On day one of our April 2021 HTN Now webinar series, we heard from Torbay and South Devon NHS Foundation Trust and HCI (Health and Care Innovations LLP) about their digital partnership and how their multiple conditions app, CONNECTPlus, fits with the trust’s 2021 transformation strategy.
Adel Jones, Director of Transformation and Partnerships at Torbay and South Devon and Richard Wyatt-Haines, CEO and Founder of HCI, linked up to present and chat about the benefits of joint working and shared digital challenges.
Adel kicked off the conversation with a little bit of background about Torbay and South Devon – which is home to one of the oldest acute hospital estates in England, dating back to 1928 – and how it came to be an integrated care organisation.
“We’ve been working at this for a really long time but it’s all predicated on really strong partnerships,” she said, highlighting how collaboration has been a crucial part of the trust’s history.
“If we look to our future, actually having one of the oldest buildings in the country, we’ve got a huge opportunity through our new hospital programme – we’re in the second wave [of that] – and our ambition is to transform our services. Building on those provider collaborations with our local NHS colleagues but also our place-based collaboration, really building on that prevention programme, using ‘digital first’. Making sure that, through digital, we are fully getting the benefits of prevention and putting people in control of their care.”
Richard asked Adel to elaborate on the trust’s history of innovation, too. She continued: “We’ve got national leading day surgery procedures, we’ve got the lowest length of stay in the country – or one of the lowest – and our bed basis is very, very low and that’s about our innovation in community design.
“With innovation, what we’re really great at is thinking up great ideas and putting those into place and making that happen. What we’ve learnt along the way, is that is a different skill to adoption and spread and really getting the benefits. We’re a hugely innovative bunch of people but with that comes, perhaps, a lack of discipline.”
Richard added: “I guess that’s where, in a way, we came in, isn’t it? As an example of that, HCI came into being [when] we’d done some pilot work together looking at how could we use short video in pathways of care?
“We started playing with it initially in paediatric day care surgery, then hip and knee joint surgery. And we what we saw immediately was what we were expecting – patients’ anxiety levels would drop. We also thought we’d see a difference in terms of patient participation in their journey of care, and we readily saw that.
“Alongside it we then saw the ability to reduce the number of appointments – and shorten appointments,” he stated.
By providing patients with videos to watch at home, to help with areas such as rehab, Richard went on to say that they found “if we used video we could actually prevent some appointments taking place…that’s how we started.”
The partnership and its joint venture sprang from that, but Richard added that the initiative is – and can be – much broader than that, being “not just for the trust, for the nation really, because we knew this was transferable.”
Combining HCI’s skill-set – the building of technology and apps, and commercial know-how – with the trust’s innovative thinking and clinical knowledge, was key in the development of the NHSX National Video Library and the CONNECTPlus app.
Explaining that patients often have “multiple conditions” and want everything in one place rather than across individual apps, was what led to the partnership’s move across to embrace digital as well as video.
“The critical bit for me is that we ran some co-design events…our clinical staff and patients ran sessions where those people with multiple long-term conditions were able to tell us exactly how it is for them”, added Adel. “What they said to us was ‘we want one digital platform’.”
Praising how HCI can act “more nimbly” at times, Adel highlighted how the two organisations were able to work in a complementary way, due to their shared ethos, despite occasional differences in approach.
“We can make stuff happen”, stated Richard, stressing that the trust’s “rigour” was just as important as their pace.
“We both have this shared set of objectives…we understand your need to transform and we need to achieve that as well,” he said.
Moving onto what they’ve achieved together so far, Adel delved into how their use of the education videos had led to a reduction in appointments in areas such as pre-diabetes, podiatry, physiotherapy and maternity.
This led, interjected Richard, to “the sponsorship we’ve had over COVID from NHSX…where we’ve got this national library that has been available to everybody to use to support their pathways of care.”
After surveying service users throughout the pandemic, Richard commented that 62.5% of respondents had said using the videos had saved them further need for contact with healthcare professionals. That project provided reach across the country, from Torbay all the way to trusts in Sheffield and Liverpool
Looking to the future and their challenges, Adel said, “We have a significantly ageing population…our COVID backlogs are now enormous…we’re no different to anyone else, [so] there are some significant risks for us if we don’t transform what we do.”
Adel also explained the scope of the challenge – encompassing an increase in demand, as well as financial pressures, the need for embedded procedures, enabling care closer to home and remote delivery. One of the main aims, she said, was “to maintain that pace” of change harnessed throughout the pandemic.
But, having spoken to local patients, Adel stressed, “People are telling us that they’re happy to be part of this transformational change…we’re really looking at a ‘digital first’ approach to our transformation journey…we’ve got an opportunity to really utilise our partnership with HCI to make our services better for our local people.”
Focusing on the difficulties of change and adoption, Adel shared her learning that “you can have the toys but if you don’t change the process or pathway within which the digital tool fits, actually you don’t get the benefit.”
Turning to the solutions, conversation turned to strategies, empowering users to engage and ensuring the trust also focused on those who may be ‘digitally excluded’. Richard picked that thread up, emphasising that national objectives around reducing outpatient appointments by 30% can’t be expected to occur without giving those patients the right information.
“They need information…in a way that’s accessible,” he explained. “We started in long-term conditions and then we had the opportunity to… [say] this reaches as a well into pan-care. Now we’re looking at that ability to look at hip and knee replacement – there’s a massive pent-up demand up there.”
Crucially, however, Richard also brought up the need for information and resources to be bespoke to trusts and local community areas.
“You, your team [are saying] ‘what’s the scale of the opportunity’…[but] your team would also say, ‘it’s got to be our localised pathway of care, because what we do here is unique to Torbay’. We had to build so that we could tailor it locally to every trust we work in. Whether you’re in Sheffield or in Gloucester, it’s going to be yours.”
Quizzed about app functionality and scope and how the technology is patient-focused, as part of an audience Q&A session at the end, Richard added, “the app can contain as many conditions as you want…for the individual patient, they switch on only the conditions relevant to them, so feels like their app.”
While Adel concluded the session by offering to share her trust-perspective on the technology with any interested audience members.
Watch the full webinar below, to find out more about the partnership and the challenges they faced.
