Beyond the buzzwords: Accelerating digital in hospitals
By Integrated Care Journal-
In July, the government launched a selection process for eight new hospitals in England. Backed by an initial £3.7 billion of investment – with NHS trusts invited to bid-for-build – this represents the start of “the biggest hospital building programme in a generation”, which will potentially see 40 new hospitals built across the UK by 2030.
The scheme emphasises the hospitals will be built as quickly as possible while “prioritising standardisation, digital technology, sustainability and modern methods of construction. ”
Digital transformation initiatives have been implemented throughout the Covid-19 pandemic with significant success. So, with the combination of lessons from the past few years, plus the government’s agenda for building hospitals, we need to ask what digital technologies need to be included and where.
Embedding healthcare digitisation
Healthcare reform must build on the momentum generated by the pandemic to ensure digitally enabled solutions are sustained in the long-term. Using this framework, alongside the government’s agenda, Public Policy Projects have identified several areas of scalable digital acceleration in hospitals.
In January 2021, NHS England recommended that all integrated care systems (ICSs) establish a second related pathway, Covid virtual wards, to support the earlier and safe discharge of Covid-19 inpatients. When moving from hospital to a virtual ward, patients are given a pulse oximeter and supporting information to monitor their oxygen levels at home. They are contacted daily as they would be on a ward round in hospital and given clear guidance on what to do if they have any concerns, such as contacting the Covid virtual ward team.
Currently, 94 per cent of hospitals in England run, or have run, Covid virtual wards. A recent study from BT found that 98 per cent of NHS staff have seen increased demand for remote health services in the past 12 months.
A recent LSE-Lancet Commission on the future of the NHS confirms that the UK does poorly in comparison to other high-income countries in relation to mortality and morbidity associated with heart disease. Hypertension is the strongest modifiable risk factor for ischaemic heart disease and stroke. It is also associated with an increased risk of vascular dementia, and, for all these reasons, it places a considerable strain on the NHS.
According to Public Health England, hypertension affects more than one in four adults in England, approximately 12.5 million people in 2015. More than 5.5 million were also estimated to have undiagnosed hypertension, and that number is bound to have increased since. In Canada, 65 per cent of adults with high blood pressure are both diagnosed and managed to recommended levels, compared to only thirty-five per cent in England.
National screening programmes such as NHS Health Checks are not economically viable, as the health system (in this case, an over-stretched primary care service) needs to screen too many individuals amongst the general population for heart disease to prevent a stroke, and potentially save a life. A possible solution is to target the intervention at those who most need it, when they are most likely to respond to it.
The Screening for Hypertension in the Inpatient Environment (SHINE) system has been developed in Oxford to detect those individuals at risk of undiagnosed hypertension whilst they are in hospital (around 14 per cent of patients), with the aim of enabling its management to be undertaken in the patient’s home after discharge from the hospital. “At-risk” patients are automatically identified through interrogation of the electronic patient record (EPR). Following hospital discharge, patients have their blood pressure monitored at home for 24 hours using Ambulatory Blood Pressure Monitoring (ABPM).
The findings from the SHINE study show that approximately half of those with elevated blood pressure in hospital are confirmed to be hypertensive at home. This makes for a uniquely efficient screening programme, compared to the standard NHS Health Check, which typically requires screening 27 patients to diagnose hypertension in just one. As a result of the pandemic, the screening is now carried out entirely remotely, with a video call for the patient to be shown by a nurse how to fit the ABPM but without the need for a GP appointment until the diagnosis of hypertension is confirmed. Many digital transformation initiatives have been accelerated through the Covid-19 pandemic, however, challenges certainly remain across the board.
Currently, optimism and reality do not align. Referring to the BT study, while 97 per cent of UK adults have used technology this past year to connect with the NHS, only 18 per cent of health organisations currently use patient health apps. This is despite almost 70 per cent acknowledging smart apps contribute to better patient service. Only 40 per cent of NHS staff use an online booking system, undoubtedly causing delays and reduced level of service during the challenges of this past year.
Building an accelerator culture
In recent decades, there has been greater emphasis on moving to more specialised hospital-based care. With the rise of digital transformation and the legacy of the pandemic, we need to make sure the NHS, including hospital trusts, have the primary care and generalist skills to complement growing specialisation.
The ground is already being laid to achieve this. Earlier in May, Skills for Health, the UK’s Sector Skills Council for Health, launched the Developing a Resilient Workforce Survey. The report will paint an insightful picture of the UK health sector, capturing cross-sector skills gaps, the impact on learning due to Covid-19, ongoing training needs, flexible and remote working, equality, diversity, and inclusion at work, as well as the organisational and people development requirements to support an increasingly complex workforce.
Cutting across the technology, policy and workforce issues behind healthcare digitisation – PPP are currently working on phase two of the Health Digitisation Series with our Digital Horizon: Building an Innovative Health System State of the Nation report, aiming to frame discussions that will help define the delivery of health and care in a technology enabled 21st century.
Issues of staffing, training and inclusion in digital healthcare transformation have been topics rightly covered at length over the last few years. While efforts to accelerate digital services within hospitals are moving at pace, substantial change during and after the pandemic needs to lean on workforce capacity, capability and flexibility it needs to deliver the services of the future.
If you would like to participate in future roundtables or find out more about the ongoing Health Digitisation State of the Nation Report, please get in touch through firstname.lastname@example.org.