The impact and legacy of COVID-19 on community-based multidisciplinary teams organising integrated health and social care for older people with long-term conditions: Findings from the evaluation of the integrated care and support Pioneers

Abstract

ObjectivesThe COVID-19 pandemic severely disrupted health and social care (HSC) services in many countries, including England. At the same time, it forced systems to respond innovatively to radically changed circumstances and challenges. This study identifies the impacts and emerging legacy of the pandemic for community-based multidisciplinary teams (MDTs) supporting older people with multiple long-term conditions living in their own homes.MethodsThirty-eight strategic, operational, and frontline staff involved with MDTs in seven areas in England were interviewed between July 2020 and August 2021, as part of a wider evaluation of the Integrated Care and Support Pioneers programme. Interview transcripts were analysed thematically.ResultsInterviewees described an initial period of pandemic disruption characterised by uncertainty, shifting of priorities and resources within the HSC system towards emergency care, and redeployment of staff away from MDTs. These circumstances required the development of new ways of working with MDT patients/clients and with one another. Remote, mostly virtual, MDT working between professionals was seen by most as a positive adaptation, though some felt that in-person meetings were better for the development of working relationships. Others raised concerns about access to, and quality of, care provided to vulnerable patients remotely, or in person but with a delay. At the local system level, the crisis response lowered barriers to collaboration between organisations, blurred professional roles, increased flexibility in the use of resources, and engendered a stronger sense of local cohesion among a wide range of staff in HSC. Most respondents wished to retain these attributes of the local system permanently.ConclusionsThe pandemic's legacy seemed to accelerate innovations in health and care provision and increased cohesion and closer working relationships. Remote ways of working were perceived to have improved the efficiency of MDT meetings and facilitated involvement of professionals external to MDTs. The implications for patient/client care were more complex. We suggest that the potential impact on inequalities of remote access to, and provision of, care for people served by MDTs will need to be considered if these changes are to be maintained. The resilience of MDTs and the HSC system may be improved by upskilling staff and creating a more flexible workforce capable of working across organisations during future crises.