Uniting clinical and academic leaders across London to evaluate changes in care

Challenge

During the first wave of the COVID-19 pandemic, health and care services quickly innovated and adapted to provide care and protect patients and staff. There was a sudden need for rapid implementation of new pathways and service models, and to provide services remotely. As a result, there was an urgent need to understand whether these major changes were indeed positive changes or potentially harmful, but there was no existing system in place to support this evaluation work. 

What we did

In response, the London Evaluation Cell was established in June 2020 – a collaboration between the London Applied Research Collaborations (ARCs), the three London Academic Health Science Networks (AHSNs), London regional NHS clinical and transformation leads, and Public Health England representatives, chaired by an NHS Chief Executive. The Cell had three aims:

1. Articulate evaluation priorities in the form of research proposals, detailing the most significant health and care changes caused by COVID-19 in London, for further evaluation, and to inform ongoing adoption and implementation of changes across the Capital.
2. Develop a learning system that allows service delivery to be informed by research findings, and timely capture, analysis and feedback of clinical/service/outcomes data. This helps to drive continual improvements to practice, that can be applied across larger populations.
3. Effective, ongoing collaboration between NHS England and applied research partners (AHSNs, AHSCs and ARCs), resulting in long-lasting partnerships, underpinning the learning system approach.

Impact

The Cell has led to the development of a network that enables collaboration and knowledge sharing that did not previously exist. This enables clinical and academic health leaders to collectively identify and set evaluation priorities, with the aim of rapidly translating knowledge into service provision across the regional care sector.

Outcomes achieved by the Evaluation Cell, with direct input from UCLPartners’ research and innovation designations, include:

• Development of a common understanding of the COVID related large scale changes during Wave 1.
• Agreeing a set of criteria with regional clinical and academic leaders in order to effectively prioritise regional evaluation plans.
• Identification of three priority areas for the London region, which require research-grade evaluation to inform future service design, and aligning these with the NHSE/I Beneficial Changes Network Themes.
• Scoping of these priority areas to identify gaps in evidence and produce ‘State of Play’ reports, e.g. A rapid synthesis of existing evidence regarding patient experiences of remote consultations during the COVID pandemic directly shared with the regional NHS England and Improvement clinical and transformation leads.
• Application of a Learning Health System approach to 111 first and COVID vaccination hubs.
• Rapid development of an evaluation framework for emergency mental health crisis hubs.
• Increased collaboration, mutual understanding, and relationship building across AHSN, ARC and service leadership.

Next steps

The collaboration is continuing to develop opportunities for future potential impact. Work includes the delivery of evaluation research proposals (remote consultations, remote Blood Pressure monitoring, and integrated palliative care) in collaboration with London clinical leaders. This is to be undertaken during 2021/22 and used to directly inform how new care approaches are incorporated within routine healthcare delivery. The group will also steer prioritisation of regional projects and development of applications for funding for ARC-AHSN collaboration. 

An ongoing commitment to this model of academic and strategic care partnership has been made, building on the experience and relationship development that took place in 2020/21. A strategic and proactive model of a learning health system is now being developed.