What can we learn from how the vanguards have harnessed technology?

Source: NHE Nov/Dec

Ella Jackson, policy advisor at NHS Providers, shares the top 10 tips that providers and commissioners can learn from vanguards when it comes to adopting digital technology effectively and efficiently.

The health and care sector is abuzz with activity to move to new models of care and develop new ways of working through sustainability and transformation partnerships. Over the last two years, working to the blueprint set out in the Five Year Forward View, 50 vanguard sites have been redesigning the way care is delivered in order to provide more efficient care that better meets patients’ needs. Behind the scenes, there has been a quiet revolution in digital technology taking place among many of these vanguards.

Digital technology can underpin and drive care that is truly integrated around the needs of people – breaking down the historical barriers between primary, secondary and social care services. At NHS Providers we are working with the Local Government Association, the NHS Confederation and NHS Clinical Commissioners to share the learning from the vanguards. Our recent report explores how a number of vanguards have harnessed digital technology, the impact this is having, and what the wider health and care sector could learn from them. 

Highlighting excellence

The vanguard programmes reflect the array of opportunities for using digital technologies in health and care. In Morecambe Bay, the Better Care Together vanguard has set up a video link between a GP surgery in Millom and Furness General Hospital Emergency Department from where clinicians can carry out a triage remotely via video, if clinically appropriate. Patients who call NHS 111 on Saturday mornings and require clinical attention are offered the option of a video link consultation from Millom Community Hospital with a GP at Cumbria Health on Call, based in Carlisle. These initiatives are helping some patients avoid the two-hour return trip to Furness General Hospital.

Better Together Mid Nottinghamshire vanguard has rolled out a telehealth tool called ‘Florence’ (or ‘Flo’) that sends text messages to a patient’s own phone to remind them to take their medication or send vital sign readings to their clinician using integrated biometric devices.

The roll-out of Flo started in Nottingham in 2012 in heart failure services. The evaluation showed that in 2013-14 the project resulted in a 35-48% reduction in home visits by the heart failure nurse team. When Flo was extended to the ADHD clinic, non-attendance at clinics reduced from 55% to 0% among patients using the tool. Mid Nottinghamshire vanguard has been able to build on these successes to accelerate the pace of the programme.

As well as playing a part in supporting people to stay well at home and receive care closer to home, digital technology has the potential to support more flexible and efficient use of the workforce. The Salford Together vanguard is an integrated primary and acute care system (PACS) which involves the council, primary care, secondary care providers and commissioners.

The vanguard is working towards becoming an integrated care organisation (ICO) with Salford Royal NHS FT in the role of prime provider for all adult health and social care services. The ICO also commissions mental health services and has responsibility for domiciliary and nursing home care.

As part of the vanguard programme, 450 adult social care staff transferred across from Salford City Council to Salford Royal, creating a new team of health and adult social care workers. This presented the significant challenge of integrating adult social care staff onto the trust’s IT system, including transferring their email addresses and providing access to the acute electronic patient record, while still retaining access to their core council systems.

A new population health management platform and electronic health record solution which enables staff to electronically record and track decisions about patient care is helping to make the transition to the new model of integrated care and share data across disparate systems, while providing frameworks that allow each organisation to continue to address their specific population health priorities.

As part of our programme to share the learning from the vanguards, we have asked vanguard teams to share what they have learned and what they would advise other areas looking to adopt digital technology. From this we can offer 10 top tips:

  1. Steal with pride. Technological solutions don’t need to be new or bespoke, so long as your infrastructure is supportive. They also don’t necessarily have to be fully integrated, but do need to be interoperable with existing systems – the telemedicine solution at Morecambe Bay sits on top of the existing network infrastructure;
  2. The starting point for any project should be the perspective of the end users. Both the technological solution and the plan to introduce it should be co-produced with people who use services and clinicians. Working in partnership with patients and clinicians can help to identify, and mitigate, any likely barriers to adoption;
  3. Identify and work with enthusiastic clinicians, and communicate with them regularly. For many vanguards, engaging clinicians has been fundamental to their success. Better Together Mid Nottinghamshire recruited a clinical champion who has advocated the use of Flo among their peers;
  4. The introduction of new digital technologies requires a corresponding shift in mindset and culture among staff. Conversations about ‘what matters to you?’ and subsequent personalised care plans can be reinforced – but not replaced – by technology;
  5. Programme teams should plan for the ongoing training and support needs of users. These do not stop when the project goes live;
  6. Integrating connections between organisations’ networks is likely to take considerably more time and effort than anticipated. Recruiting a strong information governance lead who can advise on all IG issues relating to clinical safety, patient safety and data sharing issues is critical;
  7. Existing contractual models can frustrate attempts to move to new ways of working. Contracts and payment systems may need to be redesigned to incentivise new approaches, like remote consultations, which needs providers and commissioners to work together to find creative solutions;
  8. IT and clinical teams should build the vision for the technology in partnership. IT teams need to understand what teams require to do their jobs, while staff also need to understand what is and isn’t possible. In Salford, the IT team tackled this by holding open days and workshops with staff;
  9. Collaborative relationships within and between organisations are fundamental to successful change programmes. Vanguard teams have put in considerable effort to engage colleagues and develop strong, trusting relationships. Work with your local partners – CCGs, local authorities, the voluntary sector – to make sure that everyone is connected and work isn’t duplicated;
  10. While technological solutions don’t always need to be bespoke, they do need to be considered within the context of local needs, and anchored to wider change programmes across organisations and whole health and care systems.

The vanguards have been demonstrating the potential for digital technology to enhance existing services. Of course, digital technology is only a means to an end, not the end in itself, but it can be a powerful hook and catalyst for change. While adopting new technologies in the health care sector presents a unique set of challenges, our report shows that it is possible to overcome them, and for digital technology to enable more efficient, integrated, precise and personalised care.


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