“Health service evaluation is crucial to ensuring that people get the best care”

Our Evaluation Support Lead Trish Harding is retiring after eight and a half years working with Bristol Health Partners. She looks back on her time with us.

When reflecting on ‘my Bristol Health Partners years’ it struck me that I’ve come full circle. After moving between various jobs and organisations locally, I will be ending my career in service evaluation where it started back in the 1980s – employed by the same NHS provider and what’s more, working on similar if not the same issues!

I first got into evaluation after completing postgraduate research on the politics of health education and then getting a job with Bristol and Weston Health Authority (forerunner to University Hospitals Bristol and Weston NHS Foundation Trust) working on the Bristol Inner City Health Project. This was a community health project set up in response to ongoing concern about health inequalities among communities living in inner city Bristol. I found myself evaluating innovative and challenging initiatives, often addressing wider determinants of health, to improve health outcomes for people living locally. For me, health service evaluation is crucial to ensuring that people get the best care. It helps us to understand what works well or not so well, and why, and this knowledge helps inform commissioning decisions to improve and develop services. Organisations should consider whether they can afford not to evaluate: without evaluation, how will they know they are meeting the aims they set out to achieve?

I was delighted to be back on familiar territory when I was appointed to the evaluation post with Bristol Health Partners some 25 years later in 2013! During the intervening years, I had been working in research posts at the University of the West of England (UWE Bristol) and in the local community and voluntary sector but had then changed direction and returned to university to train as a social worker. It felt exciting to be thinking about evaluation again and I hoped my years as a social care practitioner working in two of the Bristol Health Partners partner organisations (Bristol City Council and Avon & Wiltshire Mental Health Partnership NHS Trust (AWP)) would prove useful.

That initial enthusiasm has stayed with me. I can honestly say I have loved the job. The work has been hugely interesting and varied, and my role has evolved over the years.

In the early days, staff members were employed by the different partner organisations. I was employed by AWP but ‘hosted’ by Bristol Clinical Commissioning Group (CCG) in their evaluation team (then part of Avon Primary Care Research Collaborative) as Bristol Health Partners was still relatively small and had very little office space. At that stage it was led by Professor Peter Mathieson and had a team of three – Lisa King (Programme Manager), Zoe Trinder-Widdess (Communications Manager) and me. Although I was based in the CCG, I worked almost exclusively with Bristol Health Partners providing guidance to Health Integration Teams (HITs) on service evaluation. Being involved in the ‘Evaluating the HITs’ Working Group with evaluation specialists from both universities and from the newly formed West of England Academic Health Science Network (WEAHSN) was incredibly helpful. We were keen to evaluate the HIT model and explored various avenues for doing this, including seeking funding for a realist evaluation, running an MSc student pilot to explore HITs as ‘communities of practice’, and developing a ‘productive relationships’ questionnaire. Eventually, the Working Group accepted a bid from CLAHRC West (forerunner to the NIHR Applied Research Collaboration West) to conduct a preliminary evaluation to develop a programme theory for the HIT model.

After two years, the AWP Quality Academy took over hosting my post and I was based at Blackberry Hill Hospital. During this time, the team grew to include a management assistant and two ‘in house’ project managers. There were now six of us! Not long after, we moved to the Bristol City Council office at 100 Temple Street. At this point my role became fully managed by Lisa and based within the core team.

Bristol Health Partners celebrates its 10 year anniversary this year. Looking back on those early days of limited staffing and resources, including office space, it has been wonderful to witness it grow into its current size and stature, strengthened by its designation as an Academic Health Science Centre – only one of eight nationally.

As Bristol Health Partners has evolved, the evaluation role has grown and developed too. It has been great to work on such a variety of HIT projects and to have the opportunity to work with such interesting and inspiring people. I have had several proud moments over the years – for instance, talking to people about the work of the HITs at our NHS Expo stand and when evaluating our sponsorship of the Bristol Health and Care Awards in 2017. However, I have been particularly proud of the work that I’ve done collaboratively with other evaluators across our local health and care system. For instance, working with others to develop best practice guidelines on the governance and ethics of service evaluation, and with the WEASHN on guidance on the adoption and spread of HIT innovations and improvements.

I think it’s really important for HITs to consider how they might spread the learning and outcomes of their health improvement projects so that others can benefit from these. I’ve been working recently on a case study demonstrating the impact of the Stroke HIT’s public and patient involvement (PPI) in the stroke services redesign across Bristol, North Somerset and South Gloucestershire. We are hoping the case study will be used to demonstrate the effectiveness of this model for other areas of health and care service development, and that it will potentially inform models of PPI and co-production across our HITs.

I’ve also enjoyed being part of local evaluation forums and networks. My membership of the West of England Evaluation Steering Group comes to mind and the Principles of Pragmatic Evaluation (POPE) Workshop that we organised in 2015. And more recently, it’s been great to be part of the stakeholder group reviewing and updating the NHS Evaluation Works and NHS Evidence Works online toolkits. Over the years, I’ve been fortunate to have a good network of support from other evaluation specialists – notably colleagues in Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, the WEAHSN, and for a while, the UK Evaluation Society’s former South West Evaluator Forum.

I feel privileged to have worked alongside HIT directors and project managers on a diverse range of evaluations as well as supporting them to build links with health and care commissioners through lunchtime presentations. I have fond memories of HIT networking lunches and, of course, the many HIT conferences with which I’ve been involved. From my somewhat terrifying first conference experience when Emma Gibbard and I ran a whole conference session on evaluation, to later conferences playing games such as Acronym Soup and the amazing Partnerology! The work with HITs has remained stimulating over the years, and with the onset of the COVID-19 pandemic and the shift to online or remote services, there was a renewed interest in service evaluation as we needed to rapidly understand the impact of these new ways of working. These were unprecedented times and I found myself supporting the HITs to map and evaluate service changes. There was a desire across the system to capture learning that could inform the reset and recovery work of the CCG/Healthier Together. Also, it was felt important to understand any potential impact on widening health inequalities. In response, three of the HITs conducted surveys of their clinical members and service provider networks. Common themes across the survey findings were then presented in a paper and shared with the CCG and with others conducting research on remote services.

However, as the COVID-19 restrictions began to be lifted earlier this year, I started to think about retirement plans as well as evaluation plans! My husband and many of my friends are retired and so I’ve decided to take the plunge and join them. I’m looking forward to having new experiences and more time to do the things I enjoy.

There is no doubt that my wonderful managers and my colleagues in the core team have been one of the best things about working with Bristol Health Partners. I feel incredibly lucky to have worked with them all. It’s a ‘dream team’ in so many ways and I will miss them. I like to think that service evaluation is now well and truly embedded. There is a huge commitment to evaluation within the core team and I feel confident they will continue to support this activity across the HITs and other Bristol Health Partners initiatives in the years ahead. In the meantime, I will be busy learning Spanish. I’ve discovered the word for retirement in Spanish is jubilación – a much more positive term I think!