Governance is often sited as a barrier rather than an enabler for change and collaboration. In this, the final guest paper in the series ‘Valuing Governance – When Sovereign meets System Governance it uses the experience from Covid-19 Test, Trace and Protect Programme to highlight ways in which policy makers and implementers across the system have designed and delivered an effective collaborative solution. This learning provides a strong basis to continue to build effective collaboration and integrated working across Regional Health Boards, cross boundary negotiations and other opportunities in the future.

The term ‘unprecedented’ has been used on a daily basis since the pandemic began and the fifth Bevan Exemplar Programme Cohort was conducted in these ‘unprecedented’ times.

This cohort is not the same as any other in the previous five years of deploying health and care improvements in Wales using the Bevan Commission’s prudent methodology.

The staff employed during this cohort faced the most adversity of any group so far.

Cohort Six of the Bevan Exemplar Programme ran from October 2020 to March 2021, at the height of the second wave of the Covid-19 pandemic.

This independent evaluation, undertaken by Professor Nick Rich and his research team at Swansea University’s School of Management, was performed at the conclusion of the Cohort Six programme and draws insight from project and programme level data as well as participant experiences.

The Bevan Commission, in its capacity as the leading independent think tank for Health and Care in Wales, were asked to make recommendations to Welsh Government on how Wales should set about establishing a voluntary Long COVID Registry.

At the time of writing the report, the Office of National Statistics (ONS) identified that there were 1.2 million (1.9%) people living in private households in the UK who were experiencing self-reported Long COVID symptoms, with these symptoms adversely affecting the day-to-day activities of 775,000 people (64% of those with self-reported Long COVID).

This report aims to provide an overview of the exploratory desktop research, key findings, option appraisal and recommendations from the Advisory Board and wider stakeholders to Welsh Government.

Key recommendations include:

• Establishing a Long COVID registry for Wales in order to address unanswered questions, provide long-term monitoring of the disease and improve the management of long COVID.
• A Long COVID Registry that informs research, service improvement and a greater understanding of the disease for patients and their experience as it evolves.
• Collaboration with patient groups and end-users as an essential component in the co-production and development of a Long COVID Registry for Wales.
• A self-referral mechanism to promote equitable access into a Long COVID Registry.
• Greater clarity and coordination across agencies and organisations to realise the full potential of a future Long COVID Registry in Wales.
• Utilisation of existing digital infrastructures in Wales and data linkages to connect current systems, databases and avoid duplication.
• Adoption of the Prudent Healthcare concept, and adherence to the prudent principles in order to derive the best value from a Long COVID Registry.

Most people practice self-management as part of their usual care, especially people living with long-term conditions or disabilities. All of us require the knowledge, skills and confidence to look after ourselves on a daily basis and know when to seek care and support in order to optimise our health and well-being. Supported self-management is not only prudent; it can enable people to live a fulfilled life and access health and care services when relevant and appropriate. It can also helps establish shared decision-making between the person and their care team to ensure their skills, strengths and capabilities are seen alongside their needs and are built upon when addressing ‘what matters’ to the individual and their family.

This resource aims to set out some simple keys to success for the introduction of Protected Elective Surgical Units (PESUs) to help ensure the continuation of surgical services for patients undergoing urgent or complex elective surgery in an environment where they are protected from acquiring Covid-19 and other infections pre and post operatively. This is not seen as a temporary measure and is aligned with the goal of maximising patient care through safe and efficient work practices as part of a more robust system for elective surgical services. This is seen as a sustainable healthcare delivery model.

The Bevan Commission developed and led the National Adopt and Spread (A&S) Programme, funded by the Welsh Government to test mechanisms for prudent innovation along with adoption and spread whilst working nationally on a live delivery programme. This report brings together the insights and learning from this unique programme, consisting of 54 adoption sites working with 15 Bevan Exemplars promoting more innovative, prudent health and care, with a comprehensive programme of support provided by the Bevan Commission.

The findings show that despite the challenges faced by many teams during COVID-19, successful adoption took place across Wales with wide ranging service, product and process-based innovations. Exemplar Innovations expanded beyond their original adoption sites, and were tested in new contexts, and also contributed to service-wide changes. Teams of practitioners, clinicians and professionals in health and care settings changed the way they worked, engaging over 200 colleagues in more than 24 organisations.

Volunteers have always made a vital contribution in Wales, but the Covid pandemic has made the power and potential of volunteering more visible.

Pressures on our health and care system and its workforce demand that we look more seriously at how we can maximise the potential of all our resources, including volunteering.

There is a growing body of evidence to support the positive impacts of volunteering on the health and wellbeing of patients, carers and service users, on staff, on health systems and on volunteers themselves.