In a recent HSJ roundtable the panel explored the advances that have been made in caring for people remotely with the help of technology, whether these changes are embedded and the challenges still remaining

Computer and stethoscope

When Rupa Joshi thinks of how technology has been used to support patients during the first wave of the pandemic, she comes up with no shortage of examples. But one feels especially powerful: video consultations and, in particular, virtual group consultations for those living with long-term conditions that place them at high risk from covid.

“Patients were feeling very frightened, upset at home, not feeling they had access to us,” says Dr Joshi, a practising GP and co-clinical director for Wokingham North primary care network.

Combatting that fear – ensuring that patients feel empowered, even when traditional face-to-face access to services needs to be restricted due to covid or capacity concerns – has been and likely will continue to be a key item on the NHS agenda.

And so HSJ recently brought together a panel of experts for a virtual roundtable, designed to explore just how digital solutions might assist in empowering patients and combatting capacity pressures.

Reestablishing patient management

For Graham Walsh, chief clinical information officer at Calderdale and Huddersfield Foundation Trust, the pandemic has led to an important reappraisal of how best to manage patients.

“We often see technology as cold, but I think it can be a way to empower patients. I think covid has forced our hand a little bit – allowed clinicians to realise that it’s OK to work remotely, it’s OK to use technology.”

According to Laura Ellis-Philip, a similar pattern has been followed at Ashford and St Peter’s Hospitals FT. The organisation had already been trialling the web-based Attend Anywhere video conferencing solution for physiotherapy appointments, but covid prompted a wider rollout.

“It’s probably one of the easiest projects we’ve ever done,” reported the trust’s director of digital. “We already had it in place, we already had training in place to use it, and we rolled it out [across other areas] in something like three weeks.”

But is this sort of change one which will persist? With widespread vaccination starting to roll out, will the expected return to something resembling pre-covid normality extend to the ways in which the NHS communicates with patients? Certainly the suppliers represented at the table suggested they had witnessed attitudinal changes that they expected to be permanent.

“We’ve definitely seen a huge change with the preparedness for organisations to want to be able to share information,” reported David Hancock, healthcare co-executive advisor at Intersystems. “The whole tone of the conversation and the mindset of people has definitely changed.”

Knowledge sharing

Case in point: the experience in north London, where information sharing between organisations has suddenly become commonplace after a year of slow progress. “When covid hit in February suddenly everyone saw what needed to be done,” said Katie Trott, chief nursing information officer at Royal Free London FT. “And health information exchange across north central London took off in six weeks – from nothing to north London joined up has been revolutionary.”

She nonetheless sounded a note of caution. “My anxiety now is that we’ve had a scattergun approach over the last six to nine months, of everyone wants to do everything really, really fast. No-one’s stopped and taken a breath and thought: ‘What do we need to keep promoting?’”

It was a point echoed and reinforced by Thilan Bartholomeuz, clinical lead for Mid-Nottinghamshire Integrated Care Partnership. “Obviously we know what the national pressures are in terms of things like 62-day times, pathway issues, cancer issues, urgent care. But, depending on the [geographic] area, there will be very specific system issues. And it’s about trying to identify what those pressures are, and then start seeing what solutions we need.”

Meanwhile Tina Marshall, UK country manager for Visiba Care, feared there was a danger the NHS now perceived digital as a job that has been completed. “Everybody seems to feel as though they have done digital transformation, but I would argue that they haven’t. We haven’t actually looked at the entire patient pathway to see where digital technology could fit into each place.”

For many panellists, one area where there is clear value in continuing progress is monitoring of patients outside of health settings. “We’ve seen the openness that different trusts [now] have towards technology, and remote monitoring in particular,” said Harriet Buck, strategic partnership manager at B Braun Medical.

It’s notably been helpful for patients with covid – remote monitoring with oximetry has enabled patients to stay out of hospital, in the knowledge that healthcare teams can react if data shows any deterioration in condition. Karen Kirkham, clinical lead at Dorset Integrated Care System, expected such a setup to “move pretty rapidly in the next few months”, but also hoped it would be the start of similar work in other areas.

“[There’s] the opportunity to roll that same telehealth monitoring to a whole range of conditions – COPD, asthma, and so on – with a much more patient-centred, personalised approach.”

“We will provide care much more into patients’ homes now, remotely, because it’s just how things have changed,” agreed Richard Cullen, chair of Rotherham Clinical Commissioning Group and the digital lead for South Yorkshire ICS.

The panel

  • Thilan Bartholomeuz, clinical lead, Mid-Nottinghamshire Integrated Care Partnership
  • Harriet Buck, strategic partnership manager, B Braun Medical
  • Richard Cullen, chair, Rotherham CCG and digital lead, South Yorkshire ICS
  • Laura Ellis-Philip, director of digital, Ashford and St Peter’s Hospitals Foundation Trust
  • David Hancock, healthcare co-executive advisor, Intersystems
  • Rupa Joshi, co-clinical director, Wokingham North PCN
  • Karen Kirkham, clinical lead, Dorset ICS
  • Tina Marshall, UK country manager, Visiba Care
  • Alastair McLellan, editor, HSJ (roundtable chair)
  • Katie Trott, chief nursing information officer, Royal Free London Foundation Trust and West Hertfordshire Hospitals Trust
  • Graham Walsh, chief clinical information officer, Calderdale and Huddersfield Foundation Trust