AN INVESTIGATION ON WHETHER THE PANDEMIC HAS EXPEDITED DIGITAL TRANSFORMATION IN THE UK, A CRITICAL ANT STUDY USING NORMALISATION THEORY

To state that the NHS is no stranger to reform, is not a novel statement, it can be argued that over the past several years it has taken a U turn from the ‘competitive’ aspect to manage healthcare in which Andrew Langsley published in 2009 (McKinsey 2009), to that of collaboration, integration, managing the health of a population and how we use digital technologies for better system and patient outcomes. It can be further argued that collaboration and integration are also not revolutionary statements as the need for such reform can be dated back March 1961, in which Enoch Powell made the iconic ‘Water Tower’ speech, this largely reflected on the need for an integrated service for mental disorders, stating the need for transformative change, the aspirations for long term planning, the development of integrated services within the community and the management of the nations population health needs remain just as prevalent today(The Nuffield Trust 2021).

The Long Term Plan (LTP) (2019), required Integrated Care Systems to build upon the lessons learned from previous designs and previous work accomplishments that the previous sustainable development and transition partnerships and vanguards had provided. (Aziz et al., 2021). This was argued by Wodack (2020)., and was further evidenced in the NHSE England report: Integrating Care (2020) Next Steps To Build Strong and Effective Integrated Care Systems Across England. This called for all parts of the health and care system to work together as Integrated Care Systems, involving:

1. stronger partnerships in local places between the NHS, local government and others with a more central role for primary care in providing joined –up care.
2. stronger partnerships in local places between the NHS, local government and others with a more central role for primary care in providing joined –up care.
3. povider organisations being asked to step forward in formal collaborative arrangements that allows them to operate at scale.
4. develop strategic commissioning through systems with a focus on population health outcomes.
5. the use of digital and data to drive system working, connect health and care providers, improve outcomes and put the citizen at the heart of their own care.

There is an acknowledgement that some systems did not hesitate to embrace the digital opportunity and the need to develop effective models for joined up working, whilst other systems were seen to be at a different stage in their journey, and this transition may have provided significant challenges to accomplish. (Horne et al., (2013), (Porter 2020).

Yet, who would predict that in 2019 the world would begin to experience its most significant healthcare crisis in a century and that the need for collaboration, joined up models of care and digital interventions would again take centre stage. This asks a very important question: from the critical themes that have been highlighted to address – at what point do we sit up and start to learn our lessons?

This case study provides a critical analysis of an initial COVID response of of how together an embryonic heath and social care system developed a cross system intelligence (Customer Relationship Information Management Tool) and data analytical functions and how this has enriched human-technology interaction and influences on processes to sustainability, and how this has enabled greater collaboration and joined up working. ‘The Team Oldham Response: Customer Relationship Information Management Tool’, at its core a bio – psychosocial approach to health management – physical, social, economic and environmental focusing on getting the basics right at system level to improving patient experience and population health outcomes. emergency response to COVID-19, in particular the design and implementation of a data management system, which underpinned Helpline and Place Based Hubs. These Hubs captured patient level information and referred vulnerable patients to be seen by the most appropriate person, and the appropriate time.

This case study aims to fill a research gap by examining the NPT framework as an alternative theory within the health-social setting, it provides researchers with a systematic and consistent model for describing, assessing, and enhancing the implementation potential. Critically, the NPT model considers implementation and sustainability from the early onset (Murray et al., 2010). It is within this construct that NPT renders itself as a valuable lens for assessing how COVID-19 has expedited the expansion of and sustainability of health care digitisation in the UK.

In addition, it also seeks to provide significant perspectives for analysing how humans interact with inanimate materials. The premise of the Actor Network Theory is that it confers social benefits when actors or agents in a network interact. The ANT argues that in the said interaction, technology has the role of influencing the social processes (Creswell and Sheikh, 2010). Similarly, Mort et al. (2009) also share the same sentiment by asserting that implementing technology in healthcare has the goal of improving quality of care. ANT is a quality improvement perspective while NPT is an efficiency enhancement system. These subtle differences mean that technology within the NPT lens will be implemented for different reasons compared to ANT, yet NPT aligns with the ANT in that they both have a focus aimed at explaining the need for technological change in a retrospective approach.

1. Provide a critically analysis and compare against national & regional benchmarks: (15% weighting)

• Oldham’s populations/demographics/ethnicity/deprivation

2. Provide a critical review of Oldham Integrated Health Care Board – as this is a new structure you may need to refer to the existing partnerships/relationships as they and the culture are key of: (15% weighting)

• NHS Oldham Clinical Commissioning Group (Health)
• Oldham Council (Adult Social Care) (Unity Partnership – the IT commercial sector of the council)
• Oldham Voluntary Sector (Community Sector)
• Greater Manchester Government Authority

Introduction

On 31 December 2019, the World Health Organisation (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. On 12 January 2020 it was announced that the virus, SARS – CoV-2, and the associated disease as COVID – 19

In March 2020, the United Kingdom Cabinet Office released a statement in response to the COVID-19 Virus, almost immediately the country went into lockdown, with Manchester and Greater Manchester (GM) declaring a major incident on Friday 20^th March 2020.  The COVID-19 outbreak turned daily rhythms, routines and lives upside down, the UK’s Healthcare, social care and voluntary care systems at the heart of this crisis, with the sheer scale and pace of transformation unprecedented and breathtaking.  NHSE citing COVID-19 is the single most disruptive event facing global healthcare economies, and as such remains at the top of the UK Governments National Risk Register (NHSE 2020).

Systems aspiring to their own digital health vision were suddenly catapulted from vision to reality as the immediate transformation replaced face to face GP appointments with video consultations, replaced A&E triage with remote triage and an explosion of digital hubs appeared to land in the landed in response to NHSX emergency national policy guidelines (NHSX 2020).

The crisis has brought to the forefront the urgent need to manage the population’s health. A challenge not aligned to hospitals alone, but to a system and how the system could design and mobilise at pace new pathways that would enable and protect capacity for urgent COVID as well as urgent non-COVID care, shining a light into our communities to ascertain where our most vulnerable population are? and how do we support them?. This is a notion supported by Hantrais et al., 2020, who argued the call for more strategies to be placed to enhance the wellbeing of vulnerable members of the community and enhancing surveillance of the sick should be given priority. In addition, Golinelli et al., (2020) argues the physical and pharmacological wellbeing of patients has been considered over the psychological health of patients. Hantrais et al., (2020)

The Team Oldham Approach

Political

In line with their Greater Manchester colleagues, Oldham quickly established a Major Incident Command Structure – typically a Gold (strategic), Silver (tactical) and Bronze (operational) level governance framework which included a political Gold of healthcare leaders, community voluntary sector leaders, council/deputy leaders and deputy leader of the main opposition group to work across the ‘Oldham Partnership’ to together plan how to protect other vulnerable individuals/ groups or people at significant risk during this time of crisis.

Within days of the cabinet announcement, central government produced guidance on the agreed approach to supporting those of the population who were clinically extremely vulnerable to COVID – 19. The most appropriate starting point was the very basic elements required for survival, in that how do we reach the most vulnerable to ensure that they have food. (Maslow 1943). Community Bronze was quickly set up with joint leads from the council and voluntary sector (Action Together), to focus upon meeting the immediate needs of people in the communities in response to the pandemic – in particular food & medicines. Within days the group had mobilised 5 community hubs to co ordinate food, medicines and mutual aid and the helpline was borne to act as an access point for the community

Methodology

• Critically analyse theoretical frameworks and why a case study approach would be the appropriate choice for this particular case study
• Critically analyse and draw upon the importance of evidence from a case study over multiple organisations with different cultures and stakeholders
• Critically analyse the importance of the NPT and Actor Network theory in this case study and why they are so beneficial in a social sciences study
• Critically analyse the NPT Core Constructs, – linking these with the semi structured interview questions (Weighting 35%)

Emerging findings: empirically analyse

• Would you be so kind as to pull these onto a table from a thematic perspective – I do hope the spreadsheet helps a little (Weighting 35%)

Just to note I have broken the organisations into three levels

• Level 1 – Regional – which is the Greater Manchester Government Authority
• Level 2 – Strategic Executive Group: 2 particular organisations The Local authority & a Voluntary Sector (Action Together) – two of these colleagues together chaired Community Bronze
• Level 3 – Community Bronze – Tactical
• Level 4 – Operational