COVID-19 and the future of care delivery

It was quickly recognised that the pandemic required tools to provide safe access to health and care at a distance. Scotland is demonstrating how a rapid telehealth transformation can be achieved says Nessa Barry of the Scottish government.

The opportunity to deliver a session for new healthcare students on the subject of telehealth is an enjoyable one. However, these sessions usually begin with a hurdle to be overcome – that of terminology. Discussion on the definitions for telehealth, telecare, telemedicine and other terms under the digital health and care umbrella is always required, and will be discussed in greater detail during the HIMSS & Health 2.0 European Digital Event taking place on 7-11 September 2020..

We start with a graphic that shows citizens accessing health and care at different points along a continuum of care. The continuum runs from the home or community setting – through to an acute hospital setting. In these conversations about how technology might be used in different scenarios, and the terms that are applied, we always emphasise that the prefix ‘tele’ simply means ‘at a distance’ and that students should focus on the intervention, the health and care being provided. I have repeated that sentence many times over the years and it comes to mind now, more than ever, as we look for tools to maintain and provide safe access to health and care services at a distance.

Shifting the perception of digital health and care

Without doubt, the crucial requirement of us all, as citizens, to be physically distant as part of the response globally to COVID-19 has resulted in a significant shift in how we think about technology as a tool to overcome distance. In our personal, leisure and work lives, as well as how we access health and care services, the use of technology has (largely) been viewed as a positive. 

When it comes to the conversation around telehealth, the message that staying home will help to protect our own health, the health of those we care for and those who are vulnerable, has been highly successful. The message that adhering to this request, and using other tools to communicate, to help to protect our health and care systems has been understood and accepted by the vast majority of citizens.

Prior to the declaration of the COVID-19 virus as a pandemic by the World Health Organisation in March 2020 Scotland, in common with most other countries, had been working to implement and embed proven digital health and care solutions and to significantly extend the numbers of people benefiting from technology enabled care and support. It is impossible to underestimate the importance of the years of collaborative groundwork undertaken in Scotland on the digital health and care agenda, driven by health and care integration policy.

Scaling up technology tools

One factor that we have in common with many countries, and that is often discussed with our colleagues in the digital health sphere, is the frustration felt at times due to the slowness of scale up and the challenge to embed the new ways of working that come with digital transformation. The deployment of technology as a tool to enable us to bridge the distance that COVID-19 has imposed has also been accepted with an immediacy and a unity of purpose by health and care providers.

The latest policy framework for Scotland guiding this digital transformation work is the Digital Health and Care Strategy from 2018. The strategy seeks to strengthen all of the elements of service delivery that are essential to sustainable digital health services and locates digital health and care within the citizen-centred service redesign narrative. In Scotland, leaders across the key stakeholder groups have been aware of the potential value of digital health and care for some time. The essential groundwork undertaken over the last 15 years has no doubt helped us to gain support from the stakeholders (politicians, policy makers, budget holders and industry partners) who make rapid scale up possible.

Since the declaration by the WHO on 11 March 2020, the Scottish response to the COVID-19 pandemic has included plans for the Scottish Government’s Technology Enabled Care, Digital Health and Care Directorate to work in partnership with health, social care and housing partner organisations (public and third sector) and industry partners, to support the rapid roll-out and expansion of digitally enabled services. 

From the outset, the public-facing advice and guidance in response to COVID-19 has been provided by NHS 24.2  NHS 24 is the national provider of healthcare information and advice, by telephone and online, to Scotland’s citizens. In addition to the 111 telephone number, COVID-19 specific advice has been provided through the NHS inform website and via chatbot, 0800 helpline and App.

In March 2020, the Scottish Government produced advice and guidance on Information Governance to support the safe deployment of telehealth. This assurance has given clear support to the use of technologies such as mobile messaging and video-enabled services, for example.

Staff leading on the implementation of digital health, who are not working in front-line service delivery, have been given dedicated support and had their teams expanded to deploy digital health and care services in response to COVID-19 in areas including: primary care, care at home and public health. 

One example is the creation of an expanded team with capabilities in technology roll-out, change management and health improvement, which has led to the expansion of video-enabled consultation. Referred to in Scotland as “NHS Near Me”3, this service was part of a long-term implementation program and, by February 2020, there were approximately 300 video-consultations per month. With added support in response to COVID-19, this has grown exponentially. The milestone of 100,000 video enabled consultations between March-May 2020 has been reached. Over a third of which were carried out in General Practice.

Another example, which recognizes the value of connection between patients and their families in Intensive Care Units (ICU), has included a compressed 9-day national roll-out of a secure video messaging system for ICUs in all Scottish Health Boards.

Cultivating the right culture

Other responses to COVID-19 have included working with national partners to review and improve procurement and design processes for key digital services, such as remote health monitoring. Furthermore, being able to maintain service levels for vulnerable citizens who are recipients of telecare in their own homes is vital when reinforcing the public health message to stay at home and stay safe. Thinking differently about how to use existing services to keep in contact and support people at home is another strength of this work.

With these examples of rapid roll-out, as with others, it is important to acknowledge that merely recognizing telehealth (and digital tools more widely) as useful, is not enough. Changing the way that we work in health and care, and making these changes stick, requires the right technology and, equally important, the right people with a clear remit to do the work. A supportive environment, creating the conditions for success, which includes clear leadership, more rapid procurement processes, the production of clear (profession or domain focused) guidance provides staff with the supporting protocols and permission to use telehealth effectively.

Whilst the focus on delivery of frontline services is rightly drawing most of our attention, it is also noteworthy that, since March 2020, the number of knowledge exchange sessions, webinars, online instruction etc., has grown significantly. Staff in all sectors have demonstrated abundant goodwill in shared learning. Opportunities to expand workforce capabilities with a COVID-19 lens will undoubtedly help to shape not just the present, as we deal with this crisis, but the future of how health and care services will be delivered.