As the first wave of infections arrived, we saw near-instant digital innovation that might otherwise have taken years: the rapid roll-out of remote working platforms, shared care record projects, electronic patient record configurations, and virtual clinics and consultations. NHS Digital increased the capacity and range of NHS 111 (the 24/7 telephone and online service for people who need advice and information about urgent medical problems), and NHSX (which focuses on the digital transformation of health and social care) launched a competition for remote monitoring technology.
The adoption of digital tools was seen across all sectors; it has been particularly accelerated in primary care. More than 70% of GP consultations in England were carried out face-to-face prior to the coronavirus outbreak but within weeks that figure had become 23%, according to a recent report from the Royal College of GPs (RCGP).
In addition, digital solutions enabled strong links to be created between health and research, providing valuable understanding of the impact of coronavirus, including treatment pathways and mortality. During the pandemic some data sharing restrictions were relaxed. These included data from the RCGP research and surveillance centre which saw the number of participating practices double. Other programmes, including Public Health England’s COVID-19 Observatory, were also able to collect and analyse coronavirus data.
At a human level, an important part of this ‘digital revolution’ has simply been to make patients and staff feel safer. Discussions at the NHS Confederation’s meeting of Primary Care Network (PCN) clinical directors in July found agreement that virtual-consultations have been especially beneficial for affording staff the flexibility to work from home, for example if they need to shield, and to avoid time-consuming commutes for patients and staff in rural areas.
A much-cited catalyst for change is that the crisis created a common purpose and urgency to make decisions. It has always been clear that clinicians’ time is precious but, in many cases, it took the pandemic for many to park their doubts and explore digital solutions that allow them to meet patient needs. According to PCN clinical directors, e-triage through software such as EMIS has been especially effective in boosting capacity and the information gathered from patients through online triage has tended to be more efficient and of good quality. Where the software incorporated artificial intelligence, clinical directors saw even more time saved for staff to focus on where they can add most value for patients.
The shift to digital solutions has also been marked in mental health services. Mobile phone apps for mental health management have seen a global surge in popularity under lockdown. According to mobile app marketing intelligence firm Sensor Tower, the world’s top ten English-language mental wellness apps generated two million more downloads in April, when the peak of the pandemic was becoming a reality.
Developing this digital infrastructure at such pace has involved innovation in itself. While the government and the NHS frontline focused on ensuring the service was not overwhelmed, volunteers stepped in where there were gaps. For example, to create things like Tech4CV19, which provides a matchmaking service to put NHS leaders in touch with health tech suppliers, and to put health tech suppliers in touch with sources of business support.
A second wave of digital transformation?
As the NHS looks to reset, and not just recover from the coronavirus emergency, and to reboot the integrated care agenda with its promise of a more responsive service for patients, there may be scope for a second wave of digital transformation. Part of the answer appears to be, as the saying goes, to “keep it simple, stupid”. This means sustaining and building on the beneficial change we have seen so far through further investment and empowerment of those who have delivered it. We have seen how the coronavirus pandemic drove local innovation when staff were given the space and ability to solve problems, and so it makes sense to listen to the advice of those who know the service best to define successful next steps.
For instance, in primary care, the key asks are not for the latest, ground-breaking technology but rather the RCGP is simply calling for government to ensure that GPs have the IT tools, skills and broadband connectivity to deliver remote digital consultations, as well as some investment in digital telecare tools. PCN clinical directors are keen to sustain the new online ways of working by making virtual-consultation platforms interoperable with the rest of the system so that patient data can be easily accessed by different healthcare professionals and exchanged between different IT systems.
One area that is far from simple is ensuring that a new ‘digitised’ service takes everyone on its journey and continues to build public confidence in technology, research and population health management. This may not be straightforward as it concerns a central tenet to successful healthcare delivery in the UK: the relationship between patients and the service. Not everyone has access to the internet, some do not have the confidence, ability, access or even interest needed to use digital software and applications in this way. Some sections of the population – such as individuals with a disability, low income households and older people – are at particular risk of becoming digitally excluded.
The next step of embedding this large-scale change may be less ‘sexy’ than the rapid, agile innovation that brought us here. However, what is clear is that the service now needs support from the government and policy makers to set clear standards, expectations and guidelines on what good looks like. For example, careful thought will need to be given to restoring data safeguards, temporarily relaxed during the pandemic, in a way which does not stifle data sharing for the purpose of improving treatment, care or research.
Fortunately, we can build on programmes such as Global Digital Exemplars and Digital Aspirants, which aim to catalyse digital transformation, document journeys and enable ‘the service to learn from the service’. Through these kinds of initiatives, we need to see further levelling up as not all systems are starting from the same place. Some are very digitally mature in terms of care delivery and operations, whereas others still need to invest in fundamental infrastructures such as network bandwidth and new devices.
What comes next?
In addition to embedding the innovation seen to date, the next challenge for the NHS is dealing with a potential second wave, coupled with winter pressures and the inevitable uptick in flu cases – alongside delivering other services, including those that were postponed during the first stage of the pandemic. This means that we should be looking for where we can leverage digital solutions to ensure that we have an effective and efficient test and trace scheme in place to close down coronavirus outbreaks as quickly as possible.
Elsewhere artificial intelligence (AI) has been applied to speed up this process. The World Health Organisation has cited China as an example of where a health system was able to improve diagnostic accuracy and scale availability. Hospitals nationwide deployed AI-powered CT imaging interpretation tools, helping reduce CT reading time from hours to seconds. Other tools allowed patients at community clinics to have their scan read by medical experts miles away helping to minimise the chance of losing track of infected people, expanding diagnostic capacity and avoiding overwhelming the healthcare workforce.
As we look to the immediate future, it is clear we now face a double challenge: embedding the digital transformation we have seen to date in the NHS that has allowed for increased capacity and efficiency; and learning rapidly from other health systems, including leveraging less-well understood tools such as AI. The short-term test of our success will be, between now and whenever a vaccine is proven, whether we are able to leverage digital innovation to help contain further outbreaks and avoid them taking hold and threatening healthcare capacity. The longer-term test will be to see if we are able to embed changes, empower staff and modernise how we work before the opportunity is lost to put the health and care service on a sustainable footing into the future.
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