Community care: Digital transformation and future healthcare
The scope of an NHS Community Trust
“When I started this job I didn't fully understand what an NHS community trust was, but let’s just say I’ve learned a lot and have become more and more enamoured with the NHS,” Diarmaid Crean starts off with when we start talking about his role at the Sussex Community NHS Foundation Trust, what is does and its journey towards digital transformation.
Crean’s background is extremely varied. He has worked in the fields of travel, finance, banking and e-commerce in the private sector before commencing a career in the public sector after working as a civil servant before joining the Trust.
“Most people, when you think about the NHS in general think about an acute hospital, or a GP, when the reality is the majority of care happens outside of both of these settings. Think of all the elderly patients receiving visits every day, maybe they are being supported for dementia or getting an insulin injection, maybe they’re in a care home. As a community trust, one of our biggest services is community nursing, or what was previously called district nursing.”
Crean says he learned a great deal ‘on the job’ because in his role he was fortunately allowed to accompany nurses on their community rounds to get a feel for the frontline work, adding that Sussex community nursing is always managing particularly high demand because the county has an ageing population.
“We have about 800 nurses across the county who do up to 9,000 visits a day. These nurses may visit as many as 20 different people in one day. We go into homes to see people who may have just come out of an acute hospital or our community hospitals and help them to live independent lives, so there is a large complex support function running day in day out across Sussex,” he says.
Sussex has 13 community hospitals where people coming out of acute hospitals are looked after and helped with their physical rehabilitation, be that something like speech and language therapy after a stroke.
SCFT runs 84 different services dispersed and spread across the whole county out of 122 buildings, ranging from, Wheelchair support, our immunization Programme, children’s development centers with specialisms such as Autism and the many others.
Among all this volume and variety, where does the digital transformation come in?
Championing digital health professionals
Crean sees his role as a standard bearer for digital transformation, which has been recently helped and accelerated via the NHSx funding system which supports the Trust in this. He says the funding, helps with buying in new and updated technology, such as remote working, remote patient monitoring devices, and laptops that can run new powerful applications, but that the main part of his role is about having conversations about myriad of opportunities that digitalisation can bring with his colleagues and all the staff of the Trust.
“We’re all learning. I have learned massively over the past two years since being in the job, so now what we’re trying to do is champion the concept of digital nurses or digital health professionals, or digital clinicians. It’s not about a ‘techie’ person like me coming along and saying ‘I can make your work easier, or increase the efficiency of what you do,’ it’s about our clinicians having conversations along the lines of ‘have you thought about using this technology to help improve the care for our patients’?
The Trust, he says, runs six or seven parallel projects at any one time, working with each of the services and spending six to 12 weeks with them, asking which technology they could adapt and then training up accordingly and supporting the adoption.
“The process continues like that, it’s a constant task of encouraging people to be more autonomous with their use of technology, particularly the adoption and use of remote monitoring and video consultations, for example, or whatever works for their particular service,” explains Crean.
And he said, “Although there has been a degree of nervousness on behalf of some staff who want to be more hands-on, for instance, where they have to physically touch the patient or deal with the assessments of children with complex neurological conditions, there has been satisfaction with using technology. The ease of use of remote and virtual technologies for numerous services has seen them take to it ‘like a duck to water’ throughout the pandemic.”
Then he added “we have seen large cost savings, with for example less spend on petrol for travel, these savings can be put back into the Trust’s work and it’s good for the environment as well”.
Brand new services as a result of technology
The Trust runs a service called Hospital at Home which is for patients who have come out of the acute hospitals and then can be treated using various technologies in the comfort of their own homes, which increases the likelihood of recovery. This is via various monitoring devices, for example, such as for heart rate, blood pressure, oxygen levels and other vital signs.
“This means some of our clinical staff have become quite expert in being able to manage patients simultaneously because they can watch the data and see trends and patterns in, say, heart rate. It gives them more power to deal with a lot more patients via a call or video call.
We are also looking at a digital doctors’ bag which we will give to the care homes we support so that the staff there can actively monitor patients’ stats with an array of Bluetooth devices. This will allow our travelling nursing staff and the local GPs to remotely view the patient’s data and actively support these elderly people more closely. ” Crean explains.
The Robotic Process Automation (RPA) journey
Crean explains that the Trust is currently embarking on an RPA journey. There are countless areas where our staff spend their time doing repetitive simple tasks that could easily be automated. They are assessing a few potential solutions and working with various parts of the organisation where the Digital team thinks there are the greatest opportunities for the technology to make a positive impact. He believes that they should start with corporate services such as HR and finance, where there are some repetitive tasks such as working in spreadsheets, which can then, if automated, help save time for work in clinical departments. But he added that the Trust was still learning.
“At the moment we are working out the projects we want to start with, and we have an RPA team on it looking at piloting some, but so far we are learning from other parts of the NHS itself that are further down the RPA road. However, we are very keen to get a baseline and evaluate how the technology can demonstrate the benefits and we can see other Trusts have saved many 1000s of hours, reduced costs, increased time with patients and lifted staff away from those bits of drudgery in their jobs.,” he says.
Working in partnership with
As with the nature of an NHS Trust and the variety of services and locations involved with it as mentioned, there are obviously many different types of partners, however, Crean says the technical suppliers are obviously a big part of the Trust’s operations.
For electronic patient records, the Trust uses TPP, which is a global provider of healthcare technology which also works alongside governments to improve health outcomes, tackle inequalities in care, reduce costs and improve the experience for both patients and clinicians.
Along with this, Vodafone is the Trust’s major telephony supplier. Crean says: “With an organisation as remote and distributed as ours, Vodafone’s support works very well in keeping everybody connected to our systems.”
Crean gives an example of one older lady who had an operation at a hospital outside of Sussex and when she got home the Sussex NHS didn’t know she had had the operation.
“The woman needed help with things like standing, getting in and out of bed and cooking, so we made an urgent visit to her house and because our community nurse had her laptop and connectivity she could explain to her children (who had dialed in) that she was digitally referring their mother to various services which could assist her every day at home straight away.
When I asked the community nurse what would have been the case prior to having the technology and she said the process would have taken four to five days. You can imagine the distress of the individual and her family in that situation. But now the technology is at our fingertips and the kind of connectivity Vodafone provides makes this speed of care possible,” he explains.
Another important partner for the Trust is tech long-term player, Cisco, one of whose systems for example is used to run seven call centers across the Trust. One of these is called ECHO and this service is used in palliative care for patients either in hospices or being cared for intensively at home where possible. Crean explains it is a support service whereby nurses are on call day and night to support patients and their families. Crean says because all staff are provided with laptops and smartphones, they can stay connected on MS Teams and can also join the virtual call center from any location.
All of this demonstrates that this connectivity is vital.
“Alongside giving staff flexibility in the way they are able to work, the benefits of all of this is the reduction of costs on office space and travel, for example, so things are much more effective and efficient and we can evaluate things like how many more patients can be seen in the course of a day as compared to previously when everything was physical.
The main aims of digital transformation
Crean says he has never seen an example of digital transformation as accelerated as in the NHS over the last two years.
“I have seen nothing quite like it and Covid was the catalyst which made digital transformation even faster. NHS staff are super-motivated to care for their patients. I feel very fortunate to be involved in the NHS with my background and help the organisation make this leap and I don’t think we will go back.”
And he speaks of the conundrum of home working and returning to offices, which is a talking point at the moment within many different industries.
“I think the minute one organisation says come back to the office five days a week, the one down the road which doesn’t expect that will likely steal their employees. But it's the patients as well as they have become used to interacting with the NHS in different ways now and this hopefully also means people will become more individually proactive with their own health. And this ties in with the self-monitoring tech we have talked about,” says Crean.
But he does add a hint of caution, especially when it comes to technology such as artificial intelligence where bias and/or errors can sometimes negatively impact usage. Whereas the private sector embraces change more because they obviously make money from it, in the NHS there is, he says, rightly more concern over patient care and safety.
“The challenge for me when it comes to AI is the data. Computational technology has been around for a while and works brilliantly when you have really good data, but so far, the NHS hasn’t got a full grip on this. This is because data is residing in multiple repositories owned by different organisations so that can make data hard to grapple with.”
He added: “So there’s a question mark around the data but at the same time there is aspiration and what the NHS is trying to move towards while at the same time grappling with privacy and ethical questions. It’s a complicated multi-year challenge.
“But, as a technologist I would say it’s a no-brainer that this technology will do amazing things.”