Bringing the widest evidence base to decisions about local care markets

25 June 2020

COVID-19 has had a tragic human impact on care homes.  As we rebuild and reimagine it’s clear that there is also a profound commercial and operational impact on the whole of each local care sector.  In radically rethinking the models for provision of care it’s important to use all available tools - including some new approaches - to base this on the widest possible evidence from across the whole health and care system.

The last few weeks have highlighted the problems that stem from a fractured market in which the flow of information to the centre still takes too long and where the legacy of cuts has produced a fragile supplier market with acute workforce challenges.  If there is a silver lining to be found in the sector’s battle with Coronavirus it is that, for a brief period, it has changed the immediate priorities and incentives in the system. 

By creating a powerful common cause we precipitated an avalanche of change that we have seen across health and care since March. This has dramatically changed the workings of our intermediate care systems, improved the sharing of data and in many cases helped forge a new sense of teamwork and cooperation between system partners. 

As the immediate crisis subsides and financial priorities reassert themselves; what can this crisis teach us about how we tackle future challenges differently?

What certainly won’t work is pretending that we can make incremental change ourselves, without an understanding of care pathways end-to-end or to assume we can make effective decisions in complex systems based on gut instinct.  We must also be careful to pick our battles carefully, if everything remains a priority then nothing is. COVID helped us to clear our working day of the non-essential.

This crisis galvanised us to action because of a system-wide, urgent and compelling reason to change.  In its absence we must recognise that effective system wide reform will only take place where leaders identify, acknowledge and reconcile the often-conflicting aims and incentives of partner organisations.

The only legitimate argument for asking partners to change their ways of working and take on additional burdens is in pursuit of better outcomes for patients and customers.  To do this we need, now more than ever, shared visibility of pathway performance from end-to-end so we know where to act and just as importantly, where the costs and benefits of change will be felt.  This needn’t be the barrier it once was.  With our new-found willingness to share data and adopt new technologies, this can be achieved with the right support.  It needn’t take long either, with the advent of new technologies like Artificial Intelligence process mining that can automate much of the sorting and visualisation of pathway performance and prioritise issues to address. 

However it is achieved, clear visibility of systems performance almost always yields powerful insights on variation in the outcomes achieved by area, accessibility of services, and capacity which can often be tackled quite quickly.  The limiting factor now, as always, will be the willingness of all local partners to participate. 

Jonathan Flowers is a local government advisor

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