Will COVID-19 change the NHS forever?

Responding to a crisis

The once-in-a-lifetime impact of the COVID-19 pandemic has drawn a superhuman response from healthcare professionals across the board. From nurses to receptionists; doctors to the IT department, everyone has pulled together to keep the health service functioning in the face of unprecedented pressure. The speed at which new protocols – and even entire new hospitals – have been established is nothing short of phenomenal. But how does the health service move forward from here? Once the clapping on the doorstep has quietened and the flash bulb of the last photo opportunity has gone off, what will the long-term impact on ways of working be?

The message coming from leaders and clinicians across the NHS and social care is clear and consistent: we should not seek to return to the ways of working and approach we once knew, but to reset the way we plan, commission and deliver health and care.¹

One of the big impacts of COVID-19 is a change in how the NHS engages with people. For the safety of staff and patients, many doctors’ surgeries have vastly reduced face-to-face interaction. Crowded waiting rooms have been all-but eliminated in favour of online or telephone appointments. The introduction of remote triaging, and an increase in ‘step-down services’ provided by community and voluntary sectors have eased the pressure on frontline services significantly. It would make sense therefore to factor-in these options when looking at how the provision of healthcare returns to normal.

What’s interesting is that some of the changes that have taken place were already on the cards, or partly in progress, before the pandemic. What COVID-19 has done has accelerated them, as many who were once sceptical of digitisation saw first-hand the benefits it offers to patients and practitioners. There have also been some more ‘off-piste’ transformations. These are the small but multiple workarounds staff and trusts have found as they reacted to the changing landscape. Whether these quick, smart fixes remain in place – or indeed get expanded – for the long term remains to be seen.

How ways of working have been transformed
Like many other sectors, the COVID-19 pandemic has necessitated a shift to working from home for many healthcare workers. This is one area where a reliance on paper records can be problematic, especially as transporting them securely can be costly and cause delays. Many of the digital solutions to these challenges are already readily available, meaning workflow can continue without disruption. Therefore, trusts with strong, established workflow systems for data and document handling will be better placed to adapt. This is the ideal time for boards to revisit their IT strategies, and work with their departments to create solid, future-ready systems. Systems where consultants can pull up patient records on their screens and share and discuss them with wider teams instantly on video calls. Or ones that allow researchers to access and analyse millions of records with ease.

Ultimately, those who commit to digitisation should be able to take advantage of these slicker workflows on the front line. This means less time struggling with technology or waiting for paperwork, and more time spent face-to-face with patients. If integrated properly across the entire system, this can also contribute to reducing waiting times and improving the patient experience.

Staff, too, can benefit beyond patient interaction. For example, video conferencing can enable virtual training, taking away the pressure and stress of travel. Primary healthcare has been at the forefront of innovation in recent years, and is somewhere to look to for inspiration. The introduction of video consultations and the EPS system are both great examples and fantastic learning opportunities.The long-term view of change
These short-term, mandated changes are happening alongside longer-term shifts in processes. Going paperless has been on the agenda for many years, with the use of tablets and other mobile devices rising. The response to COVID-19 has helped to show how this sort of transition to digitisation can work effectively. Research we have carried out alongside National Health Executive has shown that staff are onboard with these changes, with 58% seeing benefits to the new ways of working, and 53% finding them more sustainable.

It is worth highlighting just how resilient the system has been too. IT systems in healthcare have long been caricatured as unreliable and out of date, and are often used as a political football. However, during the pandemic it has been clear to see that the work IT departments have done to modernise and strengthen their systems has paid off. Under incredible pressure, most systems have coped brilliantly, not just with their usual workload, but also the introduction of new digital measures like remote working and video conferencing.

A push towards greater collaboration
There is also scope for greater collaboration between different areas and trusts. The old-fashioned ‘silo’ approach should fall by the wayside to enable practitioners to find better ways of working together. A new initiative from the Royal College of General Practitioners’ Research and Surveillance Centre at Oxford University is urgently recruiting 4,000 GP practices around the country that will contribute patient data on respiratory infections, flu-like illness and suspected and confirmed COVID-19 cases. In the future, this level of collaboration and sense of ‘connectedness’ should be commonplace.

If there is a silver lining to be taken from COVID-19, and there will no doubt be others, it is that we have seen how health and care services work best when they are collaborative. The days of individual organisations working in isolation to deliver their own priorities now seems antiquated and the pandemic has shown it is time to seize the opportunity for system working.²

A hybrid future?

Despite all this promise, it’s important to remember that this isn’t just about data or workflow, it’s about people. Switching to 100% digital provision may exclude the very people most in need. Access is a problem, especially for the aged population. According to 2019 ONS figures, almost half the UK population of people 75 and over (47%) have never used the internet.³ Any new ways of working will need to take these people into account.

Care should also be taken to ensure that efforts to promote the use of online tools to access key information do not undermine equity of access and continuity.⁴

The NHS is notorious for its bureaucracy and slow pace of change, but this pandemic has shown it is capable of rapid systemic adjustments. Now, it’s crucial to learn from these experiences and adapt them into the new regulatory landscape The true impact of COVID-19 may not be revealed for many years. However, there is an opportunity to build on the progress that’s been made over the last few months. Trusts have shown how digitisation and the right IT infrastructure can benefit patients and relieve pressure on the front line. It’s important to note just how quickly this transformation took place. Healthcare. It’s vital that this agile approach is maintained.

We need to create the whole-system architecture and a national culture change that will allow these behaviours to flourish. For too long, innovation and change have been stifled, often by accident, by the lack of whole-system thinking in the way that we design and run the NHS.⁵

^References:

^{1. NHS Reset: ‘Why do we need a reset?’}

^{2. Will Pett: ‘Will COVID-19 be remembered as the catalyst for system-working?’}

^{3. Nayarra Tabassum: ‘How are older people adapting to digital technology during the COVID-19 pandemic?’}

^{4. Sophie Park et al ‘Strengthening the UK primary care response to COVID-19’}

^{5. NHS Reset: ‘Lean, light and agile governance and regulation in the aftermath of COVID-19’}