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  • Increasing vaccine uptake

    Mulla, Abeda; Teladia, Zaheera; Jones, Eleanor; Moore, Ellie; Ward, Richard; Finlay, Freddie; Taylor, Bethany (The Strategy Unit, 2021-06)
    When the national COVID-19 vaccination programme began in December 2020, it was understood that everyone should have equal access to the vaccine, as appropriate to their need, and as prioritised by the Joint Committee on Vaccination and Immunisation. Within a few weeks however, there were early indications that there were differences in uptake amongst different population groups and in different parts of the country (The OpenSAFELY Collaborative 2021). As a result of these differences, many local examples of initiatives to increase vaccine uptake began to emerge. The Health Inequalities Improvement Team in partnership with the Vaccine Equalities Team at NHS England and Improvement commissioned the Strategy Unit to collect and collate some of these examples in a structured way. What we did: using social media channels and professional networks we identified and requested a half hour conversation with people involved in initiatives to increase local vaccine uptake. We spoke to people in March-April 2021, involved in 50 different initiatives across England and wrote up each of these individual accounts in a structured way. The examples we collected focused on four target groups: place of residence, ethnicity, faith communities and health status and could be grouped as two main types of intervention: information and outreach. Representative examples of each of these are included as case studies on the NHS England website, all 50 examples can be viewed below. A blog outlining the three key lessons for working with communities beyond the vaccination programme is hosted on the NHS Confederation website.
  • Primary and Community Qualitative Insights

    Mason, Paul; Mulla, Abeda (The Strategy Unit, 2020-07)
    The COVID-19 response required rapid change and innovation across health and care. As part of a wider package of evaluation support, from April to June, the Strategy Unit led some qualitative work (training and supporting CCG staff to conduct interviews) across an STP to capture learning from primary care (primarily PCN clinical leads) and community nursing leads about their experiences. The interviews explored the rapid move to total triage, video and online team communications, changes to day-to-day practices, working with care homes and their views on the backlog and unmet need. We held weekly reflective learning workshops with the CCG to both share learning and provide practical support with the delivery of the interviews. We also provided weekly rapid-cycle reporting of headline findings from an initial analysis of interview notes and recordings. Here we share the three rapid-cycle reports that were provided to the STP during the crisis period.
  • Learning from lockdown: support for people experiencing homelessness

    Caswell, Rachel; Battye, Fraser; Callaghan, David (The Strategy Unit, 2021-02)
    There are few clearer measures of societal health than homelessness. On this count, and despite its enormous material wealth, England is in poor shape. Relative to the recent past, and any country we might want to compare ourselves to, we have a problem with homelessness. The causes of homelessness are undoubtedly complex. But the above comparisons show that the problem can be addressed: policy choices make a difference. This was shown in dramatic fashion last March with the Ministry of Housing, Communities & Local Government decision to house people rough sleeping (‘Everyone In’) in response to the first national lockdown. So Lockdown 1 was a period of great policy innovation. It was also a time of radical service innovation as health and social care services responded to a world of social distancing, remote working and PPE. At that time many Strategy Unit projects were focused on what could be learnt from this period of innovation. What changes were being made? Which changes seemed to be an improvement on pre-lockdown practice? Which ones were a step back? Which needed more evidence and further study? We were asked these questions so frequently, we produced a Guide to working through them. It was a great privilege to be asked by NHS England & Improvement to examine these questions in relation to the service response for people experiencing homelessness. Alongside this, we were also asked to look at how data collection and use could be improved. The reports below contain the detailed results of this work. These results resonated strongly with similar projects from Groundswell, St Mungo’s and Crisis. Above and beyond the results set out in the reports, we also found that: Innovation was taking place on the frontline. Changes made by services were pragmatic responses to changes in circumstance; they were not done in response to plans from ‘on high’. Policy is now running to catch up with practice. Existing problems were exposed. Data were patchy and weak; services were often strained (and sometimes unwelcoming). These pre-existing weaknesses came more sharply into focus. The hope is that temporary measures to cope with the crisis – less hiding behind ‘IG’ for example – can be now nurtured into everyday practice. The basic right of access to healthcare, that has too often eluded those experiencing homelessness, is assured. While seeing that standard administrative data was lacking, we found that it was possible to gather near live information from people experiencing homelessness. We joined forces with (the excellent) Groundswell to bring together our work on services’ experiences with their peer-led work looking at people’s experiences of this support. This combination proved powerful and we shared many lessons during a session at our INSIGHT 2020 festival. The NHS can be criticised for its approach to addressing health inequalities. The hope here must be that the inequalities exposed by Covid draws a fuller and better response in future. Recent reasons for this hope include: the content of NHSE/I’s ‘Phase 3 letter’, which focused heavily on inequality; the recent appointment of Dr Bola Owolabi as Director of Inequalities; and the energy shown by Olivia Butterworth, who led NHSE/I’s response to homelessness. Homelessness is a source of shame for our society. The best way to improve outcomes is not to tweak services, but to prevent the problem. But while homelessness remains, the NHS must feel a sense of duty and responsibility to do the best it can do, and to work closely with local government and the voluntary sector in support of this. This work gave us the chance to combine personal interests and passions with professional skills. It was part of the Strategy Unit’s ongoing commitment to addressing health inequalities and we relished the chance to contribute to a significant and vital agenda. We look forward to working with others to do so again in future.
  • We don't just need to hear 'you are more affected' - what's the action?

    Mulla, Abeda; Begum, Mahmoda; Teladia, Zaheera; Townsend, Sharon; Ward, Richard; Jones, Eleanor; Rahim, Shammas (The Strategy Unit, 2022-03202)
    Within months of the COVID-19 pandemic, international evidence on the disproportionate impact of COVID by race and ethnicity began to emerge in countries that collect ethnicity data (the UK, USA, Canada, Norway and Brazil. Each provided more evidence that people living in a country where they were classified as minority ethnic, had a higher risk of contracting COVID-19 infection with more severe outcomes when infected. As a response to this emerging data, the Strategy Unit undertook a small exploratory qualitative study between June and August 2020. We publish these stories, two years into the pandemic as a historical reflection. We recruited via our own personal and professional networks to reach people who are often considered ‘hard to reach’. We conducted 11 in-depth, semi-structured interviews with people who self-identified as minority ethnic and who had experienced symptomatic COVID-19 illness. The purpose of this study was to record individual experiences of: becoming infected with COVID-19; the impact on their households; and, the management of symptoms including how they accessed and used health and care services. Thematic analysis of the qualitative interview data identified five key themes as shown in the figure above. We previously presented these findings at the Strategy Unit’s 2020 Insight festival. We are now publishing a summary of each of these interviews as narrative stories, that is first person accounts under the headings of: My life before COVID My experience of COVID My life after (first infection with) COVID Why my COVID experience matters Whilst acknowledging the many overlapping experiences, we have grouped these 11 stories[1] according to three main categories. We have also provided a summary of each of the three categories. The interpretations are situated in the lived experiences of the qualitative team who undertook this piece of work. We were motivated to challenge the overly simplified narrative of linking the poorer pandemic experiences of minority ethnic people with low socioeconomic status, cultural practices and front-line roles. The accounts collected in these interviews reveal both the counter-arguments and the nuances within these narratives.
  • Evaluation of building the right support: Final reports

    Mason, Paul (The Strategy Unit, 2021-11202)
    Building the Right Support was a national plan to provide better support to people with a learning disability or autism. It said which services and supports are needed to help people whose behaviour challenges services or who have mental health problems. This was because too many people were living in hospitals and assessment and treatment centres. Many had been living in such places for a very long time. Often they were a long way from their home, family and friends. NHS England asked four organisations to do research to find out about Building the Right Support: The Strategy Unit ICF University of Birmingham BILD The research aimed to find out what was working, what was not working and what could be done better. This was completed in Summer 2019. The reports can be found on the website link.
  • How can we learn from changes in practice under COVID-19?

    Mason, Paul; Hawkins, Lucy (The Strategy Unit, 2020 Septe)
    During the COVID-19 pandemic we have seen rapid changes in ways of working. We have seen an increase in collaboration, particularly through digital platforms, the sharing of data, and people describing ‘true system working’. So how do we capture innovations and changes in practice? How do we learn from them? How to we identify what should be continued and what should not? How do we sort promising, effective changes from those that are ineffective – or even potentially harmful? If we don’t think about how to do this systematically there is a risk that learning will be lost as pressures to ‘return to normal’ increase. This guide has been developed to help health and social care teams and their leaders learn from service changes put in place or accelerated during the COVID-19 response. The guide is not exhaustive. It offers an overview and practical, helpful suggestions of how learning can be captured and acted upon. It signposts to more detailed resources. The Strategy Unit is currently involved in a wide range of other initiatives to support the COVID-19 response and recovery including through our collaboration with leading think tanks. Please get in touch if you would like to know more.
  • Menopause and the NHS workforce

    Mulla, Abeda; Wiltshire, Justine; Lucas, Sarah; Jones, Eleanor; Moore, Ellie; Hextell, Lydia; Mobeen, Marya; Ali, Sheila; Cummins, Lisa; Green, Ruth; et al. (2022 Novem)
    One in five NHS workers is of menopausal age, yet until recently little has been discussed about the effect this has on their health and wellbeing. Last week NHS England Chief Executive Amanda Pritchard launched new guidance aimed at supporting NHS workers through menopause. But what are the stories behind these headlines? Our new report, published today, takes a unique in-depth approach to examining the impact of menopause on the NHS, combining data analysis and in-person interviews to give the most comprehensive picture yet.