What does a growing need for remote working mean for the NHS?

When David Probert reflects on how the pandemic has changed his organisation’s approach to remote working, he doesn’t hold back. “From a clinical perspective, I would be as bold as to say we’ve probably squashed 10 years of digital transformation into about three months.”

The concept of remote consultation was not a new one at Moorfields Eye Hospital Foundation Trust. “But it had been small in measure. Since the outbreak, we’ve seen 10,000 patients using video consult technology. About a quarter to, at times, half of our emergency patients in our A&E department were seen virtually.”

The Moorfields remote working revolution has not merely been confined to clinical or emergency work. “Pre-covid we were very traditional in our approach – apart from sensible flexible working rules, pretty much everyone [employed by our organisation] was present within our organisation.

“What covid has escalated – and actually it’s not been a bad thing in terms of helping us think about the future – is to recognise that we really don’t need everybody in our hospital for five, or six, or seven days a week, working all of those hours.”

It’s a transformation which has been experienced across the NHS, which brings with it new challenges and new opportunities, and which was the subject of an HSJ webinar held in association with IBM in September. Together, a small expert panel discussed just what a growing need for remote working means for the NHS.

For one, cultural change as well as technological transformation. James Reed, chief clinical information officer at Birmingham and Solihull Mental Health Foundation Trust, reported that his organisation had put the underlying infrastructure in place for remote working pre-covid. At that point, however, it was largely seen as an option for only a few senior staff.

“Then literally overnight in March, there was this mass exodus from the offices, and certainly the corporate staff, almost exclusively, have moved to one form or another of remote working. Because we’d built the infrastructure, it meant we were able to do that.

“Our main headquarters is still largely empty. In fact, if you want to social distance, that’s the place to go, because you’ve got 20 metres in all directions.”

“Our main headquarters is still largely empty. In fact, if you want to social distance, that’s the place to go, because you’ve got 20 metres in all directions.”

He says that change has been mirrored in clinical work, with a willingness to embrace any kind of technology which can support effective remote consultation. “Most of the clinical contact that’s happening in the outpatient setting is happening by remote means. We have used video, we’ve used telephones, we’ve used text messages, we’ve used everything we can get hold of.

“It’s been about empowering the staff: ‘Look, these are the tools you have. Choose the one that works best for any given clinical situation.’”

“There’s a sea change attitude to digital transformation,” suggested Mark Davies, a former GP and now chief medical officer (EMEA) at IBM.

“I’ve been involved in the digitalisation of healthcare for at least 20 years, and this virus has achieved more for digital transformation in a matter of months than has been achieved for two decades.

“In essence, the attitude to what is possible has shifted dramatically, from: ‘Can’t do, and here all the reasons why,’ to: ‘How can we do, and what can be done?’ There have been some obvious implications of that – tele-consulting, virtual clinics. But what that leads you to is essentially our services becoming geographically agnostic.

“Suddenly it doesn’t matter about which building they’re in, and we need infrastructure, technology that is equally agnostic. So, one of the things that we have seen has been interest in cloud – so using more secure, and open, and collaborative platforms for people to be able to work.”

All of our panellists agreed that the need to support remote working is not going away any time soon. But will the desire to make new things happen at speed prove as durable? “We’ve got an awful lot of transformation work done in a very small space of time,” said Dr Reed.

“I would say, and I’m already seeing, that you can’t sustain that forever. The energy that’s thrown everything up into the air is fine for now, but it will come down again, and I think the opportunity is to really build a structure, so as things return, they’re settling down into a new pattern, rather than reverting to the old ways.”