Covid Protect shielding programme highlighted as best practice in new Yale report

Understanding the lessons learned from Norfolk’s Covid Protect, a digitally-enabled service to support vulnerable patients

Health Innovation East and the Yale School of Public Health have produced a report highlighting what can be learned from the Covid Protect programme, launched in response to the coronavirus pandemic to proactively support people identified as vulnerable to COVID-19 in Norfolk and Waveney by monitoring their health on a regular basis.

Covid Protect helped more than 23,000 vulnerable patients, drawing on the national shielded patient list as well as the eclipse population health management tool to identify at-risk patients. This group were actively targeted via an online survey, which asked if they had any COVID-19 symptoms, if they had any health or social needs (such as access to food and medication) or if they had any clinical or prescribing needs.

A virtual support team staffed by volunteers from a range of organisations telephoned patients who had not completed the survey online to ensure people weren’t missed.

The programme saw significant cooperation across organisations and sectors to respond to the needs of vulnerable people. In addition to the national Shielded Patient List, Covid Protect saw an additional 12,000 people referred to health and social care services.

We worked with the Yale Global Health Leadership Initiative (GHLI) within the Yale School of Public Health in collaboration with Norfolk and Waveney Clinical Commissioning Group (CCG) and Relentless Leadership to distil learnings from Norfolk and Waveney’s implementation of Covid Protect, which have now been published in the Covid Protect roadmap for adoption.

This roadmap is intended to be a practical resource for executive and operational staff in health and social care, including clinicians, digital technology leads, and others, seeking prototypes that could be replicated rapidly across the United Kingdom.

Five ways of working to support digital transformation

The roadmap identifies five ways of working that underpinned Covid Protect:

1. Gain explicit, visible endorsement from senior executives
2. Engage all stakeholders through a multi-pronged engagement strategy
3. Ensure every member of staff feels valued
4. Cultivate a safe culture for innovation to flourish
5. Actively and continuously empower middle management and the frontline

The team also identified three key tensions, and how they were navigated by the project team:

1. Balancing central control and local flexibility: While the project was central managed, localities had the freedom to decide how best to respond to needs highlighted in the survey. This had to be carefully managed. Allowing too much local flexibility may result in a disjointed approach, while over-centralisation can feel prescriptive and reduce responsiveness and ownership.
2. Promoting both risk taking and accountability: Operating in a rapidly changing environment, stakeholders balanced risk-taking and accountability by discussing risks openly and candidly, putting the patient at the centre of each decision, and moving forward as a unified team.
3. Working across organisations was a strength and liability: A shared enemy – the COVID pandemic – motivated diverse organisations to overcome the usual fragmentation. Without a global pandemic, leaders must find other ways to generate a sense of urgency and shared commitment.

Driven centrally by the CCG, this was a cross-sector and multi-organisation project bringing together primary care, local authorities, ambulance trusts and the voluntary sector to deliver a cohesive, proactive model of care.

Covid Protect was closed when the national approach to shielding ceased in August 2020, although it was reinstated for the second and third COVID-19 waves. The service has evolved into a population health approach known as Protect Norfolk and Waveney (NoW), creating an infrastructure that can be used to enable a proactive, targeted approach to population health management for hard-to-reach groups in Norfolk.