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How should we configure acute medical services to meet the needs of patients during peaks of COVID-19 infections and more generally during periods of intense acute care activity in the NHS?

The acute care system assesses and treats an ever increasing number of patients with greater complexity and older age. Against this backdrop of yearly increases in the demand for same day urgent healthcare, there are periods of sustained high volumes of activity, for example during the flu season. The responses by different healthcare organisations to a sustained surge in activity may differ substantially. This provides an opportunity to study the impact of different strategies within their organisational context. We plan to undertake a programme of work that will inform the best interventions for the NHS in order to deliver resilient acute medical care during winter pressures with a focus on older people.

Project aims:

  1. To determine a conceptual framework for resilience and its measurement with a novel index, to study how quality of acute medical care to older people is maintained during winter pressures.
  2. To validate and map the degree of winter resilience of health and social care systems across England using the index.
  3. To determine the structure, culture and processes of acute care systems (across community and hospital health and social care) that are associated with sustained high performance during winter pressures.


WP1: Development of an index for resilience in the NHS context (12 months) Narrative review of published and grey literature will be used to identify relevant system measures and interventions indicating preserved quality of care for older people treated in the NHS. Two focus groups with stakeholders will be undertaken to determine a conceptual framework for resilience and to identify resilience measures to use in an index. Methods that have established indices from conceptual frameworks will be followed to develop an index of resilience that is sensitive to health and care outcomes for older people during winter.

WP2: Validation of the resilience index and mapping variation in resilience across England (14 months). We will use hospital episode statistics (HES) data for elective surgery during winters to validate the index. A qualitative assessment of publicly available documents and information will also identify positively deviant approaches and describe existing winter pressure strategies and interventions across localities. Findings from WP2 will be presented to a stakeholder reference group to select local health systems for in-depth study in WP3.

WP3: In depth study of resilient local health systems for acute care of older people (16 months). Mixed methods of quantitative and ethnographic work undertaken by researchers in residence, working with managers, clinicians, commissioners and patient groups in ambulatory care units.

Patient and public involvement:

We will work with older people and their families to guide us in our conduct of the project. This will include determining performance measures, selecting units to study, interpretation of findings and advice on dissemination.


We will disseminate the research findings to patients, clinicians, professional bodies and, policy makers, as well as publish in academic journals.

Our team