Easing the transition, and transformation, to a digital focus. Hospital Times spoke to Dr Simon Eccles, Deputy Chief Executive of NHSX.

We are trying our best to reduce the usage of the word “unprecedented” in Hospital Times, but there are few other superlatives that are appropriate to describe the rate of digital innovation currently being seen across the NHS. Let us go with “exceptional”.

Dr Simon Eccles, Deputy Chief Executive of NHSX, the body placed at the heart of this exceptional digital shift in the NHS, knows that this change has been a long time coming. “We went from having 80 per cent of GP appointments face to face, to 18 per cent, with the rest being virtual.” This is but one outlier of the scale of digital change and the rapid shifts of the digital marketplace in healthcare right now. “Without Covid-19 it would have taken perhaps two to three years to progress to this position. Truly phenomenal,” Simon insists. Phenomenal is actually a better description.

Working from home is the second key, macro-level change that Simon points to as evidence of this progress. While remote working has become common practice in sectors where it is possible, that it is being embraced to such an extent in healthcare is hugely significant. “This new blended approach to working to that which best suits the individual is revolutionary for healthcare,” says Simon. “We can now provide a digital bridge to allow people to access the relevant systems.” For some clinicians, Simon acknowledges, who perhaps live in smaller, shared accommodation, having to work from home during the pandemic feels more as if work has invaded the home. A crucial role of NHSX will be to make use of the numerous intuitive applications to try to help these staff as much as possible if the second wave of coronavirus is to pose similar service disruption to the first.

Of course, Simon, who still practises as an Emergency Consultant, is not saying that bedside nursing can be done in any other way than with the patient, but for administrative tasks there is clearly scope for introducing remote working as a standard practice across health and care.

Changes of this magnitude required a rapid adjustment of Governance rules to make it clear that the point of this digital reform was to enable safe working for people, rather than to be an inhibitor. “We had to rush many of these changes,” says Simon, “and quite frankly, they have worked.”

Ensuring safety in innovation

The small team that comprises NHSX has been given an immense challenge to help facilitate this crucial digital change. The organisation launched its Clinical Communications Procurement Framework at the start of August to help steamroll innovative applications to the frontline through a streamlined, standardised framework.

Simon acknowledges that ensuring safety and proper compliance has always been, and will continue to be, a challenge when dealing with an increasingly crowded digital marketplace. NHSX is working closely with local trusts and NHS Digital to ensure that new implementations are safe and properly compliant. “When we have achieved that, we are getting these products onto frameworks to negate the need for cumbersome procurement processes,” says Simon. He praises the work of NHSX’s Chief Digital Officer, Tara Donnelly, in leading a raft of innovative implementations to bring crucial technology to the frontline.

Long-term goals

It is generally acknowledged within NHSX that, while the current pace of digital uptake is immensely promising, there are goals that will not be achieved overnight. Many products in use, according to Simon, are yet to develop truly intuitive user interfaces, are not cloud-based, and require VPN tokens to be able to work remotely. “We are certainly not going to be able to change these aspects in time for the winter, let us be clear about that,” says Simon, who is not one to sugar-coat the challenges that still lie ahead, “but there is quite an effort here to move the NHS much more to a cloud-based infrastructure to enable it to work seamlessly, remotely and very much more effectively, to interoperate between systems.”

That being said, there are several specific factors that will aid the NHS in its preparation for the second wave and what is expected to be an extremely difficult winter. Better triage tools across primary, outpatient and acute and emergency care are in the works to help better understanding of who requires a face-to-face appointment and who does not. Emergency care is moving towards a 111 first model, the aim being that people go through their symptoms online so that they are better segmented to the appropriate point of care, whether that be community pharmacist, GP or, lastly, urgent care. The ambition is clear. “We must avoid crowding in emergency care settings,” stresses Simon, “because we cannot keep people safe if there are too many people in a given environment.” Crucial to achieving this is simply knowing when patients are coming.

How much has the dial shifted?

“There is no denying that expectations have shifted; we are seeing age-old inhibitors being upended,” says Simon – who points to the reduction of face-to-face outpatient appointments as a clear indicator of this progress. While a 30 per cent reduction of face-to-face consultation was written into the Long Term Plan, all relevant parties knew it to be an ambitious target – yet in response to Covid-19 this was almost achieved overnight.  

This does not mean that we can simply throw digital around and expect it to stick. “The challenge is if you go to any trust chief executive and say, ‘good news! I have a digital product that will reduce your outpatient income by 33 per cent – how about it?’ they are unlikely to greet you warmly. There are still big challenges to address on tariffs.”

Addressing this issue requires the outlook of an integrated healthcare system, which allows providers to provide the same amount of care to the same number of citizens. Indeed, in looking at this from an integrated perspective you may be enhancing that care offer. It offers the opportunity to preserve face-to-face interaction in a truly inclusive way for those who need it or those for whom digital simply is not going to work. This is a crucial point for Simon and the team at NHSX. “We cannot widen inequalities with digital technology here. But for those who have an established relationship with their clinician or who need a quick advice and guidance triage-type call, let’s do that remotely.

“Let us not drag patients into hospital and wait for a five-minute consultation that consists of: ‘I completely agree with your GP letter. Let us get some tests organised.’ We need people to come to hospital appointments in a way that will truly benefit their care.”

So, through macro-level holistic considerations, NHSX plans to address tariff challenges faced by heath providers and, by and large, Simon believes that it is now succeeding. However, these changes must come with a general understanding across different parts of an Integrated Care System that this will move the number of appointments in different care settings and consequently the tariff in different care settings.

Digital is now clinical

The NHS is still extremely new to using digital technology on this scale, and there remains much to learn if we are to carry the tech momentum beyond Covid-19. It is time for the sector to take stock of this progress. The sector is shifting its expectations of this technology, and there is now widespread appreciation that digital innovations are clinical tools.

As Simon outlines: “in the same way as you wouldn’t accept an operating department where the roof leaked, why should you accept a clinical tool or a digital technology that crashes frequently? That can be just as disruptive to doing your job.”

There is also an acceptance that the overall transformation of health is very much a digital one. Simon certainly does not try to claim credit for this; while NHSX was set up to power this type of change forward, he likens the organisation to a supporting act in this process, as it is the trusts and frontline staff that have been embracing this technology as never before. The job of this organisation then, is to make this change as easy as possible, helping to ensure that the new digital outlook of the NHS is here to stay.