How can the NHS manage the needs of covid patients in the longer term?

While the world is now almost two years into the pandemic, it is likely that covid-19 will remain a priority for the NHS for some time to come. That’s not only because – despite the vaccination programme – there will be people newly diagnosed with the infection who require high levels of care. It’s also because of the still-unknown burden of “long covid”.

Continuing to meet the needs of covid patients while also addressing the backlogs that have built up in other areas of care will clearly be challenging. To discuss how best to meet that challenge, HSJ recently brought together a small panel of experts for a webinar. The event, run in association with Lumeon, explored what we have already learnt about how best to manage covid and where the service might go from here.

For Davina Deniszczyc – medical and charity director at Nuffield Health, as well as a practising GP – the answer is likely to lie in a continuing combination of face-to-face and digital-delivered care. The organisation has been running a rehabilitation programme for those living with long covid, with six weeks of remote support and then sessions delivered in person.

“If there’s one [good] thing that has come out of the pandemic, I think it’s our [healthcare’s] adoption of some of these hybrid models and new models,” she argued. “We were forced to do it, but you know what, a lot of them are better.”

It was a point echoed by Erfan Karim, senior director mobile integrated health at NYC Health + Hospitals. The organisation operates New York City’s public hospitals and clinics and was, he says, “in the epicentre for covid in the city”.

“That challenge gave us opportunities to rethink what blended care in digital and in person could look like. We were able to combine various tools in our toolbox, things that were not leveraged previously, to really provide the optimal care for patients.

“And I think ‘care’ is a broad term,” he continued. “It’s not just limited to healthcare services, but also to care services. Assuring patients that they are going to be okay, that someone is looking after their needs and able to monitor them on a daily basis.”

To this end, the organisation implemented a remote monitoring programme for those diagnosed with covid, using video and audio but also text messaging. “We were able to build a programme that monitored over 7,000 patients during the height of the pandemic and keep those patients out of the facility. We were overwhelmed in the facility, but they were safe at home, they’re able to connect with the physician, escalate based on clinical criteria.”

At University College London (UCL), researchers have been exploring the implementation of these sorts of models. A rapid study last summer was followed by a systematic review of models across seven countries, with the team now studying the effectiveness of some of the setups introduced in last winter’s wave.

Naomi Fulop – professor of health care organisation and management at UCL – said findings from this evaluation will “tell us a lot more” about the value of remote monitoring. “But,” she reported, “these models have the potential to identify deterioration earlier and help keep people safely at home”.

If remote monitoring is to remain as a longer term solution, however, she said there are areas that will need attention. “We need to think about the balance between clinical and non-clinical staff that is required for these kinds of models. Originally, in the first wave, these services were set up really quickly with discretionary input. But in terms of sustainability they need dedicated funding, clinical and non-clinical staff and project management support.”

She did suggest there was potential in some circumstances for remote monitoring to become “business as usual”, both for covid and for long-term conditions such as heart failure or certain respiratory conditions. “I think it’s about being clever about understanding for which patients remote monitoring is appropriate and helpful.”

That will include considerations of digital access. Our panel agreed that any technological solutions must be designed with clinicians, and with digital inequality among the patient population in mind.

“What we’ve learned is basically no apps,” said Gajan Srikanthan, medical director at Lumeon. The company provides a digital solution – described as an orchestration platform – which supports the effective and efficient management of patients through an intelligently automated and coordinated care journey.

“We should be targeting people through mobile technology, but we want to use simple things like SMS and email to be able to further that engagement. From an inequality perspective, there will be populations who aren’t able to engage digitally with some of the proposed solutions. We need to make sure there’s a safety net to catch those patients and make sure that if they aren’t responding, if they aren’t engaging, the system is able to detect that and to then route them to a more personal intervention, or more face to face.”

Mr Karim described it as health services having to advance the ability “to meet the patient where they are, at home, on their own terms, and really provide superb care that makes them comfortable from a physical level and also psychological level.”

“I think as healthcare professionals and healthcare delivery systems, we really need to think about all the tools that are going to be available and how to leverage them as we move forward through this pandemic and post-pandemic,” he concluded.

An on-demand version of this webinar is available.

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