At the start of the Rewired London 2020 conference at Olympia, NHSX CEO Matthew Gould discussed the use of remote consultation as the health service prepares for Covid-19.
There was a question whether the conference would go ahead, given the recent government emergency meeting to prepare the country in the event that the virus spreads.
As Computer Weekly has previously reported, a number of high-profile events have already been cancelled. London Book Fair, taking place on 10-12 March at the same venue in Olympia, has just been cancelled.
While the health service is preparing for the strain of having to cope with a large proportion of the population falling ill, the readiness plan, and the IT impact of this plan, are lessons CIOs in any sector can learn from.
Speaking in the digital transformation session, Gould said: “There are three areas we are thinking about: what can be done with 111 [non-emergency number]; online can relieve pressure – there is more of an emphasis to encourage people to move online; and there will clearly be a need for remote consultation.”
If the infection rate increases, Gould believes patient will want to have the ability to have remote consultation. The NHS will need to cope with a far higher level of remote consultations than it is used to.
The health service must also look at how it can use data effectively to cope with the outbreak, added Gould.
1. Online access for citizens and staff
Sarah Wilkinson, CEO of NHS Digital, reworked the presentation she planned to give at the event to focus instead on the NHS Digital response to coronavirus.
In her opening remarks on the level of activity the NHS is now facing, Wilkinson said: “We are not just facing a little more demand. It strikes me, looking at the past few weeks, that there is fundamentally new unprecedented demand from citizens to use digital channels, which avoids the need to use the physical channel.”
Wilkinson described how NHS Digital was also seeing demand for new ways of working. “Clinicians are working in different places, and are being asked to care for people in different practices,” she said.
On 2 March, the BBC early evening news broadcast the 111 number, which put the 111 system under considerable strain.
“The teams did a whole load of load test on the 111 system and we could see that the system could handle 12 times the volume of calls. But on Monday at 6pm, BBC mentioned 111,” said Wilkinson, adding that the call volume was 19 times higher. “It was the highest we’ve ever seen.”
As people become familiar with the 111 online channel, Wilkinson anticipates that the service will experience “less excitable” moments. “Demand should become easier to manage, but it is difficult to manage at the moment,” she said.
2. Changing protocols for data access
Healthcare professionals need access to patient records, but if retired clinicians are asked to come back to work, or emergency medical centres are established in places such as army barracks, Wilkinson said that data-sharing regulations that govern how such data can be accessed, and by whom, must also be addressed.
She said there needs to be a way to provide clinicians with quick access to the summary care records system. Any clinicians can access it if they have the right login credentials.
“We need to be able to authenticate staff pretty quickly for the summary care record system,” she said.
Beyond the summary care records system, Wilkinson said: “A lot of protocols need to adapt fairly radically. We are continually evolving clinical response protocols and guidance is being adapted very quickly.”
3. Ability to change algorithms rapidly
Another complex issue the team at NHS Digital has been tackling is how to adapt the NHS Pathways algorithms that define the routes taken when patients use the 111 service.
NHS Pathways is the clinical algorithm system that effectively asks questions to come to a clear conclusion on how the patient should be directed.
Wilkinson said the system requires extremely rigorous change control because it needs to cater for the whole population with different conditions, some of whom may have rare illnesses.
“The algorithms themselves are designed by our clinicians, and reviewed by an independent national clinical governance group,” she said.
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But for Covid-19, she noted that there is a need for rapid changes. “Clinical responses evolve rapidly. Call scripts are evolving daily. Occasionally we get a sub 24-hour break. We got the very first workaround deployed in five hours,” she said.
Thanks to Brexit readiness, Wilkinson said her team has a business continuity plan internally for coronavirus: “We are ready to standup and can enable 50% of our staff to work at home.”
Having the right tools to support team working is another area Wilkinson said the business continuity plan has needed to consider.
For Wilkinson, what the growing use of citizens using the NHS online service or app to find information about the coronavirus shows is that there is always an opportunity to drive the right changes.
“You can drive things in the right way. Using the digital channel access to healthcare is a good thing and drives people’s behaviour. They have a better interest in their own healthcare,” she said.