What does the ‘new normal’ look like in Digital Healthcare post Covid-19?

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There is no doubt that Covid-19 has pushed digital way up the healthcare agenda.  Systems that would have taken months to get approval have been implemented in a matter of days. Processes in primary, secondary and social care have changed dramatically and barriers have come down. 85% of GP consultations are now being done remotely and 95% of practices have video consultation capability. Trusts have also been told to provide remote telephone or video triage for their elective backlog and referral streaming is being put in place to ensure care is delivered in the most appropriate setting – avoiding unnecessary on-site outpatient appointments and reducing the risk of cross-infection.

Gaps in the infrastructure and data governance…

The health tech response to the outbreak across the NHS has been hugely impressive and the NHS’ central bodies have flattened procurement and decision-making structures to enable fast deployment.  NHS E&I, for example, suspended the contracting mechanisms that could make redesigning and pricing up systems tortuous and told organisations just to get on with it. NHS Digital rolled out Microsoft Teams to everyone with an NHSmail address in just four days – to facilitate remote working.  And whilst the information governance blocks on data sharing have been temporarily suspended, once normality is resumed these will all need to be addressed.

The current exigency has given us some major successes but there are still gaps; one of the big ones seems to be the collection and use of data across, what is still quite a disparate tech landscape, in health and social care.  For a truly integrated and interoperable population health solution the data architecture must be right. There will be many challenging discussions ahead, but we are starting from an immensely elevated position from even 3 months ago.

There will be a reckoning

The NHS has shown what can be done when digital transformation is prioritised, and funding made available. At the beginning of the outbreak the Health Secretary announced a £13.4 billion debt write-off as part of a financial reset to leave Trusts free to invest in maintaining vital services and implementing long-term infrastructure improvements.  An additional £14.5bn of spending was approved, of which £6.6bn has gone to the NHS and the rest to local authorities and devolved governments.  The initial rapid discharge of thousands of fit patients from hospital showed how quickly care can be integrated when budgetary silos are ignored. The new funding has been used to free up hospital beds, buy new ventilators, buy diagnostics tests and PPE for NHS staff, home delivery of medicines and supporting medical and student nurses and retired staff returning to the front line…

Remote video consultations have proved invaluable in our time of lockdown. NHSX’ Simon Eccles signed a 12-month contract with one supplier to provide digital video services across all Trusts for outpatient appointments, other GP suppliers have provided their video consulting software free for 12 weeks and even more IT suppliers have given their solutions and services across the NHS free for the period of coronavirus emergency.  However, there must ultimately be a reckoning as we near the 3-month deadline and the easing of lockdown.  What works must undoubtedly be kept and somehow funded.  This C-change provides an enormous opportunity for the NHS to invest in solutions that deliver – so let the discussions begin!

Recovery and Reset

We are now entering the Recovery and Reset phase of the NHS response to Covid-19 where normal services are gradually being brought back online. And, as HSJ recently reported, there is no going back – providers across London, for example, will need permission to reverse changes made during Covid-19. Services in London are now to be commissioned and funded on a Population Health level with a radical shift away from hospital care. Integrated Care Systems (ICS) will be the core of the new health and care delivery system with centralisation of specialised services and a joint, single waiting list across all providers.

Artificial Intelligence and RPA – underpinning fundamental changes 

Some of the major strides have been made in the area of Robotic Process Automation (RPA) where bots have been designed to augment existing systems for integrated, streamlined functioning that is saving the NHS many man hours and giving data accessibility now.  NHSX, NHS England and NHS Digital have all taken advantage of existing capabilities, for example, in East Suffolk and North Essex NHS Foundation Trust (ESNEFT).  Darren Atkins, Chief Technology Officer there has been doing some amazing work.  His Something Incredible Blog details the huge contribution the trust team have made to the Covid-19 effort by automating key operations with the Blue Prism Cloud (BPC) solution, at a local and national level and delivering significant support to social care.

Examples of how BPC technology is supporting the Covid-19 Recovery and Reset programme: 

NHSmail for Social Care – A single bot was written that has allowed 7033 care homes to be allocated NHSmail accounts for inclusive communications during the pandemic. This alone saved the NHS 18 working weeks of admin time.

Health Rostering into Power BI App – This implementation integrated a rostering system with no HP7, API or SQL back-end into to a BI app that enabled hourly reporting of clinical staff attendance – to meet fluctuating staffing needs as self-isolation cases arose.

Managing Covid-19 Pathology Results – managing incoming requests and routing of results

Batch Tracing of PAS Death Notifications – Accessing data on a non-spine-compliant PAS to enable daily death notifications

Social Care Supermarket Delivery Slots – a joint collaboration again with NHSX, NHS Digital, ESNEFT and the CQC to get shopping offers, and food delivery voucher codes to social care organisations using bots – without impacting NHSmail server timings.

Darren is rapidly being joined by a number of other NHS trusts working with Blue Prism Cloud to deliver a digital workforce across the Healthcare sector to manage the ‘new normal’.

Many of the NHS Trusts have engaged with BPC via the Fortrus Ltd Digital Transformation Framework for a compliant and swift route to market so they can deliver the benefits back to the NHS in record time.

These are just a few of the implementations making a huge difference to the front-line. From patient scheduling, remote physician consultations, logistics and supply chain management, vaccine research, and workforce planning, these short-term automation developments will be invaluable even when recovery is complete.

Integrated care across the community 

Integrated care was a fundamental plank in the NHS Long Term Plan. Now almost by default we’ve been forced to implement it and we’ve learned first-hand why true integration with social care is needed.  We can look forward to the increased use of technology including a boost in NHS 111 usage, remote consultations, e-prescribing and online triage. We have also realised that long-term conditions can be managed out of hospitals. So, as we get back up and running with outpatients, cancer treatments and elective procedures, we must build on the new spirit of co-operation across traditional boundaries of primary, secondary and social care and capitalise the valuable work done to date.

Darren Atkins – https://www.somethingincredible.co.uk/post/my-ai-week-15-covid-reflections

HSJ – Fundamental changes to London’s NHS in the wake of Covid-19

Fortrus – £10bn Digital Transformation Framework for the NHS – https://www.fortrus.com

 

Contact Louise Wall for more details – 07979 597396,

louise.wall@e18-consulting.com