Prevention rather than cure: transforming digital health and care in the NHS

Speak­ers:

Fiona Edwards, account­able offi­cer and chief exec­u­tive, Frim­ley CCG and Frim­ley Inte­grat­ed Care Sys­tem
Steven Flock­hart, direc­tor of cloud engi­neer­ing and dig­i­tal oper­a­tions at NHS Nation­al Ser­vices Scot­land
Will Owen, direc­tor of health­care, Ser­vi­ceNow
Helen Thomas, CEO, Dig­i­tal Health and Care Wales

The UK is brac­ing itself for more restric­tions to halt the spread of coro­n­avirus, due to the emer­gence of the omi­cron vari­ant. At the same time, a record 5.83 mil­lion peo­ple were await­ing non-emer­gency hos­pi­tal treat­ment at the end of Sep­tem­ber, plus the dras­ti­cal­ly revamped health and care bill is on course to pass into law by April 2022. Address­ing the chal­lenges inher­ent in the sec­tor with regards to dig­i­tal solu­tions and trans­for­ma­tion, Ser­vi­ceNow spon­sored a time­ly vir­tu­al round­table that explored the chal­lenges and oppor­tu­ni­ties in the future of pub­lic health­care.

How has the pan­dem­ic trans­formed dig­i­tal care for the NHS?

SF: It has pret­ty much changed every­thing, from mobil­is­ing our work­force to enabling them to work from home, and kit­ting peo­ple out with the tech­nol­o­gy required for that. Addi­tion­al­ly, it has changed some of our fun­da­men­tal pri­ma­ry health­care sys­tems, and we have built new sys­tems – for exam­ple, to roll­out vac­cines – very quick­ly. We have done an enor­mous amount to pro­tect cit­i­zens and front­line med­ical staff using dig­i­tal tech­nol­o­gy, with the devel­op­ment of smart­phone apps and oth­er tools.

FE: The way we work togeth­er across all parts of the health ser­vice –
local author­i­ties, hos­pi­tals, pri­ma­ry care and com­mu­ni­ty men­tal health – has been trans­formed to achieve fleet of foot. We weren’t this agile two years ago, and this sense of team helps progress. In clin­i­cal prac­tice, we have fun­da­men­tal­ly moved to a mixed approach of vir­tu­al and face-to-face con­sul­ta­tions. These changes and the deploy­ment of more tech­no­log­i­cal process­es are not with­out their chal­lenges. But we have been work­ing with the pub­lic to help with the tran­si­tion.

HT: Team­work and col­lab­o­ra­tion have been crit­i­cal in response to the pan­dem­ic. We met with key stake­hold­ers almost hourly at the start of the cri­sis. There was a bat­tle rhythm, and we used our col­lec­tive pow­ers to prob­lem-solve quick­er. Sup­pli­ers stepped up, too, mak­ing it pos­si­ble to pro­cure or devel­op ser­vices and sys­tems at pace; not the nor­mal cir­cum­stances you expe­ri­ence when procur­ing nation­al sys­tems for the NHS. You just had to get on with it. As such, we deployed a con­tact trac­ing sys­tem in only 40 days. Now, the demand for dig­i­tal ser­vices from patients is evi­dent. The pan­dem­ic moved the dig­i­tal agen­da for­ward a decade.

WO: From GP-lev­el right the way through to mul­ti­dis­ci­pli­nary teams, there was a demand to imple­ment and scale dig­i­tal plat­forms at speed. It sparked some incred­i­ble co-cre­ation and inno­v­a­tive pro­grammes, such as track and trace and the Scot­land vac­ci­na­tion pro­gramme, which Ser­vi­ceNow deliv­ered with­in six weeks. This part­ner­ship enabled 2.5 mil­lion vul­ner­a­ble cit­i­zens to receive their vac­ci­na­tion in the first 14 weeks. We went from a state where pro­grammes that would have tra­di­tion­al­ly tak­en years, now take weeks. There is now a dig­i­tal front door, mean­ing the speed of adop­tion for dig­i­tal plat­forms has been expo­nen­tial dur­ing this time.

How are col­lab­o­ra­tion and part­ner­ships with tech­nol­o­gy experts dri­ving dig­i­tal trans­for­ma­tion for the NHS?

SF: The pan­dem­ic helped to break down bar­ri­ers and drove col­lab­o­ra­tion and cama­raderie. Four­teen local health boards in Scot­land oper­ate autonomous­ly, but there has been no dif­fer­ence in opin­ion by tak­ing a user-cen­tric approach. At the start of the pan­dem­ic, per­haps we under­es­ti­mat­ed the country’s dig­i­tal matu­ri­ty. Uptake for apps – vac­cine sta­tus, for exam­ple – has been mas­sive. At the devel­op­ment stage, though, we have to adopt the ‘fail fast’ approach and learn from solu­tions that don’t quite work. We now have reg­u­lar, healthy con­ver­sa­tions with coun­ter­parts across all four nations to share knowl­edge and best prac­tices.

FE: Clear­ly, tech part­ners are cru­cial. Our trust­ed part­ner, with whom we have built a rela­tion­ship over sev­er­al years, takes us into a more exper­i­men­tal domain with their exper­tise and com­pe­tence. It is essen­tial to give time, effort, and resources to build co-designed and co-owned projects that ben­e­fit all res­i­dents in our care. It is vital to have that mind­set as a part­ner and a provider. We must be pre­pared to have an open and con­nect­ed sys­tem that allows for more things to be built on top that will enrich and empow­er the lives of cit­i­zens.

WO: The secret is not to try and solve a com­plete prob­lem; think small with tech solu­tions. Tech­nol­o­gy plat­forms can be the answer in most cas­es, but it’s real­ly about use cas­es. As a first step, we sit down and engage with our cus­tomers and work out, from a patient expe­ri­ence or clin­i­cal pro­duc­tiv­i­ty per­spec­tive, what it is we are try­ing to achieve. Work back­wards from that. In most sce­nar­ios, strate­gic part­ners with­in your ecosys­tem will have the dig­i­tal capa­bil­i­ty you need to deliv­er a pro­gramme suc­cess­ful­ly.

HT: For dig­i­tal progress, it is all about cre­at­ing that ecosys­tem. In Wales, we take a hybrid approach to solu­tions and ser­vices and use an open-archi­tec­ture mod­el. The big thing for me is that it puts stan­dard­ised data at the heart of the archi­tec­ture. Patients and clin­i­cians can access that infor­ma­tion in real-time. Before the pan­dem­ic, whilst lots of digi­ti­sa­tion had occurred, not much had changed since the the 1948 NHS mod­el, with a con­tin­ued reliance on the paper record. We are mov­ing to dig­i­tal­i­sa­tion, which starts with redesign­ing our ser­vices – and that’s an excit­ing dynam­ic – but its evo­lu­tion relies on trust­ed ecosys­tem part­ners.

What will the dig­i­tal­ly focused NHS of the near future look like?

WO: There has been suc­cess with remote con­sul­ta­tions, but more needs to be done to cre­ate a sim­i­lar if not bet­ter expe­ri­ence than face-toface meet­ings. There also needs to be bet­ter inter­op­er­abil­i­ty between video con­fer­enc­ing plat­forms and more robust, scal­able solu­tions. We will also see more med­ical apps, which will help grow and cre­ate more expe­ri­ences and ser­vices for patients. We need to expand those omnichan­nel capa­bil­i­ties and ensure we are reach­ing every­one with­in the care sys­tem. From a clin­i­cal per­spec­tive, there are so many man­u­al, labour-inten­sive process­es that can be auto­mat­ed.

FE: There needs to be a long-term ambi­tion and a com­mit­ment to achiev­ing that ambi­tion. We have an oppor­tu­ni­ty to take a rad­i­cal change in approach and test new ser­vices. If suc­cess­ful – such as ear­li­er diag­no­sis of demen­tia, or remote mon­i­tor­ing – we should scale them. The bank­ing indus­try is a good com­par­i­son. It was forced to change and digi­tise. Fur­ther, by cre­at­ing a com­mon data pool will sup­port antic­i­pa­to­ry care.

SF: Inter­est­ing­ly, we have been able to off­set more than 20m miles of patients trav­el­ling to see health­care pro­fes­sion­als through our Near Me video con­fer­enc­ing solu­tion. With the push for more sus­tain­able solu­tions, this shows the direc­tion of trav­el. Open bank­ing is an excel­lent exam­ple of what is pos­si­ble in health­care. In terms of data pri­va­cy, recent leg­is­la­tion passed in Scot­land, which gives pow­er to cit­i­zens to opt in to shar­ing infor­ma­tion, has made our lives eas­i­er. That author­i­ty allows us to inno­vate more.

HT: Gov­ern­ment sup­port cer­tain­ly helps progress, and in Wales, there is a pol­i­cy called Pru­dent Health­care, which is very much about co-pro­duc­tion and co-design­ing with the patient, so they take own­er­ship of their health and care. Technology’s not a block­er to achiev­ing this; for this to hap­pen at pace, we need the devel­op­ment of stan­dards to move data around and work in part­ner­ship with oth­er areas of the UK. Once the right safe­guards are in place, we can put the data and apps into the hands of the patients to empow­er them.

To find out how Ser­vi­ceNow can enable dig­i­tal trans­for­ma­tion in your organ­i­sa­tion, please vis­it servicenow.com/uk/healthcare