Community Care: Digital Transformation and Future Healthcare DIGITAL REPORT 2021
IN ASSOCIATION WITH:
COMMUNITY CARE: DIGITAL TRANSFORMATION AND HEALTHCARE’S FUTURE
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A new take on care in the community: how digital transformation and technology is changing the healthcare landscape
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hen 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 it 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.” 4
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Diarmaid Crean Chief Digital and Technology Officer, Sussex Community NHS Foundation Trust
SUSSEX COMMUNITY NHS FOUNDATION TRUST
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SUSSEX COMMUNITY NHS FOUNDATION TRUST
Community healthcare and technology digital transformation
“I WOULDN’T SAY THERE WAS SOME FANTASTIC DESIGN BEHIND MY CAREER, IT HAS PROBABLY BEEN JUST A FORTUITOUS OPPORTUNITY” DIARMAID CREAN
CHIEF DIGITAL AND TECHNOLOGY OFFICER, SUSSEX COMMUNITY NHS FOUNDATION
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. 6
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“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.
DIARMAID CREAN TITLE: CHIEF DIGITAL AND TECHNOLOGY OFFICER INDUSTRY: HEALTHCARE LOCATION: UK
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
EXECUTIVE BIO
SCFT runs 84 different services dispersed and spread across the whole county out of 122 buildings, ranging from wheelchair support, our immunization programme and children’s development centres with specialisms in areas such as autism and others.
An international digital leader and innovator in organisational transformation, product development, digital communications, marketing, branding and e-commerce. 26 years’ experience delivering change across both the public and private sectors. A passionate practitioner of service design. Currently obsessed with the new opportunity of advancing a part of the NHS using the power of digital, technology and data. Since joining SCFT in 2019, Diarmaid has been leading the Digital team working with all the Trust's services to help them maximise their use of the huge array of available technology and improve digital maturity of the Trust. SCFT are the 1st community NHS digital aspirant Trust.
The future of healthcare is digital
“Right now, we have a golden opportunity to shape the future of healthcare. While I don’t underestimate the challenges of the recovery phase, I’m convinced that a smarter, connected, more coordinated and universal use of technology can help. It’s key to getting healthcare on a firmer, more future-ready footing.”
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Professor Shafi Ahmed
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Connecting community health - the glue of the NHS Vodafone is working with Sussex Community NHS Foundation Trust to ensure patients have connectivity to virtual healthcare Sussex Community NHS Foundation Trust recognises that connectivity is key when it comes to the future of community health, for both patients and staff, which is why they are working with Vodafone.
Hospital at home The trust runs a service called Hospital at Home which offers remote monitoring devices which Crean describes as a “wraparound service” like a hospital setting.
The trust, which is the main provider of community health for patients from Brighton and Hove to West Sussex, employs more than 6,000 workers, clocking up 9,000 home visits per day.
“During the pandemic our clinicians were unable to go into their homes, so we deployed remote monitoring technology and managed large cohorts of patients by monitoring their vitals and carrying out video consultations. It’s a very clever piece of technology and efficient in terms of reducing our carbon footprint.
“The majority of care in the NHS happens outside of an acute hospital or GP surgery,” said Diarmaid Crean who is Chief Digital and Technology Officer of the trust. “I see us as the glue of the NHS. As we are seeing more patients being treated at home we need to ensure these patients can connect which is why we have partnered with Vodafone. “People get better at home, not in hospital,” said Crean.
Mobile device manager In order to manage the amount of laptops and smartphones used by staff, the trust partnered with Vodafone for the secure Mobile Device Manager. “This helps us manage tens of thousands of devices. The Mobile Device Manager allows us to manage all of that equipment and enables us to allow our staff to keep working. This new way of working allows the trust to drive efficiencies, said Crean. “I would see our relationship with Vodafone as being pivotal in us realising that opportunity. “The ambition with Vodafone is for the relationship to deepen and strengthen as we are such a mobile workforce.”
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SUSSEX COMMUNITY NHS FOUNDATION TRUST
STATS The number of repeat prescription requests made via the NHS app increased by 4905% — from 45,931 in January 2020 to 2,253,141 in December 2020, and the number of patient record views rose by 3,329% — from 258,404 in January 2020 to 8,603,392 in December 2020.
DID YOU KNOW...
Microsoft Teams was made available to NHS organisations for free in March 2020 (for a limited time period) to counter the increased risks associated with coronavirus.
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NHS Digital finished rolling out the messaging tool to all NHSmail users between March 23rd and December 31st, it has been used to send 118 million chat messages and to host 26 million meetings. The busiest day in 2020 was Wednesday, December 16th when there were 237,997 active users and 1.02 million chat messages – compared with 60,937 active users and 0.35 million chat messages earlier in the year on March 31st.
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buying in new and updated technology, remote working, remote patient monitoring devices, and laptops that can run new powerful applications, but 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 at 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 and digital
“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”.
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 over a 6 to 12 period, asking which technology they could adapt and then training then accordingly and supporting the adoption.
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 hospitals they can be treated using various technologies in the comfort of their own homes, which increases the likelihood of recovery. “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.
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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, 12
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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.”
SUSSEX COMMUNITY NHS FOUNDATION TRUST
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. The Trust has been using one of their systems to run seven call centres across the Trust. One of these is called ECHO and this service is used in sussexcommunity.nhs.uk
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“I LOVE THE FACT THAT THE NHS RIGHT NOW IS TRYING TO FIND OUT HOW IT CAN EMPOWER PATIENTS WITH TECHNOLOGY” DIARMAID CREAN
CHIEF DIGITAL AND TECHNOLOGY OFFICER, SUSSEX COMMUNITY NHS FOUNDATION
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 are also able to join the virtual call centre 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 digital transformation accelerate as fast as it has 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 supermotivated 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.” 14
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March 2016 Year Founded
Circa 6-7,000 Number of Employees
Circa £250m Revenue
SUSSEX COMMUNITY NHS FOUNDATION TRUST
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 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 more concern over patient care and safety. “The challenge for me when it comes to AI is the data. Computing technology has been around for a while. It 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 which 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.”
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