In our latest HTN Now panel discussion, we were joined by Antonia Frost, CNIO at Sussex Community NHS Foundation Trust; Jen Tomkinson, assistant director of primary and community care development (urgent response and acute deterioration) at NHS England (SW region); and Roisin Reade, product manager at Civica, to discuss innovation in community healthcare.
The session covered how innovation supports a future model of community care, the role of digital and what needs to be the focus in order to modernise services. We also explored what good looks like, looking at short-term goals and how the recent 10 Year Health Plan will shape the future direction.
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What innovation looks like in community care
Tackling the first topic of what innovation looks like in practice when it comes to community care, Antonia explained: “Innovation is about how we solve the problems that we have in our NHS services. It’s not about introducing technology and hoping it will fix something. It’s not always about inventing something or creating an app, either. Often it’s something simple, such as using a tool we already have in a different way.” Expanding on this idea, she noted that innovation across the NHS is all about delivering existing services in “new and better ways that support our staff and our patients, so that they have a better experience of the care that we provide”.
Antonia went on to share an example from her own trust, where funding received from NHS England through the Digital Aspirant programme allowed them to create the Innovation Lab – a place where people can share their digital ideas and solutions. “There was a lot of collaboration with frontline staff and technical experts,” she explained. “They’d think about what the solutions could be and then we’d try small pilots, which was great in some ways, but we also discovered quite a lot of problems with the process.”
According to Antonia, these problems came from the procurement, compliance and making sure clinical safety and information governance were all covered. “We’ve since changed our approach and are now pretty confident about which technologies are really making a big difference, so we’re putting all of our focus into supporting our workforce in terms of adoption and developing skills,” she said.
Speaking on the type of innovation that has gone well within the trust, Antonia shared: “Some of the things that we know make a significant difference to patients and to our staff are remote monitoring and virtual consultations, as they offer real potential for us to communicate better with patients. When technology doesn’t work as well, it’s not necessarily because it didn’t do what it should, it’s just that the problems it solves are smaller, so the effort involved to put them in place might not be as valuable.”
Antonia highlighted an example of what this might look like: “If you’re using a very specific tool around heart failure, there’s probably only one service that’s going to use it. And while it might be great for them, the cost to set it up and implement the tool might not have the wide appeal that other tools have.”
For Roisin, innovation in community care should focus on educating the marketplace, where software vendors can say: “We understand the problems you’re facing and we have this great bit of software or this great integration that we think could help.” She noted how this doesn’t necessarily have to be about new software, either, stating: “We can look at things that are already in use and working well and try to integrate them too.”
Roisin also highlighted some of the important areas to focus on for innovation: “Does it make the pathway any easier for the patient because they have access to that information at their fingertips? Does it make it easier for the clinician because they’re not having to duplicate the same data in two different systems?” She added that innovation “can even be as simple as just really good, smart integration. It doesn’t have to be some whizzy app.”
As for Jen, she referenced the NHS App as a good example of effective innovation in this area: “The 10 Year Health Plan has given the very strong message that the NHS App is going to be front and centre of innovation across the NHS, which I think is really key. But we also need to consider the tech-enabled care market.” She suggested that there should be a focus on “things that are within people’s homes that support them to live independently and flag any issues they may have”, using falls technology and robotics as examples of this type of tech.
Jen also spoke about remote monitoring as a key enabler, using an example of patients at BNSSG managing their own intravenous antibiotics at home. “They administered their own medication alongside remote monitoring, which allowed us to do virtual consultations so they wouldn’t be disturbed by us coming in and visiting them,” she said. Finally, she emphasised the importance of “supporting wearables or devices that people can be using at home”, sharing how this can provide clinicians with important data that can help to support decision-making and improve innovation.
Data requirements for innovation in community care
Our panel moved on to explore data requirements in further detail, with Roisin noting the need for capturing accurate and real-life data when it comes to patient appointments. “We have clinicians, district nurses and therapists out in the field using our scheduling tool. When they arrive to do their patient visits, they check into the system, complete the visit and then check out.” Explaining the benefits of the data collected with this, she noted how organisations can now understand how long certain procedures take: “They know that they’re taking 18 minutes or 27 minutes, giving them very accurate activity data, which obviously then feeds back into their capacity versus demand.”
Roisin shared that “the more data, the better”, but also conceded that it’s not all about the volume of data, it’s also about “making sure it’s as accurate as possible and understanding what to do with that data. That’s where analytics and insights can play a part.” She added how bringing in AI is one thing, but “to really understand the data that you’re looking at and use that to guide you through clinical decisions” can offer a different level of support.
Jen noted how outcome tracking is “a really important data requirement in terms of understanding the interventions needed and driving that towards what matters to people in their own homes”. Patient satisfaction, well-being and objective clinical markers are good indicators to keep track of, she added.
Jen also spoke about population health management, sharing how even though she thinks it has yet to be used to its full potential, she believes it to be “the future of predictive analytics and supporting clinicians when flagging those who are at risk of deterioration. It can help to provide early intervention or support to people who have a long-term condition and might need something different. So, I think that aggregated data is going to be able to support us.” In her opinion, population health management can also help clinicians and organisations focus on “underserved populations through a health inequalities lens”, which she noted is a “really key bit around the data requirements that are going to be needed in the next 5-10 years”.
Support required to spread adoption and improve implementation
When looking at the amount of support required for successful adoption of innovative technologies, Antonia noted: “We hear from our board within our trust and then also from NHS England or from our ICB, about the many different improvement priorities that we have, and then the front line are left with far too many of them all at once.” She went on to share the best way to tackle this challenge is with “fantastic project and programme management, as well as support from specialist teams who can help to coordinate everything”.
She suggested that many of these programmes and projects are set up in silos where “one person is responsible just for their own area and doesn’t necessarily see the bigger picture”, adding that more coordination across programmes, particularly when thinking about the different levels of decision-making, could be more beneficial.
Antonia also emphasised the importance of fully understanding what’s involved with implementation and adoption, particularly from the clinician and patient perspective: “We might see it as doing one thing, but for a clinician or a patient, that probably means learning more than one new system and understanding how they integrate with each other. The level of implementation support is high, but there’s a need for the coordination between services to really improve that setup. And innovation should be patient-centred more than anything, so when we try to do improvement work, we really need it across different sectors and trusts in a way that works for patients and staff.”
Jen sees the implementation side of things as the most challenging part, simply because of the time it takes. She explained: “Often, we task ourselves to spread an innovation within about 15 minutes, and actually it can take years for that kind of adoption to happen.” She noted how the planning stages also don’t get enough time either, adding: “It’s really important that, where we can, we involve the people who it’s going to impact during the design stages. So, if we are changing things for clinicians by introducing remote technology, then we should be enabling them to be part of what that looks like and bringing them along on the journey, because they’re the people that will make it happen on the ground.”
In her own experience from past implementations, Jen noted the importance of thinking about potential pitfalls, sharing that some of the ones that were unexpected for her included clinician concerns around safety and governance. “We didn’t get in front of that early on and things got delayed or there was a lack of trust because we couldn’t answer those questions. So, really thinking about what the pitfalls and the concerns of staff might be before you start can be really helpful.”
Speaking as someone who has had experience on both sides of implementation, Roisin added her insights around the type of support required to improve adoption, highlighting collaborative partnerships as a key element. “As software providers, we really need to partner with the organisations that we’re working with. It’s important that we’re not just coming into the organisation to implement the technology and then leaving them to it. It has to be a long-term partnership offering support as well as aligning your clinical priorities with the implementation to make sure you’re getting the most out of it.”
She spoke about getting clinicians on board and making sure they understand the clinical priorities, “so they understand that when they go out and capture the data, that it supports the system to evidence how busy they are, allowing them to get more staff to help deliver patient care”.
Ranking and prioritising innovations
To prioritise different innovations, Antonia made a point about looking for solutions to problems based on the impact they might have on an organisation. She used her trust as an example, sharing how they have been thinking about ways to reduce hospital admissions: “We’ve focused our attention on using remote monitoring tools and setting up services around that, measuring what the impact is on hospital admissions and thinking about whether we’re focusing that intervention on the right patient groups to get the outcome we need.” She added that ultimately they want the innovation to succeed and if it doesn’t, to “stop using it and try something that will work, focusing on the data as well as the user”.
Roisin explained that part of her role as product manager means speaking to customers “early and frequently”, which requires “a constant understanding of the latest problems that people are facing and coming up with ideas to try and solve them”. She added: “I don’t think we would successfully deliver any innovation without having that customer feedback loop. It’s about getting out there. It’s about understanding the problems. It’s about what’s going to bring the most impact.”
Digital and health inequalities
When asked by the audience how to ensure digital doesn’t make things worse for neurodivergent people or underserved communities, Jen reaffirmed that user-centred design should be key. “When I worked in operations, we used patient and carer support groups to help us with some of the design around the remote technology. So we actually put it in the hands of people with a learning disability and carers who looked after frail, older people and took their feedback to the technology supplier to show them what they were telling us.” As a result, the team was able to make the remote monitoring service easier for the communities it served.
She then emphasised the importance of making sure everyone has accessibility to these services within healthcare: “We need to make sure that we consider whether or not they need a 5G-enabled device, for example. We can’t rely on someone using their own phone or their own broadband, because that might financially exclude people.”
Echoing this idea of inclusion, Roisin said that suppliers should be “held accountable”. She noted: “There are accessibility standards that we need to meet. Put them in your tender requirements, ask the questions in demos and hold us to account.” From her perspective, suppliers should be making sure they have accessible products, and this should form an important part of the conversation with organisations, she added.
Antonia highlighted how technology in general can be “a massive benefit for people who are neurodiverse and come from groups that are often under-represented”, as it offers an alternative way to access different services. However, she also recognised that “digital access routes aren’t going to be for everybody, and we’re not designing them to make everybody go down one route; we’re designing them to make additional choices for people”.
She emphasised that “inclusion is not only about patients but also about our staff, who often have their own neurodiversity, which might mean that digital is harder for them or potentially much easier for them if we do it right”. With this in mind, she noted how “user-centred design is not just about how we design things for patients, but also how we design them for staff”.
What good looks like now and in the future
Next, our panel considered what good looks like in terms of priorities for the future, with Roisin starting by suggesting: “It’s really about offering services that are data-driven and that are proactive and not reactive.”
Expanding on this, she explained what this would look like: “It’s about being able to have access to key data and use it in anticipation of something happening. For example, using predictive analytics to tell you that in six months time, you’re going to have a new batch of patients on your caseload that need insulin. You can then start thinking about upskilling your workforce and your diabetes management, to help prepare.” In terms of looking forward, Roisin added: “The only way that we’re going to be able to drive better outcomes for patients is to really use that digital aspect, and for me, it’s all about the data.”
For Jen, there were a couple of elements to consider, including having joined-up systems that “enable staff and carers to access information in a way that actually saves them time without adding any burdens”. She noted that being able to use what’s already out there to “really innovate” is key, adding that healthcare is still “miles behind other areas such as retail providers like Amazon, so even simple things like being able to support our staff with the best route to get to their visits would be a step in the right direction”.
Antonia echoed a lot of what Jen had to say around joining up the different sectors, as well as agreeing with Roisin that “using data in the right way” can help with making improvements for the future. However, she also reiterated that it should be about “not excluding people or increasing digital divides” before referencing the 10 Year Health Plan. “AI is a big part of the plan, and at the moment we haven’t necessarily got a good handle on where it’s going to have the most impact. What good doesn’t look like is chucking AI on top of elements that you don’t really understand. What good does look like is really understanding what we’re trying to do and then using AI to support that.”
Short-term goals
In the short-term, Antonia emphasised the importance of access and digital literacy before considering the need for “champions in services who can support the really important changes”. She also noted that “instead of trying to do everything at once, trying to do things in a more planned way that works for the frontline and for patients” would be more beneficial. “We need to slow down to do it right and support our staff along the way,” she said.
For Roisin, better integration is key, sharing a need for “integration between systems that should be talking to each other and sharing data, as well as getting rid of siloed working”. She outlined how this will help with decision-making, allowing clinicians to see patient history with greater visibility, which will ultimately lead to “better efficiency, a reduction in duplication of data entry and a more seamlessly integrated care pathway”.
Finally, Jen suggested it would be good to have a “roadmap for the implementation of tools that are already out there, in order to offer support to clinicians”. She referenced AI as a good example of a tool that could benefit from a roadmap which outlines how to use it in healthcare, noting how this would “save time for our staff, supporting them to be more efficient”.
