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The impact of digital solutions and technology
We looked at digital and technology initiatives in responding to COVID-19 and the impact they have had in terms of organisations working together.
Before the pandemic, we know that the safe use of technology in health and care services was making a positive impact on many people’s lives. In some places, the pandemic has accelerated the use of technology, and it was rolled out at pace, quickly advancing digital solutions to support people’s care in areas where there was previously reluctance.
Digital systems opened up access to virtual consultations and clinics, as well as allowing relatives and friends to have contact with people who use services and those shielding in adult social care settings.
They allowed oversight, advice, online prescribing, and data-driven decision-making around service delivery, and aided information sharing – including individual patient records and shared treatment plans.
Video conferencing within the system enabled improved communication – this helped share learning and information quickly, including records. More joined-up work was possible between teams and this improved how patients were managed.
However, IT systems were sometimes a barrier – not all services had a digital presence, and not all people had online access. There were some concerns about the pace at which systems were implemented. Some staff still didn’t feel confident using the new digital systems while some patients struggled to adapt to using the new digital systems, which led to missed appointments.
Some providers (especially larger ones) were already well set-up with the right hardware. This made it easier to move to remote consultations, with good communication and better information sharing. Others had to procure equipment – sometimes it was the CCG or ICS that provided laptops, tablets, and webcams, and sometimes it was the provider.
We heard that a lack of equipment (computers, tablets and webcams, and/or a lack of funding for equipment – particularly in care homes and for smaller dentist and GP practices) made it more difficult for them to jump straight into remote consultations and communication. Also, poor wi-fi or no wi-fi was a problem in some places.
We heard positive comments about common access to the central NHS email system, which is now also available to care homes. More NHS email accounts have been created to enable safe exchange of information – one comment described how the NHS email account meant it had been easy to share records, such as discharge assessments, discharge letters and medicine charts between the acute setting and the care homes. We also heard from some dentists who said they used NHS email for sending prescriptions to pharmacies and to receive pictures from patients. However, access and use of NHS email wasn’t consistent in every system we reviewed, with one system noting that full implementation across the ICS would improve digital interoperability.
Among the main reflections across all of our reviews, there is a call for further development of a common integrated care record across care areas, with national support, across the system. People say this would enable much better information sharing and collaboration. However, while further development of an integrated care record is a priority area, there were uncertainties about who could access it. A statement by the Information Commissioner's Office has helped, in which they said they would take into account the compelling public interest in sharing information during the pandemic in decisions on the interpretation and enforcement of the General Data Protection Regulation.
While the majority of people we spoke to indicated they were assured about the safety of digital and technological innovations shared across health and social care providers, information governance issues were raised in light of the pace at which systems were implemented. Security concerns were raised around the use of video-calling apps such as Zoom, and some staff resorted to personal IT equipment, such as laptops, for work with patients, which also may pose a data security risk.
Advanced IT and technology did not always assist with efficient and timely access to care for people
Across the areas we reviewed, technology has enabled remote healthcare as a replacement for familiar face-to-face care. This has included remote triage, appointments/consultations, ward rounds and prescribing. It also included some remote services for people living in care homes, using a variety of apps, platforms and systems.
Generally, this has been seen as a positive development, helping people to access care during the pandemic. Services told us they got positive patient feedback, and that some form of remote consultation would be likely to continue in the long-term.
In some cases, moving to remote care has been beneficial compared with face-to-face consultations. For example, some people with social anxiety have found a video call with their therapist more productive than a face-to-face meeting, and some people who had struggled to get to GP or other appointments have benefitted from faster access to health care. Many older people were able to use online services, either on their own or with help – it was not necessarily the case that older people found it harder to access health and social care digitally because of their age.
However, it was acknowledged that remote care would not be appropriate for certain clinical scenarios and there was some concern that this could prevent other medical or social conditions or safeguarding issues being spotted. We heard that for some people, remote care will never be appropriate or work safely. For example, some older people (especially people living with dementia or visual and/or hearing impairments), accessing and learning about new information technology can be stressful or impossible. The impact on patients and their treatment from remote care is yet to be fully understood, and it needs to be monitored and reviewed.
We heard how people’s first experience of digital care was important, how it can be hard to get people back on board if their first experience was not a good one. In addition, some people are less digitally literate and need to be supported by friends, family or care staff to access healthcare digitally. Websites in English-only could be a barrier for people who do not read English well.
We also heard that caution is needed when directing people to ‘digital-first’ services – some older people saw signposting to online support like a door being closed on them, and it was important to retain alternatives to digital or online appointments. Feedback from Healthwatch suggests that some people may have “fallen through the cracks” – patients who wanted to access a service but may not have met the relevant criteria in the options within the primary care digital triage tool.
Enabling virtual appointments in areas of deprivation
In some areas, providers helped one another to access necessary IT equipment. In Devon, we heard how larger providers helped smaller providers with equipment. In Lincolnshire, we heard how access to digital technology was limited in some places – or there were specific areas of deprivation – so offices were provided where people could access IT equipment, where they could have virtual appointments. And in Sussex, we heard about a coordinated approach to ensuring that providers had access to the digital equipment and training they needed.
Accelerated and shared digital approaches supported providers to work together and keep connected well
Care providers needed to adapt quickly so they could effectively communicate with one another in local systems, and with people who needed their services. Within individual workplaces and between system partners, the move to online communication, hastened by the pandemic, has been very well-received by the people we interviewed. A positive example for some was the time saved by not having to travel.
The use of video and messaging software in the workplace to hold meetings, communicate and deliver training was thought to be time-saving and effective by many. For some organisations the change was described as revolutionary. Online meetings between different providers or system partners enabled collaboration and information sharing in, for example, primary care network meetings or multidisciplinary teams.
However, we heard how online meetings led to a loss of staff cohesion in some cases, as well as increased tiredness and back-to-back meetings that meant less time to digest information.
Some providers with residents or inpatients provided people with equipment such as tablets or phones, or they supported people to communicate with loved ones. For some people this also improved their digital skills and confidence. However, some residents needed significant support to use digital platforms – and some people with dementia were unable to share the benefits.
We have heard from many across our reviews about the way local systems have gathered and shared information in response to COVID-19. Providers used digital means to share care records and individual patient information both internally and with system partners. There were a number of dedicated platforms for them to do this, including some well-established electronic systems. Those providers or ICSs with existing systems appear to have fared better than those who have had to establish them more recently.
Some systems also collated and shared information to build an understanding about the wider population, such as data to identify coronavirus hotspots or information on people who were shielding during the pandemic. We also heard how shared information about vulnerable people provided a safety net, including an example of a database that enabled food to be sent to people identified as being vulnerable.
However, some places had a less joined-up experience, especially where there was no shared or electronic system. Some local areas struggled because their own technologies would not work with partner organisations. We heard of examples where referral systems did not successfully link together. There was recognition that more work was needed to develop system-wide integrated care records.
Oral health care
Our collaboration reviews included work to find out how dental services were provided during the early stages of the pandemic.
Access to dental care became a problem when lockdown occurred, as dental practices were advised to provide advice, analgesia and antibiotics where necessary to treat infection. Where possible, this was to be provided over the telephone. Where active treatment was necessary, practices were to refer patients to urgent dental care centres. Some places responded quickly to set up urgent hubs as they had well-established system relationships. Others took more time. We were told how managing people’s expectations of what was classed as ‘urgent’ was initially difficult and that affected some people’s mental health.
We found that despite the challenges, community dental services with their specialist teams continued to provide services for the most vulnerable, making them the ideal place to set up the urgent hubs. In most places, community dentists provided training to care home staff in line with government and Public Health England guidance, and they provided easy access for urgent questions and advice.
We also found that high street dental practices adapted their working patterns to accommodate and make vulnerable people feel safer, for example seeing them at the start or end of the day when there were no other patients in the practice.
We heard across the reviews how there was a more specific focus on care provision and support for vulnerable groups – for example, in rural communities, for homeless people and people from Black and minority ethnic groups.
We heard PPE described initially as a huge challenge and access to ‘fit testing’ to make sure staff have the right type of well-fitting PPE remains a concern. Generally, there was prompt implementation of a coordinated approach and infrastructure to ensure that PPE was available for the urgent dental centres. We heard that where local systems took the lead for PPE, this was managed effectively between local dental committees (LDC), local dental networks (LDN) and Public Health England.
We heard general concern that national messaging could have been more effective and timely. Sector expert groups worked to pull together local guidance. National guidance was described as “difficult to follow” and as coming from several, sometimes conflicting, sources. LDCs and LDNs told us they translated this guidance to ensure it made sense for everyone.
Looking at shared planning and system-wide governance, oral health in most areas was not seen to be an integral part of the system – this included joined-up technology access and development of system-wide governance, such as development of online consultations.
LDCs and LDNs were central to communications – updates were emailed directly to all registered providers. Protocols are now in place and learning has been shared so systems are now better prepared. We also heard about good joint working between local leaders to simplify medicines-related governance.
Dental providers were proud of their staff and said how well people had adapted to a new way of working. In ensuring safety of staff, and looking at health and care skills, we found:
- Employees felt supported through training, shared experiences, technology and online groups.
- Regular communications ensured staffing levels and skills shortages were monitored.
- Support from employers was offered in different ways, such as risk assessments, counselling, bereavement services and team meetings. In one area, there was a team baking event on Zoom, so that people furloughed still felt included.
- Some dental professionals supported acute services, testing sites and NHS 111 triage. We were told in areas where oral health staff worked in hospital settings, people’s oral health was monitored, and training was given to staff for continuity.
Technology assisted oral health care responses. We heard how many people over 65 were able to use technology to access information and services. They recognised the benefits and value in virtual consultations – they were satisfied with remote appointments and we heard they would be happy to use these appointments the future. In one area, a reported barrier was clinicians not wanting to use a digital option due to privacy and difficulty in diagnosing.
There were some issues for dental practices, such as not having access to the electronic prescribing system. We heard this caused problems at first, when practices were trying to reduce travel and face-to-face contacts. We heard that improvements could be made to integrate oral health in future. Other findings included:
- Use of NHS email across health and social care services was inconsistent – full implementation across all dental practices would improve consistent communications.
- Dental providers have a lack of access to summary care records and this has been a continued barrier to ensuring people can move through a system effectively with one record. In Cumbria and Lancashire, they told us they had developed an urgent referral tool that linked to the summary care record to ensure the best continuous care for people.
- Last updated:
- 15 October 2020