In a series examining the challenges and opportunities for healthcare arising from the pandemic, Sally Williams hears from Professor Tim Briggs CBE, National Director of Clinical Improvement for the NHS and Chair of GIRFT, a national programme designed to improve the quality of both surgical and medical care within the NHS by reducing unwarranted variations. This is what he said on 24 June 2020.
The presence of COVID-19 has transformed the way we work. I’ve been amazed at how clinicians have stepped up to the plate during the pandemic. Clinicians and their NHS organisations have worked together to achieve in days the type of change that would previously have taken years to accomplish.
The biggest risk for me is that we go back to the old ways of working (which didn’t actually work). We must keep doing things differently and use this crisis as a huge opportunity for change.
GIRFT during the pandemic
When the lockdown was imposed in March, it was a busy time for GIRFT. We had 46 programmes on the go, across 21 medical specialties, 16 surgical specialties, clinical services (like radiology and pathology) and cross-cutting areas (such as coding and litigation). We had issued 11 national reports, several other supplementary reports and had nine more coming to fruition.
We paused everything on 13th March: it wasn’t appropriate to continue with face to face hospital visits with COVID-19 hitting the NHS. We shifted focus to helping the national effort. My clinical leads have returned to the frontline, as have I. Many of our non-clinical staff were deployed to work on a project to verify the technical specification of personal protection equipment (PPE) on the market.
Much of our focus during the COVID-19 crisis has been about supporting the community. GIRFT, working in partnership with the Royal National Orthopaedic Hospital Trust, set up an academy to train staff working in care home and home care services in infection control, swab testing and the correct use of PPE. We trained 360 ‘super trainers’, who in turn have trained 3,200 local trainers, who offer training to the 15,000 care homes in England. Over 99% of care homes are now covered. This was a collaborative effort with NHS England and NHS Improvement.
We have been piloting virtual community multidisciplinary hubs to provide support to community healthcare providers. It works by community providers emailing with a request for help (firstname.lastname@example.org). We then draw on the expertise of our clinical experts and provide a webinar that answers the specific issues raised. Our aim is to help those that are struggling and to learn from the best performing providers. Based on the pilots, three priority areas have been identified: rehabilitation, respiratory care and wound care.
GIRFT has contributed to developing the NHS guide to remote and virtual consultations. It’s a new system for all of us, including me. I’m doing telephone consultations when usually I’d see patients in clinic. It’s good for patients, as it means they don’t have to travel to hospital. And it’s good for clinicians, as it means they can be more efficient in how they use their time.
Going forward there will be consultations via email, telephone and video, with face to face appointments for those people who can’t do it in other ways. I’ve been astonished at how good technology – such as Zoom and Microsoft Teams – has been. It will revolutionise the way we do things and not just consultations.
Technology means we can begin to think of restarting the GIRFT programme. Hospital visits will be undertaken quite differently. It will be more productive, more efficient and better value for money. We’ll compile a data pack on the specialty we’re examining in the usual way. This looks at a wide range of factors, from length of stay to patient mortality. We will issue this to every NHS organisation (Trust) being reviewed, but instead of a face to face meeting at the Trust – known as a ‘deep dive’ – with medical staff and senior managers, we will use technology to discuss the findings remotely.
I’m quite excited about it all. We might miss some things, such as nuances of body language, but technology will allow us to achieve 95% of what we had before. We will reserve face to face visits for Trusts that request them or to learn from those that are exemplars.
We can also use technology to better share and support service integration. Every area is expected to become an ‘integrated care system’ (ICS) by 2021, which means commissioners and providers will work together to manage improvements in services and health outcomes for local populations, across primary care, secondary (hospital) services and community care.
Moving into recovery
As we move into the recovery phase, GIRFT will play a major role. The plan is to use GIRFT data and metrics to set the standard for each specialty – what we want the new normal to be as regards patient outcomes. This will set the benchmark for what NHS services should be aiming to deliver. The top decile will become the new norm for quality outcomes and efficiency. We have been piloting this approach in London, across the five ICSs. We have started with orthopaedics and ophthalmology, which have the highest waiting lists, and are already extending into general surgery, gynaecology, ENT, spinal surgery and urology, with the other surgical and medical specialties to follow.
There’s a real opportunity to achieve greater consistency across healthcare and better standardisation of good outcomes. GIRFT visits have drawn attention to variations – the NHS is delivering world class outcomes in some places, but not others. The opportunity now is to reset quality standards across the board and for the GIRFT programme to drive continuous improvement across the NHS.
Clinicians are up for it. The specialty societies and the royal colleges are behind it. It’s an exciting time for the profession to help transform NHS services along population lines, and to join up primary, community and secondary services. Where royal colleges, and others, identity a need for improvements in hospitals, GIRFT is well-placed to provide the improvement service needed.
I know many clinicians have been working flat out and it will take a bit of time as we try to restart services. At the end of the day, if we get all health services to aim for the top decile, we will improve patient outcomes, deliver efficiencies (such as the reduction in unnecessary procedures) and, in doing so, improve the quality of working lives for our staff.
The vision as we move forward must be equality of access and excellence in outcomes for all NHS patients.
As told to Sally Williams