Clean Digital Clinic and Telehealth

Interviewee: Sarah Bowman, Director of Recovery, Rotherham & Doncaster & South Humber NHS Foundation Trust (RDaSH)

The position of Director of Recovery is a new temporary position created in order to focus on recovery, reset and transformation.

Approach/Methodology

Despite the significant impact across health and care services in the initial pandemic surge, the aim was to avoid service suspension wherever possible. It became clear very quickly that digital interaction could improve the resilience of services by providing a safer alternative to face to face care whilst preserving service delivery.

This was a challenge as the Trust was not digitally mature, but informatics, IT and change teams worked together to enable the use of new IT platforms and technologies and support staff to change traditional working practice to be able continue to clinically engage with patients for the ongoing delivery of care.

However, in mobilising this it was also identified that digital exclusion could become a major barrier for certain vulnerable groups who may not have the equipment or expertise to engage in this way.

Digital exclusion was focussed on as a priority and testing of a potential solution began – A Clean Digital Clinic: Setting up an isolated clinical space with a desk and tablet device.

Impact

The immediate impact was the ability to support ongoing care to those individuals who were:

Considered to have increased vulnerability where face to face interaction was not preferred or recommended
Did not have access to technologies to support digital engagement (as we support areas of particular deprivation)
Did not have skills to use technologies such as virtual platforms, nor support to do this

Ultimately, this prevented an unnecessary growth in patient access waits and maintained service provision at the point of need.

Early barriers were experienced where uptake was lower than anticipated. With support to increase the awareness of the initiative and the protections that would be afforded in using this solution, as well as an opportunity to test this and allow experiential acceptance, uptake is improving.

Formal evaluation is ongoing to provide a full and thorough review.

Next Steps

Digital exclusion remains an area of priority and further solutions are under exploration, particularly as the “digital first” approach is one that will be sustained in the longer term, not in the place of face to face, but as a complementary alternative, improving flexibility and access.
A secondary solution is already under exploratory assessment – A system for loaning telehealth equipment for those who have IT knowledge but no access to equipment.
Assuming this provides positive potential and possibility, this is expected to be initiated during the Autumn period.

Wider Areas of Learning

One of the more general areas of positive learning was around the enhanced health and wellbeing offer mobilised for staff during our pandemic response.

This included a stepped model of support, access to a psychological wellbeing hub, mobilising of wobble rooms and a focus on humanistic support alongside more traditional professional and managerial support channels.

Feedback has been overwhelmingly positive and as such, the enhanced staff health and wellbeing offer has been extended with utilisation of charitable funding, including those contributed by Captain Tom Moore.

Further learning included changes mobilised to respond to the National mandate around discharge and making sure we cared for as many people as possible in the community. This has been a core focus for many years but action was accelerated in our pandemic response. More complex patients were supported in the community by home-based treatment and crisis support teams in mental health services; and rapid response teams in community services to mobilise the home first model of care.

Increasing care in the community was supported by the initial redeployment staff to manage increased demand. Around 100 staff in total were redeployed at the peak of the initial pandemic surge.

From a sustainability perspective, it is now critical that we use the learning we have seen from the pandemic and work with commissioners and partners to define what services should look like to deliver this ambition longer term. It is also critical that we maintain this position culturally as the major incident catalyst starts to subside and with it the risk of shifting back to traditional ways of working.

Alongside the digital first approach, we have also significantly changed the way we work to fully mobilise agile working practice. The trust were already well progressed in mobilising agile working across clinical community teams, however the degree to which this was stepped up and scope of use across clinical and corporate teams was successfully extended.

This has directly contributed to keeping our people safe, enabled engagement and support networks and supported new ways of working outside of traditional NHS sites. We also expect that this may support a very different estates profile in the future. Whilst this way of working has not suited everyone, this has on the whole received positive feedback from both staff and individuals using our services.

This has included positive feedback on the new live virtual mandatory training sessions, particularly in reference to improved accessibility and positive engagement.

We are working to ensure that alternatives are in place to respond to individual circumstances but this is certainly a shift change the trust will be looking to maintain at a much heavier degree in the future, especially considering our extended footprint.

In more general terms, the pandemic focus has reinvigorated a culture of innovation across all levels of the organisation. Staff have responded to the situation as it changed, adapted approaches and most importantly kept the patient and their families at the centre throughout it all.

Enhanced support has been offered to carers, recognising the potential increased burden from interrupted care more widely across health and care. This has included opening up channels to talk as well as supporting families through socially distanced walks where traditional day services were suspended.
New self-care enabled products have been utilised in services such as Woundcare to improve independence in a safe and effective way. Telehealth technologies have also be used to support self-management of physical health and long-term conditions such as diabetes.

Testimonial

The test now for all of us is on taking the collective learning – the best bits from across health and care – and transforming services to create a more adaptive, responsive and digitally supported NHS. Utilising the ‘Adopt and Adapt’ methodology to drive change collectively, efficiently and consistently.

– Sarah Bowman, Director of Recovery, Rotherham & Doncaster & South Humber NHS Foundation Trust (RDaSH)