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What can we learn from COVID-19 about how to fund, co-ordinate and deliver rapid service evaluation in health and care?

12 February 2021 | Professor Mike Roberts
Health and care services have innovated quickly in response to the pandemic. But how do we evaluate rapid implementations made at scale?

During the first wave of the COVID-19 pandemic, health and care services innovated and adapted quickly to provide care and protect patients and staff in the context of a rapidly developing global pandemic.

The level and speed of changes was unprecedented, with rapid implementation of new pathways and service models and a dramatic shift to digital and remote provision. As a result, there was a huge and pressing need to understand whether these major changes were indeed positive changes or potentially harmful.

It struck me at the time that while the system was spending tens of millions of pounds adapting services in response to the pandemic, funds were not systematically allocated to evaluating the effectiveness or value for money of these changes. I observed a gap in how rapid service evaluation is funded, co-ordinated and delivered at the local, regional and national level to meet the needs of the service and the public it serves (in this video I expand on why I think this issue is so important).

To gain further insight on these issues and potential solutions, UCLPartners offered to lead a piece of work as part of the AHSN Network Health and Care Reset campaign . Our work was designed to consider the learning from COVID-19 that could inform how the system might prioritise and resource rapid service evaluations, the intention being to enable more efficient and effective scale-up of health and care innovations whether in or outside of a pandemic.

We asked the London School of Hygiene & Tropical Medicine to carry out a series of interviews with key stakeholders from a range of organisations and settings to explore if these perceptions were widely acknowledged. We then shared the emerging findings as part of an AHSN Network sponsored roundtable discussion in December with 12 leaders from national NHS bodies, NIHR national and local organisations, NICE and third sector representatives. We will be sharing the recommendations that emerged in an AHSN Network White Paper later this month, and at the Health Plus Care Online conference on 25 February.

What this work has uncovered is some great examples of individual and organisational leadership and innovation during the pandemic in response to the need for rapid evaluation.

For example, Health Innovation Manchester led work across their local system to collectively define trials and diagnostics to evaluate and respond to the national priorities on research, along with local priorities for innovation and transformation from the City Region’s NHS command and control structures (see our video with Prof Ben Bridgewater, Chief Executive of Health Innovation Manchester, for more information).

South West AHSN, meanwhile, used rapid learning from the pandemic to change their usual approach to service evaluation, allowing them to gather information quickly and in a way that was meaningful and useful to stakeholders in real-time (see our video with SW AHSN Evaluation Lead and Spread Fellow Sarah Robens).

In London, the three London AHSNs and the three London NIHR Applied Research Collaborations (ARCs) came together to create an evaluation cell that has agreed a set of criteria with regional clinical and academic leaders to prioritise regional evaluation plans. The cell is working to define and prioritise specific evaluation and research questions and to develop a Regional Learning Health System Programme using research grade evidence.

If the health and care system is going to reset using new service models and pathways, we must understand quickly the benefits and potential harms…

Professor Mike Roberts

The outstanding conclusion from this work was, however, that in the first wave of the pandemic there was no pre-existing national programme to evaluate the changes in the NHS rapidly implemented at scale. Neither was there, or has there been since, adequate funding for service evaluation provided by the NHS nor has there been an expansion of relevant expertise capacity in the system. The Beneficial Changes Network programme seeks to address this gap, integrating robust applied research with rapid service evaluation. This is a positive step but there remain bigger questions about how service evaluations should be prioritised, funded, resourced and conducted in order to better align with the needs of the system.

In our forthcoming White Paper, we’ll be getting under the skin of some of these issues and putting forward recommendations about how the system could use learnings from COVID-19 to develop an NHS service transformation strategy underpinned by rapid evaluation that sets out a long-term plan of informed change. To find out more, please join our session at the Health Plus Care conference on the afternoon of 25 February, or sign up for emails and we will share our full findings with you when they are published.

If the health and care system is going to reset using new service models and pathways, we must understand quickly the benefits and potential harms these may have for patients and of course have an early understanding of the cost benefits. We can only do this if we are collecting and analysing relevant data, preferably that already routinely available, and undertaking ongoing and rapid evaluation, so that we may support with evidence an agile health and care system that is responsive not just to COVID-19 but to the needs of the population its designed to serve. Our forthcoming White Paper draws on insights from a wide range of stakeholders to make a number of recommendations to support this vision.