Organising Care in a Time of Covid-19

The COVID-19 pandemic has led to radical transformations in the organisation

and delivery of health and care services across the world. In many countries,

policy makers have rushed to re-organise care services to meet the surge demand

of COVID-19, from re-purposing existing services to creating new 'field' hospitals.

Such strategies signal important and sweeping changes in the organisation of

both 'COVID' and 'non-COVID' care, whilst asking more fundamental questions

about the long-term organisation of care 'after COVID'. In some contexts, the

pandemic has exposed the fragilities and vulnerabilities of care systems, whilst

in others, it has shown how services are organised to be more resilient and

adaptive to unanticipated pressures.

The COVID-19 pandemic presents a rare opportunity to examine empirically and

to develop new theoretical frameworks on how and why health systems adaptto

such unusual and intense pressures. International contributors consider how

responses to COVID-19 are transforming the organisation and governance of

health and care services and explore questions around strategic leadership at

local, regional, national and transnational level. The book offers unique insight

and analysis on the dynamics of policy-making, the organisation and governance

of care organisations, the role of technologies in governing, the changing role of

professionals and the possibilities for more resilient care systems.

Justin Waring is Professor of Medical Sociology and Healthcare Organisation at

the Health Services Management Centre, University of Birmingham, and is Visiting Professor at School of Public Administration, University of Gothenburg.

Jean-Louis Denis holds the Canada research chair (tier I) on Health System

Design and Adaptation. He is Senior Scientist, Health System and Innovation at

the Research Center of the CHUM (CRCHUM), and Visiting Professor, Department

of Management, King's College London.

Anne Pedersen is Professor at Copenhagen Business School.

Tim Tenbensel is an Associate Professor at the University of Auckland's School

of Population Health.

Auteur

Justin Waring is Professor of Medical Sociology and Healthcare Organisation at

the Health Services Management Centre, University of Birmingham, and is Visiting Professor at School of Public Administration, University of Gothenburg.

Jean-Louis Denis holds the Canada research chair (tier I) on Health System

Design and Adaptation. He is Senior Scientist, Health System and Innovation at

the Research Center of the CHUM (CRCHUM), and Visiting Professor, Department

of Management, King's College London.

Anne Pedersen is Professor at Copenhagen Business School.

Tim Tenbensel is an Associate Professor at the University of Auckland's School

of Population Health.

Contenu

1. Intra-Crisis Policy Transfer: the case of Covid 19 in the UK

Martin Powell and Sophie King-Hill, University of Birmingham, UK Learning from abroad and policy transfer feature in the literature on learning (eg Bennett and Howlett 1992; Vagionaki and Trein 2019) and in health care (eg Klein 1997; Ettelt et al 2012), but it focuses on 'normal' rather than crisis policy making. This chapter brings together the literatures on learning and policy transfer with material on crisis learning in order to assess policy transfer in the Covid 19 Pandemic in the UK. The leading authors in the field of policy transfer, Dolowitz and Marsh (1996) suggested a series of questions that might be addressed: Who transfers policy? Why engage in policy transfer? What is transferred? Are there different degrees of transfer? From where are lessons drawn? What factors constrain policy transfer? They later added a further question about how the process of policy transfer related to policy "success" or "failure." (Dolowitz and Marsh 2000; cf Marsh and McConnell 2009)). However, although their titles stress 'learning' and 'lessons' (eg 'Who learns what from whom' (Dolowitz and Marsh 1996) and 'Learning from abroad' (Dolowitz and Marsh 2000)), the literature arguably say little about learning (eg Ingold and Monaghan 2016). The policy transfer literature focuses on 'normal' times, but there is little on policy transfer in a crisis, with its constituent elements of threat, uncertainty, and urgency. Conversely, it is broadly argued that lesson-drawing is one of the most underdeveloped aspects of crisis management. The literature distinguishes learning across crises and learning within a crisis, or inter-crisis and inter-crisis management, and between 'routine' and 'non-routine' or 'less routine' crises (eg Moynihan 2008, 2009).

While there is some literature on inter-crisis learning from Pandemics (eg Stark 2018), the material on intra-learning during Pandemics is limited. For example, Baekkeskov and Robin (2014) claim that 'pandemic response is unique' because it was ruled by bureaucratized experts rather than by elected politicians. They argue that while natural disaster responses appear to follow a political logic, national pandemic vaccination policies follow a bureaucratic logic. However, pandemic vaccination policies diverge significantly between countries because expert judgments differ significantly. Baekkeskov (2016) focuses on the different response policies in the Netherlands and Denmark to the 2009 H1N1 'swine' influenza pandemic. The main aims explore how the main elements of learning, particularly cross-national lesson-drawing and policy transfer play out in the Covid 19 crisis. The main research questions are drawn from Dolowitz and Marsh (1996, 2000) framework (above). However, it addresses them with respect to the crisis and learning literatures. From the crisis perspective, how do threat, uncertainty, and urgency relate to policy transfer in a non-routine and intra-crisis situation? From the learning perspective, to what extent did the UK look to learn from abroad?; where did the UK look, and why?; and what did the UK learn? The material is primarily drawn from documents such as the Minutes of the scientific advisory bodies (eg SPI; NERVTAG), and associated scientific published articles (eg Lancet), Hansard Debates, media sources, and (possibly) interviews, and analysed by Interpretative Content Analysis.

2. Population health management in the NHS: what can we learn from covid-19?

Kath Checkland, University of Manchester, UK

The NHS Long Term Plan (NHS England 2019) sets out the agenda for NHS services in England for the next decade. One of the key strands of the Plan is a move towards what is called 'Population Health Management'. This approach is briefly defined as: [the use of] predictive prevention (linked to new opportunities for tailored screening, case finding and early diagnosis) to better support people to stay healthy and avoid illness complications (NHS England 2019 p12). Later in the document it is explained that such an approach involves the active identification of people at risk using digital tools and large data sets, and the provision of care of some kind to prevent future health problems. This approach is lauded as being 'proactive' in contrast to previous 'reactive' care. The evidence underpinning the introduction of such an approach is not described.

The covid-19 crisis provides us with an opportunity to interrogate the population health management approach in more depth, and to consider critically what it might offer, what the problems might be and what this means for the post-covid organisation of the NHS. Early in the covid-19 pandemic it was announced that in the UK a cohort of 'clinically extremely vulnerable' patients would be identified using digital tools and singled out for special care to prevent them contracting the virus. This process was called 'shielding' and it represents an example of population health management. A cohort of people ha…