This is the first study of a programme of new work called SHaPERS: Social and Health cAre Professional Experiences of the Redesign of Services.
Led by our implementation team, the study looks at the Covid-19 pandemic and the implementation of Personal Protection Equipment (PPE) guidelines in the UK.
The research question under investigation was identified by practice, in conversations with public health staff on the frontline of implementing PPE guidelines.
The study brings together the experiences of key professionals in local and national roles across Public Health England. It explores how rapid, responsive, and equitable the implementation of PPE guidelines were and how to make improvements in future critical Public Health incidents.
In the case of a global public health crisis where there is little evidence to inform decision-making, how can public health work in ways that enable and limit a flexible response to an emergent situation?
In the Covid-19 pandemic, Personal Protection Equipment (PPE) was a critical but limited global resource. The PPE needs of frontline social and health care workers varied across clinical and community settings and different populations (e.g. older people versus children).
This was against a backdrop of emerging understanding about the transfer of Covid-19 and changing guidelines regarding the appropriate use of PPE equipment. The limited availability and variation in ability of organisations to procure setting-appropriate PPE made decisions about whether, what, and how PPE should be used in different settings, especially critical. Government guidelines about which frontline service deliverers should use PPE, how, and when, changed rapidly in response to the emerging situation. The resourcing for Public Health England (PHE) had been reduced over recent years, potentially hindering its ability to respond to the broad range of challenges presented by a crisis of this unprecedented scale.
As a result of these conditions, local authority Public Health increased their remit to include some of the translating of Government PPE guidelines to local action across their social and health care settings. In the UK this response looked different within each region and across local authorities, depending on differences in their existing structure, ways of working, and the communities they serve.
In one region of the UK, in some local authorities, small ‘cells’ emerged to manage the procurement and distribution of PPE and the translation of PHE PPE guidelines across the range of social and health care providers in their region. In implementation science and knowledge mobilisation terms, they acted as “knowledge brokers”, interpreting the Government guidance for these organisations and supporting them to understand whether and how to use PPE and under which circumstances and for whom.
Limited PPE worldwide meant local decisions were necessarily informed by prioritisation of comparative (as opposed to actual) need and risk of each setting. This created a challenge for individuals placed at the forefront of discussing PPE use with providers amidst public and provider fear and uncertainty. It also highlighted existing inequality of resource allocation across social and health care services.
Local authority Public Health professionals rapidly found themselves in a new PPE knowledge broker role, with little or no time for training and support and making life and death decisions for their service users and deliverers. They were tasked with translating an ever-changing set of complex and general guidelines for all social and health settings, originally focused primarily on clinical health care settings. They were at the forefront of fielding the uncertainty and frustrations of services who have difficulty accessing PPE and who themselves were facing fear from their workers and the public.
For future international public health incidents, it is critical that we understand how implementation decisions are made in public health and the structures and processes that enable and limit responsivity to an emerging public health crisis with limited evidence. We need to know how to implement public health guidelines rapidly, responsively, and equally across the full range of social and health care settings. We must understand how implementation decisions at all levels of public health exacerbate or reduce inequality for vulnerable or marginalised groups or services and how to address any inequality. We need to know how to implement these changes in a way that best supports the mental health and wellbeing of the people in these emergent knowledge broker roles and thus the sustainability and effectiveness of the roles for the longevity of the crisis.
This study will summarise the experiences, knowledge, and perceptions of key professionals to decipher what was done and how it worked or not, and how rapid, responsive, and equitable implementation of guidelines could be improved for future critical Public Health incidents.
Understand and map how different local authorities implement a knowledge broker role in Public Health to translate Government public health guidelines rapidly to social and health care practice during an international critical incident, and what worked about these roles under which circumstances.
Co-develop learning with PHE and local authority Public Health and co-produce recommendations (and a dissemination plan) to enable rapid and responsive knowledge translation during future global public health incidents that is equal across local social and health care settings.
Rapid theory-led mixed methods qualitative study of people working in PHE and local authority Public Health in one region at all levels of the pathway to implement PPE guidelines during the Covid-19 pandemic. Theory development tested and refined the initial logic model developed by the research team using key informants from local authority Public Health and PHE.
Data Collection: Semi-structured qualitative online interviews and online focus groups to co-develop learning and co-produce a dissemination plan based on the interview findings.
PHE and local authority Public Health practice recommendations: A report of the key recommendations for preparing a rapid, responsive, and equitable pathway for future public health crisis guideline implementation, will be circulated in PHE and local authority Public Health as well as across key contacts in the UK following the co-produced dissemination plan developed in the focus groups by participants. This may include:
- recommendations for recruiting (or upskilling) and training ‘knowledge broker’ roles within local authority Public Health, exploration of what these roles need to look like to work well and how to successfully implement them
- development of a clear pathway of responsibility and roles for rapid and successful interpretation of PHE guidelines across all relevant social and health care settings
- guidelines for how to support the mental health and wellbeing of people in public health knowledge brokering roles during a public health crisis.
Particular attention will be paid to settings for whom the generic guidelines for PPE were least appropriate and for whom interpretation at the local level was most critical (for example, care homes and women’s shelters).
Online dissemination workshop will be open to all PH professionals in the UK who were involved in PPE guideline knowledge brokering during Covid-19, including managers at all levels. Key informants and senior PH professionals involved in the development of the study recommendations will be invited to lead/co-lead the workshop.
An academic paper will disseminate the generalizable findings for rapid, responsive, and equitable implementation of PHE guidelines during a public health crisis
Potential bid for funding to test the model for new PHE implementation of guidelines within ongoing pandemic, such as track and trace.