Building a Brighter Future

The design and evaluation of evidence-based, integrated, future-ready care pathways

Home healthcare worker helping elderly man with walker.

Building a Brighter Future: the design and evaluation of evidence-based, co-produced integrated care pathways for (a) frailty/older people and (b) perioperative care/orthopaedics that are future-ready while addressing the pressures and problems of the present.

Torbay & South Devon NHS FT (TSD) has been allocated £350 million to re-provide the estates and digital infrastructure of Torbay Hospital. TSD is one of 48 recipients of the Government’s New Hospital Programme (NHP) money. There is no established framework for designing for the future while addressing the problems of the present.

Torbay and South Devon NHS FT (TSD) has been allocated £350 million to re-provide the estates and digital infrastructure of Torbay Hospital.

TSD is one of 48 recipients of the Government’s New Hospital Programme (NHP) money. There is no established framework for designing for the future while addressing the problems of the present.

Torbay and South Devon NHS Foundation Trust

Strategic outlines and project aims

In July 2021 TSD submitted their Strategic Outline Case to NHP. Plans are to replace and/ or re-furbish the hospital buildings taking into account the predicted 25% growth in population and the >90% rise in the very elderly in the next 15 years. Transformation of services provided are required in order to maintain quality services to the local people as well as decreasing the reliance of hospital in-patient care. This is at a time when the NHS has been stretched and challenged by the COVID pandemic. In addition, health and care is at the brink of innovation transformation in developed countries given current and future technological capabilities, some of which have been accelerated by COVID e.g. use of virtual appointments.

Planning for the 2025-2040 health care system is more complex than ever before. We can make plausible hypotheses about the ways in which digital and clinical innovations could lead to a redistribution of care away from hospitals and towards satellite sites, virtual hubs and patents’ homes. Further changes can be put in place now while others await technological advances, but even today’s changes should be made with the future anticipated configuration in mind. Furthermore, practical questions arise about how to design the transition from the hospital of today to the health system of the future without compromising patient care, staff morale or best resource allocation.

This 24-month project aims to research these challenges by embedding research-informed, collaborative design into the co-production and evaluation of integrated care pathways for (a) Healthcare for Older People (HOP) (pre-frailty/frailty) and (b) perioperative care/ orthopaedics. These specialties are part of TSD’s flagship transformation programme, the Drumbeat Programme which orientates specialist teams to the drumbeat of transformation, TSD’s case for change and action. This programme will be part of the delivery of transformation, establishing what works and what doesn’t as well as reporting on the outcomes for TSD services and service users.

TSD recognises the need for transformation to be fit for the future delivering high quality care with best use of resources. Within TSD’s strategy, the Health & Care Plan sets out the case for change and key priorities. In order for specialist teams to understand the level of change required and opportunities available here, the flagship programme to drive this transformation has been designed and set up, involving 15 care areas- the highest users of in-patient facilities as these specialties are key to the appropriate sizing of the new build on the Torbay Hospital site. Within these care areas care of the older person and orthopaedic pathways are heavy resource users and therefore ideal to involve directly in this research.

Within the context of the planned transformation programme, the primary aims of the study are:

1. To collate evidence (from formal/grey literature and interviews with national and international stakeholders) of clinical, technological and service innovations relating to pre-frailty/frailty and perioperative/orthopaedic care with respect to inputs (e.g., staff, equipment, data and information systems, guidelines, training), processes (e.g., relating to acceptability, definition of roles, embedded evaluation) and outcomes (quality, clinical effectiveness, cost-effectiveness).

2. To research the effectiveness of the transformation programme’s approach and context for example surfacing differences in knowledge, attitudes and values between professional groups and between clinicians and lay people and identifying changes in roles, technology and use of space which acceptable to different groups and that can be introduced in the short and longer-term.

3. To study the roll-out of initial innovations identified in (1) in the two integrated care pathways in the short, medium and longer-terms, ensuring the appropriate processes are embedded and research how changes relate to current operational and policy pressure versus also maintaining a mindset of ‘design for the future’.

4. To evaluate the inputs and outputs of new care elements implemented in (2) through before/after changes in e.g., numbers of patients engaging in digital and other preventive activities, ratio of face-to-face to virtual consultations, ratio of hospital-based to community-based activity.

5. To research the enablers and barriers to implementation or change, using the NASSS (Non-Adoption, Abandonment, Scale-up, Spread, Sustainability) framework

6. To provide generalisable research insights for regional and national decision-making with respect to the NHP by:

a) Establishing practical and evidence-based design-process and pathways for orthopaedics and frailty potentially suitable for related programmes
b) Creating guidance on methods for designing for the future while dealing with challenges of the present.