As part of our agenda of events for the April 2021 edition of HTN Now, we spoke to Kelvyn Hipperson, Chief Information Officer at the Cornwall Partnership NHS Foundation Trust (CPFT) and Royal Cornwall Hospitals Trust (RCHT).
Here, the CIO gives us a fresh perspective on the challenges involved with tech at rural trusts, what stands out about Cornwall’s offering and all the exciting digital developments that are still in the pipeline…
Hi Kelvyn, tell us about you and what you’re working on currently
I’m CIO for the Cornwall Partnership Trust and Royal Cornwall Hospitals Trust – so a joint role across both. I’m also System Digital Lead for Cornwall, so everything about my role is set up to support through digital and move towards more integrated healthcare across the county.
I’ve been in the role for two years now, since January 2019 – it feels like a lifetime ago. I certainly didn’t expect the last year, but I don’t think anybody did. It’s been a tricky one really, in the sense that it’s been such a difficult situation for so many people. But in the sense of digital moving forwards so quickly, a lot of good things have come out of it. It leaves you feeling a bit conflicted.
Within the RCHT, we’re [working on] programmes looking at EPR capabilities [and] shared care records. We’re also looking at the applicability of EPR in wider contexts – both across Cornwall and partners in Devon. The shared care record project is actually a joint project with Devon, so we’ll both be rolling out the same service.
We’re also doing much more about communication with patients and giving patients much more control about what they do. Other than that, we’ve got about 50-odd other smaller projects that support a whole range of clinical work.
We’re just about to commission a refresh of our data centres. And that’s moving us to a position over the next few years where we’ll be able to do a mix of on-premises when needed and cloud services, as we gradually introduce those.
The other really big thing in that whole infrastructure space is that we’re building a new women’s and children’s hospital. A big part of that is making sure that from day one we design it as digitally enabled. EPR is a key aspect of that but also how we make sure that the buildings are digitally enabled.
What are you looking at, in regard to the digital architecture of the new hospital?
We’re looking at kitting it out with cables and Wi-Fi but [through] that thinking about floor space requirements in a different way, now that we’ve established more ways of remote working.
Admin staff, and increasingly clinical staff, are able to work flexibly. That doesn’t just mean homeworking – it might mean working on different sites.
This is a big part of us being a big rural county, where people have to travel for treatment, potentially to different sites. We’re very much looking at the flexibility of where people work and supporting that.
And then, of course, building into sites everything we’ve done around collaboration. We have quite a smart set-up with large-screens and video consultation kit all built around the [Microsoft] Teams kit. That works really well in terms of re-producing a whole ‘meeting feel’ – if you can get some people in a room it creates a bit of a focal point, compared to running a video conference where every different person is in a completely different place.
What’s different about the Cornwall Partnership Trust and Royal Cornwall Hospitals Trust?
As an IT service in Cornwall, we’ve celebrated – well I say celebrated – our 20th anniversary last year, but we couldn’t have a big party.
But it means, as a shared service, we’ve been supporting a joined-up network and infrastructure capabilities for a long time. We’re lucky, in that respect, that we are a lot more joined-up than a lot of other areas where every single trust is effectively a distinct entity.
We’ve also got a joined-up infrastructure support service. That core infrastructure is supported centrally. That’s influenced some of our responses to the COVID situation and our ambitions in terms of joined-up care.
There isn’t any single, special project – [what’s different] is more around our ambition. Every area that we look at, we look at it from the point view of ‘what’s the best that we can do in that space?’, which links with the broader clinical strategies.
Recognising that there are a limited number of providers in Cornwall, people have less choice. People in the east of the county have a choice in that they can go to University Hospital Plymouth. But [for] a lot of the county – it’s actually a long drive just to Truro – in a world where people don’t have those choices, we should be doing the best we can. Our digital choices reflect that clinical ambition.
That also aligns with national strategies in terms of things that NHS Digital are doing. We committed very early to NHS Digital’s vision for [Microsoft] Teams and Office 365. We’re constantly biting at their ankles in terms of ‘can you roll out the next bit of functionality?’
Again, for a small area, we figure very high up the league tables in terms of the amount of use. We went pretty much overnight from almost none of this to everything being run on Teams and people were suddenly no longer driving.
How has being a rural trust impacted the past year?
We got a lot of great feedback on the video consultations. And, again, some of that feedback has been around saving people traveling time and the inconvenience of finding somewhere to park.
That absolutely aligns for us as a rural county. All of these things really play out for us. And, actually, we’ve signed up for the climate change emergency [commitment] – recognising how this all contributes to reducing the carbon footprint of the health service.
How did you tackle pandemic challenges?
Clinical colleagues absolutely embraced the need for technology to support the things that they were trying to do. That developed a really strong call for things like virtual consultations and collaboration. Because of that response and the way that was structured, pretty much everything we did was as a system-wide response. Organisational boundaries were very much broken down.
As you know, we got ‘highly commended’ in the HTN Awards, which recognised that system working – which was really nice to see. It was lovely for everybody, as we all felt we were working well together.
What else is in store for the rest of 2021?
The patient-first aspect. In terms of giving patients more access and control, digitally. The patient portal – that’s a big part of our work going forwards. We’ve started now with a small COVID response, with some [tech] called ‘I’ve Arrived’, so that when people do need to come on site, they can send a message from their handset and that goes through to the clinic and they are then able to coordinate getting them in with minimal contact. It’s really helping.
It’s all about the patient feeling more in control of the situation. We’re going to be expanding our portal capabilities to start to give them control over appointments. And we’re starting to build in the shared care records project, so that they can start to see information and interact with that.
That’s all then starting to get us thinking about digital inclusion. Because, again, Cornwall is one of those places that’s diverse in the sense that we’ve got areas of real deprivation that quite often tie-up with digital inclusion, where people don’t have access to technology.
Of course, though, then we’ve got people who have access to a full range of technology. We even have an interesting one where, in some cases, we’ve got people who have all the equipment but [in] places where there is actually a poor coverage spot. You have people who have the capability to access these things but haven’t got a signal.
Thankfully, that’s not as common as you might think. But we’ve got to work on understanding that variability. One of the things that can impact on people’s engagement with digital is the reliability and ease of access.
You can have 100MB fibre broadband in one of the major town centres and little more than a mile or so away, there might be a little hamlet in a black spot. You’ve got to be careful not to have preconceptions in the access and inclusion space. That’s something we want to do a lot more with, with council and sector colleagues, to understand that better. Some charities do a lot of great things in regard to [digital] training.
Is that something you have to take into consideration with staff, too?
Yeah, it’s something we’ve been thinking about, looking to develop our staff training. You could say we tended to do the traditional thing of training people on a specific system. But I think there needs to be a broader element of being comfortable with digital capabilities. Because, of course, you can’t train for every scenario so there is more to be done in terms of building people’s confidence. So that when they see something that is a bit different, they can handle that.
As a leader, what have your challenges been this year?
Things never stay still. Having needed to get people remote working to reduce footfall or to protect people, it’s not then ‘job done’ at that point. We’ve found lots of people have really enjoyed that way of working – but not everybody. You’ve got some colleagues that felt some isolation, so managing that situation and managing that reset back to ‘the new normal’. Helping people adjust to that is something we’ll have to do over the next few months. That said, the overall response from everybody has been incredible.
In the mid-2010s I was involved in scenario planning for global flu pandemics…and local things in the past like the ‘Beast from the East’. While it’s never the same, those scenarios involved getting people home working. So, it’s not like flexible working was so alien that we couldn’t get our heads around it. We knew it was the right thing – the challenge was, how do you do that really quickly?
Things like virtual consultations were in the strategy and you think you’ll be doing that over the next couple of years, but it happened in a matter of weeks. The lesson is more that it really surprises you how you can do things much quicker. There’s this perception that technology moves really fast – and it does, when everything comes together in the right circumstances.