NHS Wales COVID Response

A Case Study

The large-scale programmes implemented by ICST in partnership with NHS bodies for NHS Wales during the COVID-19 pandemic. These programmes are unique because they are a combination of distinct features that has not been achieved before on this scale, and implemented using ICST’s Emergency Implementation Protocols.

The outcomes from this case study:

Solutions created for everyone

From frontline teams managing patients presenting with acute COVID, to practitioners supporting recovery and return to normal services, and people living with the Long COVID, there were solutions created for everyone.

Rapidly developed, rapidly implemented

The website and first-stage resources were developed in 5 days.

Total registrants reached 4521 during the first wave alone

Reduced mortality rates

Implementation of the programme has coincided with Wales having the lowest mortality rates from COVID during the first wave of the pandemic compared to England.

Data informing service provision

Data outputs from these innovations (e.g. symptom prevalence), have informed service provision across Wales

True example of co-production

Of those patients, 90% surveyed said that the apps help them with self-management of their condition.

Background to the project

It became evident in early March 2020 that clinical practice regarding aspects of managing COVID-19 varied markedly across the UK and even at local level. The evidence-base on how to manage the pandemic was scant. It became clear that it was important to bring clinicians across Wales together to create a national approach to the management of COVID-19 that was adaptable and responsive, reflecting the likely changes in management as the pandemic unfolded and as new evidence emerged. This ranged from initial assessment at the doorstep, to management in ITU and acute palliative care approaches.

This guideline needed to be focussed, built on core principles, accessible to all healthcare staff via smart phones, tablets or computers, and utilising clinical leads across the country to promote adoption, thus facilitating the implementation process.

The office of the Chief Medical Officer (CMO) in Welsh Government encouraged the use of the guideline in each health board in Wales by writing to all Health Board Chief Operating Officers in late March 2020.

Following the success of the hospital guideline, ICST were asked to produce the following innovations:

Primary Care Acute COVID Guideline, for frontline teams who are assessing the risk of patients with acute COVID presenting in the community

A programme for healthcare professionals about supporting the recovery of those affected directly and indirectly by the COVID pandemic

COVID Recovery App, for people and their families and carers who suffer with the acute and long-term effects of COVID-19 infection

Interactive guideline on the management of Long COVID, for frontline healthcare professionals who are assessing the need of people with Long COVID for onwards referral to specialist services, referral to multidisciplinary rehabilitation services, or simply offering advice and reassurance about the progress of their recovery with signposting to the COVID Recovery App for further support.

A programme for healthcare professionals about supporting the recovery of those affected directly and indirectly by the COVID pandemic

COVID Audit, which policy makers, academics, clinical, and Health Board leads that will make informed decisions on the outcome data from the audit

The journey of success

Innovation development, under extreme pressure

The early stages of the implementation process ensures that the product is prepared for the new environment, and that the environment is prepared to receive this product.

Customising the innovation for the environment

Although ICST’s toolkits are ‘ready to go’ for a general audience, there is a process to optimise the innovation for the environment in which it is being implemented. For example in NHS Wales, the guideline needed to be adapted to include a new ‘reflex fibrosis risk assessment’ protocol that was being implemented in digital healthcare systems across the country.

Establishing the teams

Identification of those who would be involved in the development of the innovations (the innovation team), the team who would oversee the governance of the process and content (the governance team) and the team that would oversee the implementation of the innovation into the system (the implementation team).

Alignment and awareness campaign

As part of ICST’s implementation methodology, the active alignment of key stakeholders, or people with influence in the system, is key to ensure that there are no barriers to implementation. In doing so, ICST supported NHS Wales to run awareness campaigns prior to the launch of the NHS Wales Liver Toolkit.

Testing the toolkit

A representative sample of users were recruited to test the toolkit and make sure it was real-world compliant. The feedback from this process highlighted a few areas of improvement that we addressed before proceeding with the formal launch.

Ongoing implementation success

Continuous optimisation of the toolkit

Throughout the implementation, ICST monitors the uptake and engagement of the innovation, as well as survey data and feedback from the audience. The findings from this help inform further development work, ensuring that the innovations continue to be optimised for the audience. One such finding, suggested that users preferred to use the clinical guideline as a physical copy, because it made quick reference during a short consultation much easier than accessing a digital version, so ICST organised with a local professional printing company to print thousands of guidelines, and copies were posted to every GP practice across Wales.

Active implementation work

During active implementation, ICST leads the implementation team towards implementation success, monitoring a whole range of proven implementation factors (we call them Enablers), to ensure that the value is realised for this implementation project.

Barriers overcome:

Webpages blocked

Despite proactive outreach to senior officials who were made aware of the proposed URL, the platform was initially flagged as a phishing site as a security measure against new websites with ‘COVID-19’ in the URL.

This was quickly resolved.

Hesitation to sign up

Registration for the guideline and supporting resources was required, and users had to input their profession, specialism, region, and hospital.

Initial concerns about a formal sign up process were quickly resolved, when timely email updates to all users across Wales began.

Ever changing evidence base

As new evidence emerged it was important this was relayed to the people who needed to apply the evidence into practice.

From initial publication in March 2020, to January 2023, there were 190 content updates to the COVID hospital guideline platform

For more information, check out the COVID Recovery Toolkit product page