The pandemic has witnessed a remarkable response by the healthcare sector in the UK – with digitally-driven transformation across internal processes, patient interfaces and service delivery.

In light of this evolution, the Box UK Digital Discussion in early April, brought together an expert panel to discuss the ongoing streamlining of our public services, with:

• Benno Wasserstein, Managing Director of Digital Consultancy Box UK
• Anne Marie Cunningham, Associate Medical Director for Primary Care, Digital Health and Care Wales
• Professor Hamish Laing, Professor of Enhanced Innovation, Engagement and Outcomes at Swansea University and Chair of the Digital Inclusion Alliance for Wales.

This deeply thought-provoking discussion addressed the changes that have had the most positive effect on digital service users and considered the role of the private sector in supporting the continuing development of digital services within health –  discussing what further changes are needed. The wide-ranging conversation offered first-hand insights into how the UK health service has managed data integrity and provided digital accessibility while transitioning from face-to-face GP consultations to a remote service; and how the COVID19 crisis highlighted the importance of collaboration between major players in the digital sector and wider community.

Critically, the discussion centred around “What Next” for healthcare delivery in the post-pandemic world.

Benno began by pointing out that, pre-pandemic, 25% of GP appointments were carried out remotely, with 75% face-to-face. That ratio reversed when COVID19 hit. Will it reverse again? And would that be a good thing?

It’s impacted on clinicians and admin teams as well as GPs.

“That’s a good question” mused Anne Marie. “I worked part-time as a GP during the first wave and realised that remote consultations don’t just change working life for the doctors. It also impacts hugely on clinicians and the administration team. We managed to transition to remote working because of the existing infrastructure we already had in primary care – but it did challenge us in terms of the technology we had to use and the change in mindset that’s needed, which shouldn’t be underestimated. We all had to get used to meeting the demand that was coming to us, rather than through the appointment book and the door. The experience showed us that it can end up a much more transactional service and we need to be careful not to lose the doctor-patient relationship, especially when a patient has a more complex condition that may need further investigation. We’re still in the process of teasing out how best to manage this – and get the right balance. On reflection, we were already moving towards a new balance before the pandemic, and in a sense remote care has always been with us – as a trainee doctor I used to listen to calls between GPs and patients as part of my training.

“A key consideration for me is how to create a new balance that includes everyone. That means bringing everyone in a primary care team up to speed with a new way of working. It’s not just about the technology – it’s about equipping people with confidence and expertise. And we have to protect access to the service. I work in an economically deprived community, where some patients don’t have access to emails or can’t afford to make phone calls. The door has to be open to people who need it.”

The majority of patients who used the remote service felt comfortable with it.

“It’s important to note that the transition last spring didn’t just happen in GP surgeries” emphasised Hamish. “It happened in hospitals, care homes and other places too. And it’s also worth remembering that remote primary care doesn’t just entail video consulting, which in many ways is the shiny bit – it also involves telephone consulting and remote messaging, both of which enable you to manage more patients. 82% of patients found the remote service a comfortable one, with many welcoming the fact that they don’t have to travel, that it reduces carbon emissions – and that it takes away any anxieties about going to a surgery where other people may have a contagious illness. So there’s a lot of moving parts and I hope there’s room for all of it moving forward.”

If we’re going to use data, we need to give patients access to that data, making sure that it’s current and up-to-date.

During the early stages of the pandemic, Anne Marie took additional specific responsibility for a project to support NHS Wales.

“The project involved using data from patient records to identify people who were particularly vulnerable and needed to self-isolate. It spot-lighted anomalies such as people who showed symptoms of epilepsy which has subsequently proven not to be true. The lesson we learned is that the data which is good for an individual practice is not necessarily suitable for wider use. If we’re going to use data, we need to be strong in giving patients access to that data, to make sure that it’s current and accurate. This has been a positive exercise – shining a light on an area that gets people to ask questions, so we can improve the information and what we do with it.”

Right now there are groups who are denied access – and that’s fundamentally wrong.

Benno noted the evolution of systems and software that make democratisation of patient data much more possible; and asked Hamish what progress he’s seeing in this across the wider spectrum of access and inclusion:

“This is a critical issue, because all of what we have talked about is based on the assumption that everyone can get access through a platform of some sort. Right now, there are quite a few groups who tend to be without access – older people, people with lower education or from socially deprived areas and patients with long-term conditions. That’s fundamentally wrong.” Hamish said.

“The four main obstacles to inclusion are ‘Connectivity’, which the Welsh Government is working to address, ‘Skills’ and not having the knowledge to use the tech, ‘Cost’ and simply not being able to afford access; and ‘Motivation’, with some people not seeing the point of going online. All of these blockers can be overcome – and that’s what the Digital Inclusion Alliance for Wales is working towards. We think Wales can be the real exemplar in the UK and potentially even globally, if we apply ourselves. We have the digital inclusion that sits at the heart of the Well-being of Future Generations Act, the newly-launched Welsh Government Digital Strategy, which has a mission to embed digital inclusion; and the recently-formed Digital Health and Care Wales body, which is focused on this vital area. Wales can achieve digital inclusion in Health – but there’s much to do and the Government can’t do it on its own. We need the public sector, private sector organisations like BT, communities and small groups working together to make this a reality.

Our planned Patients’ platform will put Wales ahead of the world.

“One very big and exciting change is being planned through the Digital Services for Patients platform” enthused Hamish, “which is funded by the Welsh Government as part of their Health and Social Care programme. It’s a single log-in platform that will democratise the flow of information between patients and ‘the system’: including an app that will allow you to see and update your own medical records, upload information such as your blood pressure or blood sugar level, as well as download guides on anything relevant such as diabetes or maternity.”

Anne Marie agreed;

“that’s incredibly exciting. It’s a tremendous initiative and I’m really proud that Wales is making that national commitment. Wales is leading the world in this area, pioneering the way patients can feedback health information into their direct care, helping us identify the patterns of care needed. This will put us ahead of everyone else; and working with experts like Box on projects such as developing a much more user-friendly website is making that possible.”

We need partners who can help us be agile and continually improve.

Benno observed that Box UK works with a number of Health Authorities and put the question ‘What’s Next in this digital evolution?’ to the panel.

“It’s a very fast-changing world we live in” reflected Hamish “and we need to be agile to keep pace with this change. It’s hard for the NHS to do that, so we need partners to help. It’s also hard for the NHS to have all the necessary skills in-house, so it seems inevitable that we have trusted partners to help us where we need it. It would be crazy for us to try to do everything ourselves. The right balance is doing what we can do well in-house; and working with commercial partners where we can’t.”

Anne Marie stated:

“We have over 800 people in Digital Health and Care Wales, so there’s a lot we can do to support NHS Wales. But it’s important for us to work with partners who can make sure that we’re continually skilling-up. It’s not about outsourcing to suppliers; it’s about partnering with value-add where needed.”

Drawing the discussion to a close, Benno asked the panel what they believe is the main ‘takeaway’ of the past 12 months,

  For Hamish:

“the pandemic has shone a light on the importance of digital inclusion and the impact of digital exclusion. We need to build on that, particularly becoming more proactive in caring for the vulnerable; and recognising that health both creates and is created by the economy.”

 Anne Marie said:

“The main thing for me is that we have managed to change, and we now need to keep that change going, to make the service better for our colleagues and our service users.”