated responses to system-wide problems can be initiated;

2. The centrality of digital and data to the provision of health and Social Care now and in the future. This report considers two specific elements of the digital response to the pandemic: the use of digital tools in existing and new clinical pathways to treat patients and service users, and the wider consideration of access to these digital tools with specific community groups and staff members. A recurring finding across interviews and documents however is the increasing reliance on data across health and Social Care, testing, to workforce planning. While the required infrastructure to support this has been developed at pace, and considerable early preparation work has been undertaken by the digital team, there remains a significant demand for data that will continue to pose challenges for staff capacity, available skills and effective working across organisations over the coming months; and

3. The changing shape of existing roles and responsibilities, and how teams interact within and across organisations. With the pace required as part of the pandemic response, regular references were made to staff working outside existing roles across testing, modelling, digital, and general governance teams. Staff have had to act up or down in roles, and sometimes across organisations to ensure tasks were completed on time and decisions made. Named individuals previously held named responsibilities, a significant majority of which have evolved significantly over the first wave response. As part of on-going iterations of this exercise, a continued assessment of how roles and required skillsets are changing must be considered. The risk of staff become settled in new roles that do not align with previous organisational requirements presents a risk for burnout, sustainability and effective working across health and Social Care going forward.

The scope of work to date has centred on a review of lessons identified up to a specific point in time, with findings limited to the documents shared and the key stakeholders identified over a brief period of engagement. Through our conversations and reviews of documentation, stakeholders have referenced the existence of additional documents that will highlight key learnings, and key individuals who have been involved in the first response phase with additional insights to share. It will be important for the Scottish Government and NHS Scotland to continue taking stock of lessons identified, and for there to be an appropriate mechanism through which lessons can be identified and shared across the health and Social Care system. This document will represent a cross-section of some individuals' perspectives on the response to date, and while all efforts have been made to ensure this is representative, Government should ensure that future iterations of this work continue to identify findings from across the broader health and Social Care system from both staff and patient/service user perspectives.

Next Steps for future Lessons identified Activities:

In the creation of this report, we have identified a series of suggestions to consider as part of any future similar pieces of work as Scottish Government and/or NHS Scotland determine how best to ensure lessons continue to be captured throughout response and remobilisation. These are:

• There is a variable level of output from the documents reviewed during this exercise. We have not identified a consistent approach to identifying the lessons identified from the response within or across organisations, and future iterations of this exercise will be enabled by a more standardised approach to ensure key findings are easily identifiable and shareable. Key elements of this approach would include standardisation of themes reviewed, questions asked, and the frequency and format of outputs produced; and
• Many organisations have engaged with this process by sharing documents with us, and the authors of this report thank these organisations for their contribution to the report. We have found that individual and group consultations have however provided a much more rich source of findings, both anecdotally and evidence-based. If this exercise were to be repeated within Scottish Government or organisations, it will be important to capture first-hand experiences from as wide ranging a group of staff and other stakeholders as possible. Continued focus groups or standardised surveys shared with broad groups will offer deeper insights for on-going remobilisation and response plans and would complement existing work done on formal lessons identified reviews.

It is important to recognise here that NHS Boards have responsibilities under the Civil Contingencies Act to learn from incidents and that Boards should continue to carry out local exercises to identify lessons identified from the ongoing response to the pandemic. Scottish Government will be able to play a key role in both coordinating this process across Boards, but also ensuring any areas of good practice or areas for improvement will be appropriately shared across both other Boards and into the wider Social Care sector. It will be important to ensure there is no duplication of effort across Boards and Scottish Government here; clearly defined roles and responsibilities for the implementation of lessons identified exercises (for Boards), alongside the central oversight and coordination of findings (for Scottish Government) will mitigate this risk.