No Going Back

Written by: Dr Lesley Holdsworth OBE, Clinical Lead for Digital Health and Care, Scottish Government @LesleyAHPD

It is exactly one year since I wrote a blog about COVID and what AHP services needed to be doing digitally and now. I had no inclining at the time that one year on we would still be living and working under such restrictions! In that blog I talked about the need to think differently, to not only keep providing care to those that needed our skills but also to protect our workforce. Anyone who knew me at that time was not surprised that I strongly advocated for the use of digital solutions and stressed how they could really help us. However, what I was also highlighting was that a shift to digital required a brave and truly disruptive mindset.

I have been a Clinical Lead for Digital Heath & Care with the Scottish Government since 2015, and what I can quite comfortably say is that more progress has been made this past year in terms of progressing the digital agenda than in all the others put together. The uptake has been phenomenal albeit understandable, as for many service users and clinicians digital solutions have been and continue to be the only way to access or deliver care easily and safely. I have been in awe and admiration of our professions who have risen to this significant challenge, forging and embracing new ways of working, continually finding solutions to ensure we can continue to deliver services and care. You have truly embraced the mindset, are willing to be brave and disruptive, and I salute you. What has resulted as a consequence has been the emergence of new pathways and new ways of working, with COVID-19 undoubtedly being the watershed that has spring-boarded these changes.

From the outset, in terms of clinical service provision, the focus of the Scottish Govenment’s Digital Directorate has been on three key priorities: enabling peer to peer communications, service user to clinician communications and enhanced remote monitoring/self management. Although all have involved introducing new digital solutions, in my view that is not the full story. What we have witnessed over this past year has been a major transformation in how services have been delivered, how our citizens can access them and how our clinicians are interacting with them. The story is more about the change, even transformation in some cases, than the actual tech being used.

Within a 10 day period at the end of last March, an incredible effort was made by our technical colleagues which resulted in 160,000 NHS staff being provided with access to Microsoft Teams. Many of us spend much of our day using Teams, similar to much of the world it would seem if the TV adverts are to be believed. We may well moan about how this medium dominates our current world, but we have to admit that it has been a total game changer, allowing us to easily message or call our colleagues individually and in groups, hold meetings, fast track service issues, maintain our CPD etc. I sometimes wonder how we could have done what we have without it. For those that want to learn more about Teams and its functionality, have a look here.

The pace and scale of the roll out of NHS Near Me, our national video consulting service, has also been a lifeline to many throughout Scotland. During February 2020, 300 video consultations took place. Last week there were 21,500 with close to one million call having taken place across Scotland since the start of the pandemic. Not only has Near Me minimised the risk of transmitting COVID-19, it has been well accepted by the public, and we must not forget the positive impact on our environment with a reported 22 million miles of avoided travel over the last year. If you want to read more about its origins and early design, have a look here and at the evaluation undertaken by the University of Oxford commissioned by the Scottish Government about the experience in NHS Highland here.

Rolling out new technologies at pace and scale is challenging and a logistics nightmare at the best of times. Regardless of how successful a roll out of the kit has been, this is not enough to bring about positive disruption of services and experiences. Key to this is our workforce. Ensuring that understanding, skills and confidence are embedded to fully utilise these media is critical. To that end, we have much to thank our NMAHP colleagues at NES for this past year. They have really stepped up, particularly during the early stages in April when they worked with us at pace to deliver a series of webinars that were either attended or viewed by 68% of the 12000 AHP workforce. You can access the full series here. These webinars focused on sharing the experiences of AHPs who were using video conferencing in their practice to support peer learning. We followed up those who attended the webinars to evaluate the extent to which they went on to use Near Me and how confident they felt in using this medium. By October of last year, over 85% reported using Near Me as part of routine service delivery which actually constitutes 18.5% of the total Near Me usage; all that from professions that make up just 8.5% of the overall workforce! The full results of this work can be found here in a paper we published in February this year. But that work also raised issues that we need to consider with an eye to future practice. We asked about whether respondents saw video consulting as a core element of their future practice and for what proportion of their caseload they saw video consulting being a continuing medium of choice. All reported that they now considered it to be a core element, but that for many reasons including ‘screen fatigue’, they felt that up to 50% of their caseload was optimal going forward. What they were really saying was that a blended approach is what’s needed for the future. We should be developing pathways that are focused around the user, their preferences and based on their choices which will and should include a variety of digital solutions.

Interestingly and quite rightly, our national digital strategy which was published in 2018 and expected to be relevant until 2022 is definitely not so – this has been literally blown out of the water by the pace and scale of change this past year to such an extent that its refresh is being finalised as I write and will be published in the near future, so watch this space!

There are so many more stories to share but they are for another time. We have learned so many lessons over the last year that we cannot and must not forget. If I were asked to share my headliners however, I am mindful of a recent meeting with our new Director General of the NHS in Scotland (who was previously the Director of Digital and my old boss) when I was struck by her own thoughts on this theme and feel this chimes with my own experience and basically sums it up nicely so I shamelessly stealing!

So, in moving forward, what I urge AHPs to do is to reflect on our experiences, on the progress we’ve made and what our service users tell us they want, and most importantly continue to be open, brave and disruptive. Without any doubt, digital solutions have played a major role in how we’ve been able to function during this pandemic but they are not the only tools in the box. Digital solutions are only the vehicle for the golden thread that enables us to develop new ways of working, that give citizens choice and optimise our offerings. My plea to you all is that you really think about how you can take the best of what you’ve learned into the future, what your service users say, and to use that wisdom to shape what your offering will be.  We can turn this experience into something that has a meaningful legacy and, most importantly ensure that there’s #NOGOINGBACK

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