What can digital do for the NHS?
Pritesh Mistry and Roberta Fuller talk to Fortis about how the latest digital innovations are helping move healthcare forwards
The government’s long-term plan for the NHS, announced in June, highlighted digital innovations as a major focus of their strategy to improve services and shorten waitlists.
Which new digital innovations hold out the most promise for the future and solving the NHS’s pressing challenges?
Pritesh Mistry, digital fellow at the King’s Fund, works in policy exploring how digital tools can improve health and care.
He says: “Since the pandemic, the different technologies of the NHS app, the website and access to their medical records allow people to be more knowledgeable and informed about their symptoms, possible side-effects of medication and more. This can result in better self-care or a more informed discussion with their doctor because they’re more confident.”
He points also to the introduction of sophisticated wearables, such as tracking blood sugars in real time for diabetics so that they can analyse their eating, exercise and insulin.
“It’s about changing the dynamics from the NHS being in control to the person being in control and knowing what’s happening with their health. Patients are more confident in using the tech and find it empowering. This higher level of knowledge brings clinical teams and patients together,” adds Pritesh.
Healthcare at home: virtual wards, remote monitoring, virtual reality
The shift of healthcare to the home setting is another profound change for the NHS and, as we know, can offer many benefits in efficiency and care.
In January, Steve Barclay, Secretary of State for Health and Social Care, made a firm commitment to virtual wards. “We will increase the rollout of our high-tech virtual wards, which will support patients while they recuperate at home under review by a clinical team. We now have a growing base of evidence that virtual wards are a safe and effective alternative to bedded care, so our ambition is for up to 50,000 people a month to be supported away from hospital wards by 2023/24,” he said.
Virtual wards release beds in hospitals for more urgent cases and can also, argues Pritesh, enable better care. People can be monitored at home for routine checks, such as blood pressure, as well as management of long-term conditions and feel more looked after as a result.
“Patients with long-term conditions can have regular remote check-ups rather than an appointment every six months. These short virtual check-ins mean clinicians can know that people are feeling ok and, crucially, looked after,” summarises Pritesh.
In Wolverhampton, a team took what they learned about setting up a Covid virtual ward and used it to launch their acute respiratory infection (ARI) virtual ward in July 2022. Through their ARI virtual ward, they can support 120 people with respiratory conditions in the place they call home. There are also lots of positive stories for virtual wards supporting older patients with frailty in Cheshire, Leeds, Hull and Kent. In Leeds, as of March 2023, they have saved more than 21,500 bed days since launching the pilot virtual ward in November 2019.i
Pritesh also says there will be a growing use of virtual reality technology for rehab. “Some areas are now testing out how to bring support into people’s homes, giving them VR systems to do their exercises at home when it’s convenient for them.”
The AI revolution
AI systems are effective readers for medical imaging, freeing up doctors’ time and easing the pressure on departments with high levels of vacancies. Addenbrooke’s Hospital in Cambridge, for example, was the first hospital in the world to use Microsoft’s InnerEye system for processing scans for patients with cancer.
Speaking to the Cambridge Independent, oncologist Dr Raj Jena said: “My team at Addenbrooke’s Hospital and the University of Cambridge have been collaborating with Microsoft Research to train computers to perform this task more quickly.”
The collaboration took eight yearsii and, said Raj: “The results are incredibly exciting. The research has shown that a computer can perform in just a few minutes what would normally take me several hours to do.
“This is important because it means we can start a patient on life-saving radiotherapy much more quickly and we know that the sooner we can start treatment, the better the chances for the patients.”
Pritesh also cites robotic surgery, in operation at some hospitals, as a game-changer. “Robotic surgery may completely change how long you need to be in care by reducing trauma and rehab and, as a result, how many days you need to spend in hospital,” he says.
Robot receptionists are also said to be in the planning to free up NHS staff and automate booking processes 10 times faster than a human and save on administration costs.
NHS Trusts will also be encouraged to use AI programmes to maximise the use of operating time, using systems to analyse a complex matrix of operating patterns, patient information and staff availability to free up time in theatres.
The challenges
Despite the many benefits of digital innovations, they do come with challenges around trust and digital exclusion.
In March, the King’s Fund published new research into the risk of digital exclusion, where people who don’t have devices or the confidence to use tech could be excluded and unable to access services.
“Our research shows that digital exclusion is dynamic; once people are shown how to use the tech or given access, it’s not necessarily a solved problem as their health could change. Their eyesight might deteriorate or they might not be able to use their fingers. Similarly, some people don’t feel reassured when they have an online consultation, yet other people I’ve spoken to feel positive – it’s convenient and they got the care they needed. We need to make sure staff have the skills and people have a choice between a traditional or a tech offering,” says Pritesh.
More also needs to be done to build trust in the use of patient NHS data as people worry about privacy and how their data might be used. As processes become more digital, there’s also a need for even more sophisticated security with the increased risk of ransom attacks and cyber security breaches.
Pritsh points to the research carried out by the King’s Fund, Interoperability is more than technology: The role of culture and leadership in joined-up care (download from https://www.kingsfund.org.uk/publications/digital-interoperability-technology), which shows the importance of engaging with staff to ensure that the technology and the way it is used is meeting what staff and patients need. “There’s some staff who are reluctant to use technology, who need support to build confidence and skills. Then there’s others who are frustrated with technology that doesn’t meet their needs, works poorly and feels imposed upon them,” says Pritesh. “Prioritising staff engagement by listening to and addressing their frustrations, but also creating empowered champions to support peers, identify technology needs and integrate technology into updated workflows can help to make progress in transforming services so staff and patients can benefit from technology,” he adds.
The future
With so many digital innovations arriving in healthcare, it can be hard to predict the future.
Roberta Fuller, Head of Hospital Reconfiguration at Royal Cornwall Hospitals NHS Trust, who answers the question: ‘What would you do if you were building a hospital from scratch?’ on page 22, leads with tech in her answer. She explained how digital innovations are already making an impact in Scandinavian hospitals, helping to improve all aspects of healthcare. Features she included as essential for progress include digital wayfinding, digital workflows, patient onboarding and tech-aided in-room entertainment – as well as advances in patient monitoring, record keeping and virtual 3D for estate planning.
At St. Olav’s University Hospital in Trondheim, technology is helping save time and money, one example being a navigation service for the hospital porters. A tracker on porters’ smartphones has saved an estimated two minutes per work order, meaning they would need five fewer full-time employees to complete the 700 daily work ordersiii. In Bristol, digital innovation is, says Roberta, well underway, with robotic porters as well as a clear division between patients and facilities.
Further afield, in Royal Adelaide Hospital in Australia, there has been inspiration from Norway. Working with DNV Imatis, they now have integrated a whole host of smart assets into one single, unified system of communication. This includes telecom, workflow, clinical applications, service management, patient bedside TV, room displays, patient flow digital whiteboards, self-check-in services, signage solutions, fire alarms, automated guided vehicles for goods transport and management, nurse calls and alarms.
Pritesh cautions that, despite all the exciting developments, there is also a need to make sure the existing tech is up to date and working well.
“Much of the NHS still has legacy tech. There are district nurses with laptops that are too heavy and batteries that don’t last all day. We need to make sure the existing tech is working well and effectively so that we have the capability to build cutting-edge technologies upon it.”
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This article was taken from the September 2023 edition of FORTIS magazine.
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This article was written for the September 2023 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.
