The new everyday in health roundtable

Covid-19 created immense challenges for the NHS. Overnight, trusts were forced to invest in rapid digital transformation to survive and stabilise, and cope under extreme pressures.

And this digital acceleration enhanced patient care, supported backroom staff in working remotely and kept vital services running throughout the crisis.

Our recent study with the Centre for Economics and Business Research (Cebr) shows that Covid-19 might have accelerated the rate of digital transformation in health and social care by between three and five years, as a result of forcing through innovations in operations and patient care.

It also shows that continued investment in digital change, accelerated during Covid, will help transform the UK economy and society, adding £232bn in GDP by 2040. In UK health and social care, this means digitalisation could add £33bn to sector growth, through reinvestment and service improvement.

The benefits of this will be felt across front-line healthcare, for health workers, and for patients, strengthening our communities.

To understand more about the impact of Covid-19 in the new everyday of healthcare, and to look ahead to the future, we partnered with Digital Health, a leading publisher of sector insights, to host a virtual roundtable discussion.

Brilliantly chaired by Contributing Editor, Claire Read, the panel featured CIOs from six of our NHS Trust customers, representatives from the Cabinet Office and our strategic partner, cloud and voice technology specialist, 8x8. I was lucky enough to attend in my role as Head of Public Sector.

There were three main themes to emerge from our discussion:

How Covid-19 has driven cultural change.
The potential of digital technology to enhance patient care.
The need to bring others on the digital journey, including partners like palliative care organisations.

The conversation kicked off with a reflection on the last year and the impact of digital transformation. And one theme quickly emerged.

Cultural change.

Historically, it has often been difficult to drive through digital change within the NHS. The reasons for slow adoption of technology range from concerns about interoperability and security and the lack of buy-in from senior stakeholders to budgetary constraints.

Covid-19 changed the game.

As Jeremy Drake, CCIO, Buckinghamshire Healthcare NHS Trust commented, “There was a lot of adrenaline as we went into the pandemic and our backs were against the wall. We had to come up with new ways of working”.

And Russell Tilsed, Senior Director of Public Sector at 8x8, added, “Remote deployments, onboarding and virtual classrooms have skyrocketed in the last twelve months. Again, that’s quite a cultural change.”

This point was echoed by Mandy Griffin, Managing Director, Health Informatics Service, who talked about the crisis “giving people confidence in the use of technology” and being in a position where “people aren’t tech-phobic anymore”.

Some of that was down to a relaxation in governance rules, which meant that decision-makers weren’t “bound by red tape” and were able to act with much more agility. But there was agreement that the pace of cultural change had brought new challenges with it.

Adam Thomas, CIO, The Dudley Group NHS Trust, pointed out that remote working had sometimes led to NHS staff working very long hours. “There’s a temptation to wake up at 6am, start working and realise all of a sudden it’s 8pm and you haven’t actually got out of the house.”

He emphasised the importance of protecting wellbeing and, as support staff move into a flexible working model, ensuring people are “set up properly”.

Mandy Griffin talked about how employee burnout could prevent the NHS from building on digital progress. “I think we shouldn’t underestimate how exhausted our staff are. We’re working with a very tired workforce, whether you are clinical or not, because of the rate we’ve had to work at.”

Vincent Kelly, Crown Representative, CIO Advisory, Cabinet Office, also pointed out that while remote working had been empowering, it had caused “huge personal strains”. Getting the transition into flexible working right would be “really important”.

So, while the last year has seen a dramatic change in attitudes towards digitalisation within the NHS, health leaders need to consider how a tired workforce can sustain momentum beyond the end of the pandemic and develop strategies to energise and motivate them as it transitions into hybrid working.

Another theme from the discussion was the impact of technology on patient care.

From dramatically improving and accelerating knee surgery recovery periods, to revolutionising the treatment of bowel disorders through a smartphone, it was clear that digitalisation is already improving healthcare outcomes.

Pushpakaran Munuswamy, CCIO, Basildon and Thurrock University Hospitals NHS Foundation Trust, talked about how he had been able to improve patient care for long-term conditions, such as Inflammatory Bowel Disease (IBD), by “monitoring the severity of inflammation during the disease course” and using “smartphone-based calprotectin testing” to keep clinical teams updated.

This ultimately reduced hospital admissions by 40% and was received very positively by the patients.

And Graham Walsh, CCIO, Calderdale and Huddersfield NHS Trust, a practicing knee surgeon, talked about the extraordinary impact of digitalisation on treatment.

He described how one of the key challenges as a medical professional is having the confidence to let a patient go home after surgery on day one and knowing that they will adhere to the exercise plan they have been given.

“What we found is having that remote monitoring, knowing how your patient’s exercising, knowing that they’re hitting their goals – that, for me as a clinician, was great. I could be confident that we’re progressing. Physios could pick and choose which patients they needed to see. So the right care was going to the right patient.”

Another NHS Trust CIO to recognise the positive impact on patient care was Shauna McMahon from Northern Lincolnshire & Goole, who talked about how the Trust was doing “around 10% virtual work a year ago” to “well over 50%”, and that has included virtual consultations with patients and remote monitoring.

“One of our cardiologists is doing some work now with piloting some devices to monitor patients at home,” she added.

It was agreed that the main challenges to continued digital adoption would be clinical acceptance of technologies, and budgetary restraints. Overcoming this would be about optimisation of current resources and increasing efficiencies wherever possible.

There was also a recognition that while the NHS had seen rapid digitalisation over the last twelve months, this hadn’t always been the case in partner organisations critical to patient care.

Jeremy Drake emphasised the importance of an integrated patient pathway, and the risks of not engaging with the third sector. “The more we digitalise our processes, it’s quite clear that actually care homes, palliative care providers are key partners, and we’ve got to bring them along on this digital journey, otherwise actually we’ll have broken pathways.”

This led to a question around Integrated Care Systems (ICS), partnerships between different organisations that meet health and care needs across an area. Adam Thomas made the important point that “The success of ICS won’t be about healthcare on its own. It will be about working with local authorities, local government and the third sector.”

There was also recognition that the NHS cannot afford to leave people behind as it digitally transforms. Mandy Griffin talked about the importance of considering and addressing health inequalities. By focusing on healthcare access among ethnic minority groups and people with learning disabilities, Mandy described how this had “really changed behaviour and our focus is not just how long our patients are waiting, but those who have the greatest need or limited access.”

And Shauna McMahon added that “there are some organisations in North America who actually go out and purchase tablets and set up the Internet for (vulnerable) patient groups,” suggesting that more could be done in the UK to ensure that healthcare is as inclusive as it possibly can be.

It was clear from the discussion that there have been enormous and exciting changes within the NHS over the last twelve months, ones that have transformed attitudes towards digital change and led to much more dynamism and agility.

And the future, while not without challenges, is full of opportunity – to continue to enhance patient outcomes, introduce greater efficiencies, strengthen relationships with local government and third sector organisations, and serve disadvantaged communities.

But these benefits won’t happen on their own. To realise this opportunity, decision-makers must choose to invest in connectivity, collaboration, and network technologies to give their employees the tools to be productive and effective – wherever they might be.

To find out more about the impact of digital transformation within healthcare, read our report on Healthcare and digital transformation: The new everyday.

Thanks to all those who took part in our roundtable:

Shauna McMahon, Chief Information Officer, Northern Lincolnshire and Goole NHS Foundation Trust
Pushpakaran Munuswamy, Consultant Gastroenterologist and former Chief Clinical Information officer, Mid and South Essex NHS Foundation Trust
Claire Read, Contributing Editor, Digital Health (roundtable chair)
Adam Thomas, Chief Information Officer, The Dudley Group NHS Foundation Trust
Russell Tilsed, Senior Director – Public Sector, 8×8
Graham Walsh, Chief Clinical Information Officer, Calderdale and Huddersfield NHS Foundation Trust
Jeremy Drake, Chief Clinical Information Officer, Buckinghamshire Healthcare NHS Trust
Mandy Griffin, Managing Director, The Health Informatics Service (THIS)
Vincent Kelly, Crown Representative, IT and telecoms, Cabinet Office
Russell Tilsed, Senior Director – Public Sector, 8×8