In March, independent health think tank The King’s Fund ran a digital session on ‘patient and user engagement in the delivery of virtual care’.
Supported by NHS South Central and West CSU, the event featured a panel of presenters who discussed whether the acceleration of innovation during the COVID-19 pandemic had been inclusive and patient-centric.
The speakers included:
- David Maguire, Senior Analyst, The King’s Fund (chair)
- Tara Donnelly, Chief Digital Officer, NHSX
- Marco Francis, Technology Enabled Care Lead, Bristol City Council
- Preeti Mehta, Senior Project Manager – Digital Transformation, South Central and West CSU
- Graham Prestwich, Lead for Patient and Public Involvement (part-time), Yorkshire and Humber Academic Health Science Network.
David got the chat underway by questioning “what the effect has been for patients and the public” after the pandemic response led to “a completely different way of delivering services”.
After introducing themselves and their roles, the panel went in to address the big questions. First up was Tara, who was asked how the “national picture” interconnects with “local implementation across regions”.
“What we asked is [for] regions and ICSs to come up with the areas they were most interested in scaling in remote monitoring,” she said. “We went very much where the energy was locally and that might be why we’re still getting such great traction with the scheme.”
Examples included a project on Teeside that turned smartphones into ECGs, so that patients with serious mental health conditions didn’t have to go to hospital during the pandemic.
“Every region is doing something in care homes, which we’re delighted about,” she continued.
“There’s been lots of pockets of innovation – [when] it gets really exciting is when impacting long-term condition pathways.”
Although, she said, it was all “very much led locally”, with NHSX “providing investment support for implementation and a way for that community to get together and share ideas.”
Speaking of his team at Bristol City Council, it was Marcus’s turn to explain how he focuses on patient engagement.
“We as a tech hub…instead of trying to just simply have a problem – say someone’s at risk of falls…[we don’t] just put a piece of tech in for that one absolute problem. We do everything now, discussion-based and problem-solving based, with the service user.
“We’re now talking to the service user and saying ‘how can tech help you? What could we put into your house that could be able to assist you to be more independent at home?’
“There might be times when somebody could come in for one problem but then it turns out that they actually had five other issues that they also need addressing,” he added.
Switching over to how to involve service users in the design and delivery of virtual care, Graham gave his top tips, acquired through his experiences as a Lead for Patient and Public Involvement.
“Firstly, involvement in service design and re-design requires…involvement at an individual level, involvement at a community – a community of people with similar needs – level and, finally, at a population level,” he said.
Graham also highlighted the need for people “not to make assumptions”, and for clinicians to ask, “what does my patient know that I don’t know?”
“Often missed out is including patients in choosing the measurements of success that really matter, rather than those that are convenient for organisations,” he noted.
Tara later discussed who was being offered different services, explaining: “In the NHS we’ve been making a lot of assumptions and guessing what kind of technology people might have at home – and also what they might prefer. I think the time for doing that is really over and that it’s important to make a digital offer to everybody.
“Digital offers should be made and then let’s see who wants to take them up…video consultations and digital pathways are going to be here to stay, we hope.
“The very best products, as I say, really make a point of this,” Tara added, “I was just recently looking at some stats from Baby Buddy, which is a great app for pregnancy and very, very clearly the highest users are people for whom English is a second language and people with causes of deprivation…are watching these videos and finding these resources more useful than the kind of middle class, affluent white citizen that often other digital projects seem to be aimed towards.
“The projects that make the difference get there, and they close the digital divide, which is really encouraging. We just need a lot more of those.”
Turning to joining up services through technology, Preeti added her thoughts on user engagement. “The lessons we have learnt…is engage your users from the start, not after the process has been implemented…listen to friendly users, as well as your worst critiques. There are bound to be users who don’t like your system for a variety of reasons. And taking their input on board is equally important…we make sure we go to everybody – not just our ‘friends’, but the people who are not using it.”
Summing up later, Preeti said: “Respect your users and don’t assume for them. Ultimately, patient is first and patient knows best – that’s my learning from today’s discussion.”
Marco concluded: “Technology is getting better…if we all come together, we can have a conversation and we can all learn from each other. We think that things can be improved very rapidly and it can not only help the practitioners but also help [those] in the field supporting these service users.”
If you’d like to catch up on the full event, visit The King’s Fund online.