COVID-19: What AHP Services need to be doing digitally and NOW!

This is an important message from Dr Lesley Holdsworth, Clinical Lead for Digital Health & Care in the Scottish Government. Please share widely and get in touch with your local dhealth leads who can support you.

Without a doubt, this is some rollercoaster we’re currently riding, quite scary and it’s changing daily. It will challenge those of us who work within the health and care sectors in every way and in a way, we have little knowledge or experience of. Like many of you, I wear many hats. Mother, Nonna, wife, friend and during other times Clinical Lead for Digital Health & Care with the Scottish Government and Chair of the Board of Bield Housing & Care, one of the largest providers of housing and care to our older citizens in Scotland. I am also a physiotherapist who despite not ‘touching’ a patient since 1993 will be potentially dooning a uniform in the near future.

Like you, I wake every morning wondering what the day will bring and what I can do to help. I’m also facing the return to the family home of two of my ‘children’ (in their thirties!!) with partners in tow who don’t want to wait this out quarantined and working from home from their (nice but) flats in London and Edinburgh which is both reassuring and a disruption in equal measures. But we welcome them all with love and the need to compromise. For how long? Will my kitchen be commandeered? Will we enjoy this enforced time together and have fun or squabble? Will anyone get ill? These are the unsettling unknowns.

What I do know however is that more than ever we MUST think differently to not only keep providing care to those that need our skills and but also to protect our workforce. The last week for me has be filled with meetings with SG colleagues, with AHP leads, Board NMAHPs, `Bield execs etc drawing up contingency plans and, I should have been in Krakow tonight at a Santana concert which now seems a lifetime away!!!  What is very clear however is that everyone and, I mean everyone wants to know how technology can help and support us and our service users through this period of uncertainty. In my discussions with AHP leads, we have been focusing on a number of issues.

Firstly, how can we maintain high quality and an adequate levels of AHP service delivery with a population that needs to stay safe and at home? How can we safeguard our workforce and also support those colleagues in isolation to continue to make a contribution?

For those that know me, you will not be surprised to hear that I strongly believe digital options, technology, can really help us but it requires a mindset willing to be brave and truly disruptive. We need to think about doing things differently, in different places, using kit not familiar to us and certainly not custom and practice. I recorded a podcast for NES at the end of last year in which I tried to set out the case for digital practice and why we as healthcare practitioners really need to grasp the opportunities it affords.

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Within the SG Digital Directorate our focus is on two main areas. Firstly, rolling out and at pace Near Me / Attend Anywhere . I know that many services are already using this system which is basically a video consultation that links the healthcare practitioner to the service user in their own home. No need to travel, no potential exposure for anyone, no brainer! I’m hearing stories daily of AHPs throughout Scotland moving to business as usual through this medium. Dieticians in Glasgow for example are all trained and using this to carry out routine and urgent consultations. What this actually means is that AHPs can carry a full caseload from the comfort of their and their patients own homes and continue to provide vital support.

So my first challenge to my AHP colleagues is:

How can you use Near Me /Attend Anywhere (VC) in your service? My gut feeling is that all AH professions could convert a minimum of 50% of their overall activity from traditional face to face to VC with some achieving even much higher levels, for example, Dietetics and Speech and Language therapy. Incidentally, the evidence for VC SLT is compelling – read this if you want to find out more

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The second area SG are really driving is the widespread take up of something called Microsoft Teams. Teams is a great wee app that allows you to be in touch securely with your colleagues through messaging, calls and video. It also allows you to download and view files. Interestingly, for something called Teams, one if its most clever features is the ability to create teams of co-workers who need or want to be connected. For example, physios working in respiratory units may wish to form a ‘team’; to share issues and practice. You can belong to multiple and multi-disciplinary teams and spanning organisation barriers. Just now, this could be a real game changer. Speak to your local Digital NMAHP rep and your local ehealth team to see how you can get access – we anticipate that all NHS boards should have this facility by the end of the week. Someone within your service should take a lead on this and co-ordinate efforts – it will make a real difference to how you work and the support you can access from your colleagues

What other digital options are there?

Many! So many – We’ve been running a digital NMAHP leadership course for five years now which over 250 NMAHPs have completed with AHPs accounting for 60% of these. A full list of those individuals and the projects they led can be found here – there’s some cracking stuff – have a quick look and think about how that could help you and your service NOW. One of my hobby horses relates to why (oh why) do we continue to carry out home visits in this day and age  (well 80% of them) when the evidence is so clear that digital is so so better for everyone (AHP MDT using ipads

Direct communications with your service users and colleagues  

It’s just critical, isn’t it? we need to let our service users know that we’ve got their referral, when and where their appointment is, how this is going to take place, when to come back, (or not!) etc . We also need to be able to contact our colleagues for support, information sharing and decision-making support. Like it or not, information governance and the safeguarding of data is vital. National guidance to help protect both us and our service users has been updated this week by the Scottish Government in response to the needs COVID-19 presents us with – you can read the full guidance here. It basically says that at this time NOT sharing information could be more harmful than sharing and represents a certain ‘relaxation’ of the previous guidance. We are often asked about the use of messaging services like ‘What’s app’. I don’t need to tell you that ‘What’s app’ is a great way to connect a group of like-minded people however, in general this is not sanctioned by the NHS as it’s not secure and should NEVER be used to share any patient identifiable information. The method of choice is TEAMs but there is also a recognition acknowledged within the guidance that in this challenging time, if you don’t have access to TEAMs, sending other types of messages to patients/service users about their appointments (only) is OK – never use messaging to discuss condition related issues – but please read the full guidance to ensure you are practising legally.

Signposting to reliable Information and Self Management Resources

This is such a key time to be able to reassure people about their health and wellbeing and also promote as much self-management as possible. There are some fabulous resources available and particularly those on NHS Inform. For example, the well national established MSK service and others. Being able to direct your patients to reliable sources of information is so important and also relieves pressure on struggling services. Other great resources developed by AHPs can be found here

https://www.nhsinform.scot/self-help-guides/self-help-guide-lower-back-pain

https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain

https://apps.apple.com/gb/app/nhs-24-msk-help/id556064114

Look what other services are doing using media such as Facebook to provide clear advice and content to their local communities. The MSK service in NHS Ayrshire and Arran are doing fabulous things with their Facebook page and are updating information, videos and advice on a daily basis and there are many more. Elaine Hunter (@elaineahpmh) and her team are producing some great stuff through Alzheimer Scotland @AlzScotDigital from remote clinics and advice lines for dementia sufferers and their carers.

This is THE time for sharing and collaboration on a scale we’ve little experience of but should embrace.

So what about the COVID-19 efforts at Bield? They are considerable as to be expected.  We provide housing and care to over 7000 elderly and therefore potentially more vulnerable citizens who will bear the brunt of this unkind virus. I will be working with my fabulous colleagues and our inspirational new CEO Lynne Douglas, an AHP by background, to rapidly progress our digital efforts to safe-guard the health and well being of some of our most vulnerable citizens. Our ambitions in this arena are considerable.

So, reverting to my bossy type, my key messages to AHPs throughout Scotland are:

Make digital the backbone of your contingency plans

Seriously look at what digital options are available locally to support the continued delivery of services and the safeguarding of their workforce

Free up capacity and protect your staff

Make sure AHP NHS board digital leads are supported to help develop your local plan

Involve AHPs who have completed the SG/ NES Digital Leadership programme and encourage them to contribute – they have a wealth of understanding and knowledge

Make sure that AHPs are aware of and signpost their patients to reliable sources of information and self-management support

Join our national digital network if you want to connect with other like-minded AHPs to learn and share

Our network Leadership Group have come into their own over the last week and ramped up their local and national digital efforts. Under the chairmanship of @debbieprovanRD and are doing wonderful stuff – they are the font of digital knowledge for you to tap so a BIG thanks to you all @Nic_RD_AHP @lauracamphsio @lauralennox6 @stuartWbuchanan @debbieprovanrd, @markfleming1 @francis7santos @gillieAHP @evelynnewman17 @elaineahpmh, @Daviesgill14 @annrae @jamieson_cat @Mcgee0915 @_margaretgreer @fraserahp Angela Lindsay

What I am certain of however, is that we WILL emerge from this devastating COVID-19 experience with a different mindset, changed values and a very different view about how digital can positively transform and disrupt our approach to service delivery.  I know that both AHP and Bield services will never be the same going forward and that digital solutions will emerge as the backbone in a way we could never have imagined even a week ago. What will next week bring?  A sobering thought.

If we can help with links to folk who can help you get to grips with your digital options, please do get in touch. We would love to hear from you at any time over the next few months about your experiences and lessons learned.

I sincerely wish all of us the very best over the next few weeks, a time that will test us all.

Stay safe and well, look after yourselves and your loved ones and don’t forget, family compromises will be required (well in this house!)

Dr Lesley Holdsworth

@lesleyahpd

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