In his recent speech on the future of health care, the Secretary of State applauded the acceleration in digital technology that happened in the NHS at the peak of the coronavirus pandemic. “Because so many things went right, we’ve got to bottle the best”, he announced. But now that a few months have passed, what enabled this to occur? Can it simply be bottled, and will it lead to lasting change?
There can be absolutely no argument that the pandemic saw an explosion in digital technology and remote working – and that provided a clear solution to the problems facing the NHS in March.
There has been a seismic shift away from face-to-face appointments in primary and secondary care, as well as increased use of the NHS app, NHS login and e-prescription services. Prior to the pandemic, around 80% of GP appointments took place face to face. As of June 2020, this had fallen to just under half, with around the same amount taking place over the telephone.
Technology was also used to manage coronavirus itself – a new NHS 111 online system, social media and resources for people recovering from the virus. All this shows what can happen when technology addresses a clear problem and people are provided with the space and support to be innovative. There really is something important here to “bottle”.
Our new briefing lays out the breadth of what has happened.
But change created in the chaos of necessity isn’t always for the better. We now need a thorough examination of the impact that digital technology and remote care has had on patients’ access to and quality of services, clinical outcomes and the experiences of patients and staff during the pandemic. Just because things can be done digitally or remotely doesn’t mean that they always should.
For some people, face-to-face care will still be best. Hancock said that “all consultations should be teleconsultations unless there’s a compelling clinical reason not to”, but there are vital reasons beyond the merely clinical. Continuity of care matters, and so does patient experience. People may have accepted during Covid that remote care was the right and only option, but this doesn’t necessarily mean that they actually prefer accessing services remotely when another option is back on the table.
We need services that are inclusive, accessible and tailored around the individual’s needs and circumstances. Remote care offers patients convenience and protection from infectious disease. But we need more evidence on the long-term impact of remote care on clinical outcomes, as well as use of other health care services, prescribing and treatment.
There are symptoms that could be missed during a remote consultation, and there is some limited evidence that remote consultations can lead to increased prescribing of medication or more referrals as GPs err on the side of caution. For the staff who we so urgently need to attract and keep, remote working can let them be more flexible and fit in caring responsibilities. But many also value the face-to-face interactions they have with patients.
Keeping the best of the changes we have seen will also require tackling a different set of problems – well-worn issues that have hindered progress in the past. As the National Audit Office recently warned, health service systems still often cannot communicate with one another, and the highly skilled workforce needed to get the best out of them is not fully in place.
The crisis justified exemptions to the usually slower process of procurement, and to aspects of information governance, and saw some companies offering services for free. By default, none of these changes will last forever.
As the NHS continues to resume routine services, and deals with the huge backlogs of care the pandemic has created, it’s essential that technology is used in a way that best supports and enhances care for both staff and patients. Covid-19 has starkly highlighted how the NHS can make the best use of technology to transform services – as we continue to live with the effects of the pandemic, understanding how to translate this into meaningful, long-term change will be essential.
This blog was originally published in the HSJ on 27 August and is reproduced with permission.
Hutchings R (2020) “Technology must be used in the best way for staff and patients”, Nuffield Trust comment.