The pandemic brought unprecedented challenge across our health and care system.
We worked collaboratively with our partner organisations; for example, we were part of the strong local network led by NIHR ARC West, supporting the connection of researchers and the clinical commissioning group (CCG) to help understand how changes across health and care services were affecting the people who rely on them. As a result, researchers were able to respond rapidly, reviewing evidence on topics ranging from the changing demands on primary care to the re-opening of schools to all pupils.
Here are some of the specific contributions Bristol Health Partners HITs and staff have made to the COVID-19 response in the last 12 months:
Reviewing the impact of service changes on service users and healthcare providers
In July 2020, the BNSSG CCG Evidence and Evaluation team set up a register of COVID-19 surveys being conducted across the system, with the aim to reduce duplication, promote collaborative working and provide a space for sharing best practice. Bristol Health Partners staff are part of the forum which shares information, tracks surveys being sent out and ideas with survey-based queries. The register has proved useful in highlighting where similar work has been, or is being undertaken, and for those developing new surveys or survey questions.
Because patient-facing services across the health and care system had to adapt due to COVID-19 restrictions, three Heath Integration Teams (HITs) – Bladder and Bowel Confidence (BABCON), Dementia, and Chronic Pain – surveyed HIT members to investigate the impact this had had on patients, and on the staff who deliver these services. The surveys highlighted common themes.
Impact on service users
- Service users saw the advantages of reduced travel, greater convenience, and increased flexibility. Some surveys reported improved accessibility and increased attendance at appointments because they offered a blended model of face-to-face alongside new virtual services.
- However, they also highlighted perceived disadvantages for those people unable to engage virtually, or those experiencing technical issues. Concerns were raised about widening inequalities and delays in seeking help, and the potential for a future surge in referrals. There were also concerns about the impact of services not being available.
Impact on staff
- Staff also saw reduction in travel time and greater flexibility as advantageous. The opportunity to look at working practices, and to gain an appreciation of how well virtual services can work, along with an improved confidence in online service delivery, was also broadly welcomed.
- However, it was commonly thought that the changes had been stressful and tiring for staff. Having to cope with staff and service user safeguarding issues, difficulties with technology and communication, concerns over the effectiveness of assessments and impact on therapeutic relationships, and concerns over inequality of access to services were cited as disadvantages by staff across the surveys.
The surveys showed that service users would be more accepting of the changes continuing in the case of follow up appointments, or if it resulted in a quicker appointment time.
Staff were concerned about the loss of face-to-face services and broadly favoured a blended approach to service delivery post pandemic, though perceptions varied. For example, respondents in the chronic pain survey reported that for people with chronic pain or fatigue, virtual services were perceived as advantageous, and many would like to see telephone and video consultations continue. For people living with dementia, virtual services were seen as more problematic.
The evidence gathered by our HITs could potentially reshape how services are delivered post-pandemic, and ensure that any good working practices which have emerged are retained. Findings have also been shared with NIHR ARC West and the WEAHSN who are planning further evaluation of remote consultations.
Devising a scoring system to inform COVID-19 clinical decision-making
As the pandemic started, our BHP AHSC Director, Professor David Wynick, worked alongside BNSSG analysts to rapidly produce a simple scoring system to predict who would be most at risk from COVID-19 infection. Within 20 days, this system – which would inform clinicians’ decisions about care should a patient become ill – was piloted, approved and then implemented across more than one million patient records locally. It has been in routine clinical use across BNSSG as a decision-making tool since April 2020.
Connecting patient support groups via video technology
Many people living with musculoskeletal conditions, especially inflammatory rheumatic conditions, have been shielding due to COVID-19. The Bristol Bones and Joints HIT liaised with patient support groups to share peer support resources and ideas during the pandemic, and set up informal Zoom coffee mornings every six weeks to help patients stay connected. With the Bristol Royal Infirmary (BRI) Rheumatology Patient Advisory Group, they launched a Facebook page, and provided printed and e-newsletters on patient-related issues, clinical developments and research updates.
Supporting older people in Bristol and their carers through lockdown
Lockdown restrictions have disconnected many vulnerable older people from their usual support networks in the last year. Our Active Older People (APPHLE) HIT worked with AgeUK Bristol to set up a COVID-19 Support Hub for isolated older people in the city, and those who care for them. The Hub provides access to support with technology, such as paying bills online, as well as vital health care services, and financial guidance.
Providing expertise regionally and nationally
Knowledge and understanding of COVID-19 has been enhanced significantly thanks to research from the University of Bristol’s COVID-19 Emergency Research Group (UNCOVER), As a result, UNCOVER lead, Professor Adam Finn – who is also co-director of our Bristol Immunisation Group (BIG) HIT – has become a prominent and trusted media spokesperson in the last year. A member of the Government’s Joint Committee on Vaccination and Immunisation, he is regularly approached by national media to comment on the vaccination programme, and other aspects of the pandemic.
Adam co-wrote an online practical guide called The COVID-19 Communication Handbook that provides people with practical tips about COVID-19 combined with the very latest information and evidence to talk reliably about the vaccines, constructively challenge associated myths, and allay fears. Topics in the guide include public behaviour and attitudes, policy, facts, and misinformation.
Find out more about UNCOVER research from the University of Bristol: