Covid-19 has caused huge changes to the NHS, and one main impact has been the increased use of technology to respond to the pandemic. There has been a shift away from face-to-face care with more GP and hospital appointments happening by phone or online, and an increase in online prescription requests and digital apps to support people manage their health care while they’ve been staying at home. These changes happened very quickly and were necessary to reduce the risk of transmitting the virus in health care settings.
Technology offers huge potential to support health care, but it’s important to understand what helps make its use a success for both patients and staff. Historically, the NHS has not always been able to implement and spread technology so that it benefits the people who need it. Our previous research has recognised the importance of innovators, policy-makers, health care professionals and patients working together to identify where technology can help and how to implement it effectively.
Since October 2018, we have been evaluating the Care City test bed. This was an NHS-funded pilot project based in East London, which aimed to test digital innovations in three settings:
- in home care – health checks performed by paid carers to monitor people with long-term conditions in their own homes
- in primary care – apps to support people living with insomnia and diabetes
- in secondary care – an app for remote cardiac rehab.
Our research published today highlights the key lessons from our evaluation for the NHS and social care to make the best use of digital innovations.
Due to the pandemic, services have been under immense pressure, treatment and care has been re-prioritised, and some staff involved in the test bed were redeployed. In the long term, the NHS is facing a huge backlog of care, exacerbated by an exhausted workforce. Given the changes we have seen over the past year, technology is clearly going to play a key part in addressing this. For the NHS to make the best use of technology, recognising these lessons is essential – here we highlight three of the key ones.
Co-design is important before, during and after technology implementation
Co-design actively involves people in a process to identify a problem and decide how best to address it – it is a collaborative approach that recognises the need to understand different people’s perspectives. With Care City, co-design involved the innovators, frontline staff, patients and service users. When implementing technology, co-design is important to make sure that it meets the needs of the patients, service users and staff who are going to use it, and to identify any potential challenges and solutions.
The Care City test bed made use of dedicated co-design workshops, but also recognised the value of people spending time on the ground in the different settings to see first hand how things were working, and hear everyone’s experiences. The discussions resulted in practical changes, including giving staff dummy accounts to help with training and patient testimonials to encourage recruitment.
Co-design has also been important during the pandemic – Care City organised virtual workshops to bring people together to discuss how to make best use of the innovations to respond to Covid-19. In the cardiac rehab setting, face-to-face exercise sessions were suspended in March 2020, but having an app as an option meant that the team could continue to support patients remotely. The team also ran online exercise classes so that people could socialise with others, and get advice from the team on how to exercise correctly.
Understand how the technology fits into the person’s overall care and treatment
It is important to understand how the technology fits into the wider care pathway, so that it is not seen as a replacement, or second best, to usual care. This includes the importance of health care professionals providing ongoing support to patients, such as through regular check-in calls. For this to be effective, staff must be provided with the right training, time and support. This includes ensuring they are confident explaining and offering the innovations to patients. This has been especially important during the pandemic, when health care professionals have had to help patients use the innovations remotely.
Although Covid-19 has caused disruption to existing pathways, it has also highlighted new ways to use the technology, and staff responded innovatively to the challenges. In home care, there were more opportunities to use remote monitoring when health care professionals were unable to see people face to face. This meant they could provide ongoing care and comfort to service users, but it also helped foster relationships between the carers and GPs.
Take time to understand the things that will influence how and why people will engage with the technology
A key role of co-design is understanding the particular context in which the innovation is being implemented, and the factors that might influence whether patients will use it. This includes understanding the local population, and any particular barriers such as language. One of the apps added voiceovers in multiple languages and made use of advocates within the health care team to support people who did not have English as a first language. In some cases, involving family and friends was also really helpful to motivate people to use the innovations.
The test bed had a particular focus on addressing digital exclusion. We found that in some cases, although people had the technology (such as a smartphone), their access to the internet or space on their phone for apps was limited. Some people also didn’t feel confident about using the technology for their health care. Given the huge increase in the use of digital tools during Covid-19, it is essential that these barriers are addressed to make sure people are not excluded from using digital tools, and are provided with the right support.
The test bed has shown that with the right support, technology can bring huge benefits to patients and staff. This has been further highlighted by Covid-19 – with surveys showing that NHS leaders believe the pandemic has resulted in more positive attitudes towards technology, and that these attitudes would be sustained.
Our research shows there are numerous things that we can do to make the best use of innovation in health and social care. In the wake of Covid-19, it is clear that technology can play a significant role in supporting both patients and staff.
*To find out more about our Care City work, please see our new summary of 10 key lessons for the implementation, adoption and spread of digital innovations in health and social care services, as well as our final report on the evaluation of the test bed.
Hutchings R (2021) “Implementing technology in health and social care: lessons from the Care City test bed”, Nuffield Trust comment.