Having spent the past year working on virtual ward design and implementation at the ICS level in the NHS, here are my thoughts on how the NHS can realise the benefits of tech-enabled care at scale.
Effective supplier relations
Strong relationships with suppliers are key to success in every industry.
The procurement frameworks set up centrally ensure that suppliers meet the required regulatory standards before getting in front of buyers at a local level.
However, the details within the service agreements and contracts between Integrated Care Boards and suppliers need careful consideration by a business and commercial head.
Where else do you pay upfront for services or products that may or may not be used, where the supplier has not even created the local infrastructure where the solutions sit, and where off-the-shelf capabilities that don’t 100 per cent fit user needs are accepted?!
The NHS is seen by many suppliers entering the market as a ‘cash cow’ and I feel it is now milked to its limit.
Many solutions have not been built on systems thinking mentally, rather one or two clinicians (if you are lucky) have provided input into an MVP and the final product is born.
I have sat in numerous meetings where suppliers disagree with end-user needs analysis work and tell clinicians what they need to care for patients effectively. The arrogance is unbelievable!
The level of commercial acumen within the NHS business units is low and needs immediate attention.
This should not be left solely to business consultancy firms who are generally over-compensated and will over-complicate basic programmes of work, but through well-thought-out recruitment and retention policy at a local level.
These need to focus on the long-term needs of the business.
Ultimately the NHS is a commercial organisation, it needs to act and be treated as such before digital investment runs out and the population loses faith.
Co-design and stakeholder engagement
This relates to my previous point. You cannot create a solution for anyone without knowing first what they want and how they intend to use it.
It is unacceptable to guess or ignore the requirements stipulated by end users. There is no excuse for a lack of stakeholder engagement in the current climate.
Co-design should include all end-users, clinicians, patients, carers, and support staff. Suppliers should not be looking to progress past the MVP stage without this level of engagement.
It also helps suppliers understand the level of digital literacy and digital fatigue within the end user cohort. Which in term enables them to build appropriate training support into implementation plans.
Becky Warnes
Accompanying co-design is pilot studies or proof of concept/value. As frustrating as it might appear, pilot projects allow end users to see the benefits of solutions in real-world settings.
They should be actively encouraged and should form part of any proposal, together with agreed metrics to measure success and agreed on timescales.
It is from here, that if deemed successful, a solution can be scaled. The scaling of a solution should be considered at the start of pilot stage, if not before.
This allows vital information and insights to be gathered during this period and a robust business case and programme plan to be developed.
Interoperability
Each ICS is at a different level of digital maturity and that fact cannot be ignored. Although each ICS has a Shared Care Record in place, the degree to which it is being used varies greatly at this current moment.
Interoperability is key for the NHS to realise its digital ambitions.
To be working as a supplier on the NHS frameworks and to be ignoring interoperability would be naïve and a threat to your business.
Solutions that require stand-alone clinical platforms and have no data-sharing capabilities with core clinical systems add to the complexity of data flows and the screen time of clinicians and caregivers.
Interoperability and connectivity to devices is a big need voiced time and again by end users. Ignore it at your peril.
Estates
The NHS is not leading the way in virtual care as many would have us believe.
To look for inspiration and case studies, the US, Singapore, and Israel all have advanced virtual care facilities and virtual care forms part of their standard care provision.
The estate team’s involvement is needed to implement VW at scale across an ICS. It is not realistic to think that clinicians and ward teams can support a virtual ward alongside daily physical ward duty.
Separate space is needed both physically and mentally for caregivers to provide optimum care to patients and look after their own well-being.
This could even be an opportunity for the NHS to entice back those clinicians who retired early because of the demands placed on them during the pandemic.
Virtual Hospitals would provide a designated workspace that is home to a telemedicine hub and even command and control centres.
They would be an expansion of the remote monitoring hub model that is being adopted by some areas of the country and would provide care on a much larger scale.
This approach would require clinicians to fall in love again with telemedicine, something that was adopted and quickly dropped by many during the Covid-19 pandemic.
However, this presents a massive opportunity for suppliers to demonstrate the benefits of true telemedicine capabilities combined with virtual care data insights now we appear to be on the other side of the pandemic and moving away from a ‘fight or flight’ mentality.
Successful virtual ward implementation at scale involves changes to ways of working, changes to care delivery and most importantly changes to how we implement technologies in the NHS.
It requires meeting every single stakeholder at their level of digital maturity and taking them on the journey.
It should never be a standalone offering or reserved purely for the acutely ill.
Preventative medicine and post-acute care provided remotely can provide improved outcomes for patients and great data insights for population health management.
