With a huge backlog of elective work to tackle, a panel of experts explored the role of digital in not only dealing with delayed care, but in transforming the patient journey. Alison Moore reports

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The coronavirus pandemic has led to very rapid changes in how the NHS operates and how it interacts with the public. While some of these changes may be temporary, it is likely that others will be long term and will be beneficial to how the NHS delivers services.

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But further changes – and greater use of IT - may be needed to help the NHS meet the challenges ahead. As well as a massive backlog of elective work, it will have to deal with changes in how patients are used to interacting with services and expectations that it will swiftly be able to deal with delayed care and return to normal.

An HSJ webinar, in association with PA Consulting, asked what changes the NHS needs to make to meet these new demands and how patients’ needs can be best served.

Nicholas Carding, HSJ senior correspondent and chair, asked which changes from the pandemic ought to be kept and how technology could be used in the future.

Tremendous pressure

Daniel Woodruffe, chief information officer at Lewisham and Greenwich Trust, said it had been “frantic and a bit foggy” at the start of the pandemic but it soon become apparent what needed to be done. There was tremendous pressure on the hospital network from the number of people wanting to do things like teams calls which required investment, he said, together with a need to change the culture towards virtual meetings.

People also felt unsure about whether they were entitled to good care – and some of this might continue for some time

But most virtual outpatient consultations were over the telephone with very few using video. “The tech is there and we know it works but it is about the whole way we run services…we are in danger of backing the wrong horse,” he said. He questioned what was the right level of spending on video consultations when so few patients used this technology – and sometimes clinicians preferred the telephone.

“Patient experience was really high for those who used the video. There is definitely a cohort for whom it is successful,” he said. “It’s part of the puzzle but it is not the whole solution going forward.”

Paula Cowan, a practising GP who is chair of Wirral Clinical Commissioning Group, said her area was a digital exemplar with a shared electronic record across health and care which had been important during the pandemic. The GP model had to change overnight to telephone consultations, with some video, but this had brought its own challenges.

“We needed to get the message out that general practice is open for business but just in a different way,” she said. Telehealth had also been used to monitor patients at home. “The positives of the last 12 months are that we know we can do things differently,” she added.

But Charlotte Augst, chief executive of National Voices, stressed the patient population could not be homogenised. Some had welcomed telephone contact with GPs – it could reduce stress and hassle – but others had found it difficult.

“The takeaway for me there is choice,” she said. Some people had reported “a feeling of utter disruption…a feeling of abandonment” and felt the message from the NHS was “don’t contact us.” People also felt unsure about whether they were entitled to good care – and some of this might continue for some time, she said.

Disadvantaged groups were already underrepresented in planned care and this had got worse, she said. “How can we make digital part of the solution?” she said.

Digital health expert with PA Consulting Indi Singh said there were elements to build on and harness – such as the way staff had changed the way they operated to allow them to look after people at home. “We should hold onto that and celebrate it in a very authentic way,” he said.

Building the momentum

But he said the next stage could be more complex than what the NHS had gone through so far. There was the need to recover the work which had not happened during the pandemic, there was an ongoing vaccine programme, and there was the need to build on the momentum of what had gone before.

However, he suggested there would be a need for a “granularity of insight” and this theme of the need for different approaches for different groups was echoed by other panellists.

Dr Cowan described technology as an “enabler” but said there were nuances such as the many different languages spoken in her area or the needs of people with different disabilities. Areas being looked at now were how information from remote monitoring could be uploaded into the Wirral Care Record, patient activation and the use of apps.

Digital inclusion

Ms Augst stressed the importance of building relationships with community organisations and building trust for the long run. Work with South Asian groups had shown that while elder people might regard technology as a pain, they often lived with younger relatives who could help – and may therefore be less digitally excluded than white people of the same age who lived alone.

But it was necessary to think about the service as a whole. “The new top layer of sexy digital exclusion sits on a very thick unsexy layer of inequality and exclusion,” she said. Over the last 50 to 60 years the NHS had failed to consistently provide interpretation services for those whose first language was not English, she pointed out: the same should not happen around digital inclusion.

Mr Woodruffe said that the NHS did not exploit all the data it already had – although the pandemic had accelerated this. The benefits from linking them all was beginning to be seen.

Mr Singh said at the start of the pandemic it had been just “getting things out there quickly.” But now there was an opportunity to think more about the journey patients wanted to take and how that could be transformed and what this then meant in terms of technology.

But this was about supporting staff as well as patients, and the NHS needed to maximise use of some of the tools it already had in place, he added.

There was also a need to think about an “omnichannel” perspective where people wanted to use different methods to engage with the NHS. “How do we start treating these channels not as completely separate?” he asked.

“This is about a cultural and transformation change not only just about bits of information being shared around. Invest as much in the implementation and the change and the transformation programme as you do in the technological platform,” said Mr Singh. “That is where you are going to get the real benefits.”

This webinar took place on 24th March 2021. To view the on demand version click here