The Covid-19 pandemic has resulted in a tech culture change across the NHS and Rich Corbridge argues this new agility for a digitised health and care environment needs to be built on.
Due to Covid-19, the advances that health-tech leaders have been wanting for decades have been achieved in just a few weeks. The culture change that the health system feared was too hard to make has begun. Health and social care have come together to achieve much in a short space of time.
The public has also adapted well, with population-level channel shift in a matter of months. Half of all GP appointments were carried out over the phone, alongside a surge in use of online and video channels. Hospital outpatient appointments fell from 10m in April 2019, to 6.3m in April 2020, enabled in part by virtual consultations.
‘Health and care anywhere’ seems within our grasp, as services have shown they can credibly embrace digital transformation.
Meanwhile the tsunami of unmet need that is now emerging, such as the backlog in delayed care, is thought by many to be as frightening as the initial impact of the virus was.
Might we go back to old ways? Early signs suggest not. The Royal College of General Practitioners has already said that there is a compelling case to keep ‘total triage’, so that patients talk to a doctor online before coming into the surgery.
The offer of virtual and face-to-face appointments needs to be driven by what works best for the patient and the clinician, based on a mixture of evidence and intuition and, above all, common sense.
Time to redefine health and care
So how do we ensure that such short terms gains evolve into longer term, sustainable change?
As discussed at the Swiss Post Solutions virtual round table I chaired recently, this is a time when the capacity to deliver, will be stretched to its very limit. People will naturally want to focus on the here and now, more than the plans or the future.
Yet if it is done well, effective digitisation can meet short and long-term needs. It can remove tasks and better manage demand, through people-centric, outcomes-driven models of care.
By showing how it can support a shift to virtual channels, pandemic-driven digitisation has shown that tech can help achieve ambitions such as the NHS Long Term Plan’s aim of reducing face-to-face outpatient attendances by 30%.
But we can do more, by moving to data-driven pathways that cut across health and social care provision. Outpatient appointments can be directed to local care settings, home monitoring can provide regular data feeds to inform appropriate care, and triage can be automated, enabling efficient patient prioritisation.
Rather than using technology to substitute old processes, we need to use the opportunities presented by digital and data to redefine the processes of care. It means following in the footsteps of patients, and working with them, and clinicians and caregivers, to redesign digital-first pathways of care that cater for everyone’s needs.
An EHR is not enough. We have to work out what data is needed, when, by whom, and in what scenarios. End-to-end systems that cut across health and care can enable more informed care and efficient patient flow. They can provide real-time data to train the algorithms that will be vital in planning and managing future care provision.
A digitally-empowered workforce is required to drive this change. Data scientists are urgently needed, and we must continue to grow the clinical technologist community. The emergence of digital boards, and the professionalisation of informatics, is essential to help sustain progress and ensure that the profession grows with new ideas, new cultures, and new ways of working.
Taken together, these are all ambitions that the health-tech community knows are achievable. Now they need to be coordinated to create sustainable, large scale transformational change, and evolve the NHS from being a sickness service to one that has capacity to keep people well.
Collaboration, capability and investment will underpin sustainable change
System-level collaboration and leadership – of the type we have seen during the crisis – are the vital elements of infrastructure required to support user-centred health and social care, and to coordinate these digital advances.
Integrated care systems (ICSs) and sustainability and transformation partnerships have the impetus to lead the country into the next wave of innovation and transformation. As NHS Confederation said in its recent report involving ICS leaders, it’s Time To Be Radical.
Many such organisations have been working across care boundaries in response to the coronavirus. Those with digitally-mature components, such as global digital exemplar sites, were often seen delivering some of the most effective developments.
To carry on in this spirit, these organisations will need the capacity and capability to enhance their collective digital maturity, and to work with the communities they represent. This will help identify the technology required and deliver the necessary business change.
Progress will require revitalising and accessing skillsets such as programme management, integration and process optimisation. To continually improve and redefine the process of care, we can expand digital leadership and literacy to develop skills and knowledge required.
Ongoing investment in infrastructure is also required. The NHS Long Term Plan has tasked hospitals with reaching a ‘core level of digitisation’ – this needs to be looked at from a regional level, so that all those that provide care have the data they need.
Of course, there are practical and financial challenges to developing this infrastructure, as was covered in the recent NAO report into the digital transformation of the NHS.
However, these challenges can be overcome. Some, for example, may see the Health Infrastructure Programme investment as a way of turning shovel-ready hospitals into clicks-and-mortar centres of care excellence.
Build business better than usual
If those at the forefront of integrated care are looking to build a coherent future that is ‘system by default’, then we must leverage technology and collaboration to make sure that ‘digital by default’ is part of that vision, and approaches it in an inclusive way.
It is time to build business better than usual, and better than ever before. We can ensure that clinicians and citizens are the architects of joined-up care. We can use the right skills and technology to deliver sustainable change.
We have all been in this together, throughout the pandemic. Whether health, care and wellness are accessed at home, on the high street or in hospital, we need to carry on together, and work ever more closely with those leading the long-needed integration of care.