Why the new normal must be anything but normal


Author: Dr Emily Warren, Bevan Fellow

In this opinion piece, Dr Emily Warren offers her perspective on health and social care adapting to the ‘new normal’, recognising the need to ensure a positive impact on patients.

It’s a Friday morning, I think. The sunshine is pouring in through the attic windows in what is now the ‘new study’, the laptop is fired up and the coffee brewed. The cat is perched on my lap, excited to learn more about recovery planning, and I await the next relentless round of daily skype and zoom meetings. Everything feels very ‘new normal’.

The ‘new normal’ is just one of many new phrases coined in 2020 in relation to Coronavirus. Along with social distancing, shielding, pandemic and lockdown. Everything has changed, our daily lives, our routines, our social interactions. There is a ‘new normal’.

As an Assistant Director in the NHS with responsibility for transformation across health and social care, Covid-19 forced many rapid changes to the delivery of ‘normal business’; to continue to meet need, whilst protecting against the endemic virus risk. The need for services to work together in a multi-agency approach, has never been more necessary or poignant.

The pandemic has reminded us all once again of the need for good care, close to home, where as a patient or carer, service provision must feel seamless. As a former carer, I like many others, lived through years of the relentless task of trying to organise a number of support services for just one person, often when I was tired, upset and unable to cope with what felt like a mammoth task of organising healthcare, social care and all of the other important ‘bits’ . Whilst much has improved since that time, there is now a real opportunity to capture the ‘what did we do differently’ to make sure that new, more virtual and more joined up ways of working allow us to provide sustainable seamless care across our communities.

Regional Partnership Boards, created under the Social Services and Wellbeing (Wales) Act 2014, must play a driving role in remodelling services at a regional level. As the regional leadership body for health, social care, housing and third sector. They must now rise to the challenge as part of the recovery work, to bring partners together to plan, design and deliver ‘transformative and integrated models of care’. The last few months of lockdown provide a platform for Regional Partnership Boards to shake up what we do and how we do it, and meet the ambitions of ‘A Healthier Wales’ with new models of care, where we harness the learning and innovation and ensure it forms the bedrock of how we want to deliver future services in a more seamless multi-agency framework.

The challenge going forward is ensuring that these new and innovative ways of working, borne from the burning platform of a pandemic are not lost. That where we can evidence improved outcomes, demonstrate advances in multi-agency working, and show true innovation, that these are embedded into mainstream services and become the new fabric of ‘how we do business’ in health and social care.

The last 121 days, 17 weeks or 4 months have been defined by a need to do things differently allowing an acceleration in innovation of how we undertake our core business’. For example:

  • Virtual platforms such as ‘Attend Anywhere’ and ‘Consult Anywhere’ have been rolled out;

  • A huge drive to remove homeless people from the streets and provide them with shelter, care and support has been ongoing;

  • Integrated Wellbeing Networks across Gwent, have mobilised to identify and support shielding and socially isolated people

  • HomeFirst, hospital discharge service has been scaled up to ensure unnecessary admissions are avoided so that beds are available as demand dictates.

As lockdown in Wales gently eases, our emphasis across health and social care is on adapting to the ‘new normal’. We need to ensure we sustain those ‘innovations’ or changes were we can demonstrate a positive impact on patients. There is a strong emphasis from both Welsh Government and the Gwent Regional Partnership Board to we quickly capture the learning, the successes and the innovations from the COVID 19 response, so that we are able to embed the effective changes that have taken place during lockdown. The challenge is how do we do this quickly and well, making sure it ‘sticks’ and ensuring that this work actively shapes IMTP/Area service planning at a local level in the future, as well as informing the future direction of national policy.

As part of the national transformation programme, Regional Partnership Boards received funding to establish ‘Research, Innovation, Improvement’ Coordination (RIIC) Hubs. Their purpose is to accelerate and drive better quality and value in health and social care services. In my view the Hub should become the engine room for driving forward the adaption, adoption and spread of the new ways of working we have seen as a result of COVID-19. The Hub must be at the frontline, being part of driving and capturing the learning and innovation so as to inform planning, influence service re design and shape an evidence base for a model of multi-agency locally delivered ‘place based care’.

In Gwent the RPBs transformation programme is predicated on developing a model of placed based care and over the last 18 months we have worked with the Bevan Commission and Social Care Wales to help shape a workable model. The RIIC Hub, will now be an essential component of this moving forward, by mobilising research, innovation and improvement to create a shift in the planning and service re design process.

The Hub will lead 3 Learning and Improvement Networks (LINs) focused on the partnership agenda. Each network will have a specific and relevant theme and undertake learning capture, framing this into a clear improvement plan to enable adopt and spread as a fundamental part of the recovery planning and planning for COVID/ winter. The networks provide a new resource to analyse, test and develop new models within that partnership space and include:

As the mechanism for coordinating the learning review and framing the forward steps into future planning, the Gwent Hub has a crucial role to play in orchestrating and securing genuine transformation for the Regional Partnership Board.

Already there are expectations and requirements to develop recovery plans and the RIIC Hubs must demonstrate their ability to capture learning and innovation, which frames service planning and financial decisions. Their test will be the extent they can actively influence change, rather than just collecting good practice.

In Gwent the 3 LIN’s will be mobilised during August, and we are working with our colleagues in other regions to share our approach and ensure we learn from each other. The proof of impact will likely be in the ‘Christmas’ pudding, as winter hits and a potential second wave may be forthcoming. What did we do differently and how well did we do it? There is a real opportunity here to inform the short term changes, where innovation is sustained, and to consider what we have learnt to help provide more sustainable and seamless services for the future.

Dr Emily Warren

Job Title:

Assistant Director of Transformation for Gwent Regional Partnership Board and Bevan Fellow