Covid-19 had a significant impact on the original implementation plan. Changes were made to the training as well as the delivery of the intervention.
Training
The main impact was a requirement to move from face-to-face to virtual training. Ultimately, this created a benefit by eliminating travel time to attend training sessions. However, before that could happen some technology issues to be addressed and for training itself was made more difficult by having to be undertaken in a virtual environment.
As a practical skill is being taught this was challenging, especially for the Bevan Exemplar who was leading the training and who was not familiar with IT.
As the training was usually hands-on, there were adaptations that had to be made including using video for demonstration purposes. Without substantial resources for this part of the project, and with Covid-19 restrictions in place, the team had a steep learning curve on producing materials for online training. As the team had moved fast to initiate the adoption process, one face-to-face course had been delivered (in February 2020). This resulted in facilitators being available at the adoption site, and supporting the practical demonstrations to complement the virtual training.
Delivering the serial casting service
The impact of Covid 19 restricted the extent to which serial casting was offered. Paediatric physiotherapists were initially redeployed during the pandemic (up till August 2020) which delayed getting any training or casting clinics established.
In addition, Covid-19 infection control measures did introduce new challenges including:
- more difficult to find sufficient clinic space
- The process to treat patients safely had to be established and the team reported that Serial Casting whilst wearing Personal Protective Equipment (PPE) was physically challenging
By focussing on urgent cases for casting, the team supported children and young people to improve their walking pattern and reduce pain.
Other Implementation Issues
Firstly, the equipment and materials required for serial casting was newly introduced to the physiotherapy service. There were logistical issues the logistics of getting all the materials ordered and to the right locations for use locally. The team also had to identify sufficient storage for the equipment locally.
Secondly, The system for reimbursing the department for the casting materials did place a cost pressure on the physiotherapy service. The out of area service was being paid for from a different budget (orthopaedics) rather than therapies, and these operational issues require further work. As the Adopt and Spread Programme provided initial funding to support the project, the pace of implementation was not affected