Tech on the frontline - how NHSX & partners are delivering at pace

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COVID-19 has driven sharp changes in the way that the NHS and social care serve the public.  Suddenly, care is being delivered digitally. For NHSX and its partners, it has meant getting products and services up and running at a speed which would have been unthinkable just a few weeks ago. 

For example, Covid-19 has led to contacts to NHS 111 (both telephone and online) going through the roof.  Many of our clinicians have been pushed into self-isolation, either because they have symptoms, or because someone in their household has symptoms.  There is a huge demand for information for the public, and for data for those leading the response. 

Technology needs to be a key part of the way we handle the situation, and NHSX has been working with NHS Digital, NHS Business Services Authority and a range of partners to commission, build, and deliver the technology that’s needed.

We’ve built on what we had before the outbreak. The NHS website’s coronavirus pages receive millions of hits every day.  As more and more people work remotely and rely on digital information, our cyber security services are working hard to keep the data safe and the systems robust.  The NHS App continues to enable anyone to log in and order repeat prescriptions easily and quickly, and most users can now view, set or change their nominated pharmacy.  All of these services are commissioned by NHSX, and expertly delivered by NHS Digital. 

But together we’re doing much more. 

For the NHS

Our approach is to do what works, quickly, and above all to support the frontline.  This was why we introduced new, radically simplified guidance on Information Governance. It’s why we delayed the requirement for the frontline to complete their Data Security and Protection Toolkit returns until September 2020 - so staff could focus on doing cyber security rather than filling out returns.  It’s why we have tried to make the rules for remote working and remote consultations as straightforward as possible.

NHS Digital has rolled out Microsoft Teams across the entirety of the NHS estate, making it easier for colleagues - whether clinicians, supply chain specialists, IT technicians, or senior management, to speak to each other quickly and securely, without having to meet in person. And we’re supporting the quick take-up of e-rostering, as trusts recognise the value of improved workforce management. We’re working with NHS England and NHS Improvement and the regional teams to secure supplies of laptops, so that every clinician who needs to work remotely can do so. 

We are also trying to improve the flow and aggregation of data.  Managing the crisis effectively depends on having the best possible data, which has involved a more joined-up effort than we’ve ever managed before.  We have heard the cries for a better understanding of the projected caseloads at Trust level, of a need to understand their ventilator capacity, and their stocks of PPE. Pulling that data enables everything from local decision-making on how many sets of face masks to order, to national decisions on where in the country most needs ventilators. As we’ve worked on this, we have kept privacy and good governance front of mind, and worked closely with the Information Commissioner's Office and others to ensure that we follow good practice in all that we do.  We set out the way we are doing this in an earlier blog.

We are doing everything we can to reduce the burden on front line staff. Automating the sending of test results, and introducing digital isolation notes for those who are self-isolating, will free up staff time; improving the flow of data across the NHS will mean planners can get vital equipment where it is needed, when it is needed; and putting tools into the hands of patients to enable them to manage their own care, where that is appropriate, will reduce the need for patients to go into practices and hospitals. 

And we’re going much further in terms of working with industry to support our staff. We worked with the Department of Culture, Media and Sport to agree a set of commitments from telecoms providers, meaning frontline staff can access the data, calls, and text allowances they need to work remotely at no extra cost; clinicians working from home will be prioritised for broadband upgrades; and the connectivity for care homes will be improved. Meanwhile, the team at NHS Business Services Authority have been developing a staff passport to make it easier for staff to move between hospitals without having to repeat lengthy basic checks. And they’ve worked with NHS England and NHS Improvement to make mental health-focused apps free for staff, including Unmind, Headspace, and Sleepio.

We are now looking at how we can do more to help the frontline.  NHS Digital is working hard to resolve issues around smartcards, by ensuring sufficient supply and accrediting a ‘virtual smartcard’ solution.  We are looking at how data can be safely shared more easily, including through expanding the information in the Summary Care Record, and exploring the potential for rolling out local Shared Care Records at pace.  And we are setting up new mechanisms to ensure we have a proper sense of the tech pain points at the frontline, so we can address them (of which we’ll say more soon).

For citizens

How citizens engage with the NHS is changing radically. Perhaps the most visible change was the switch to NHS 111 online as the default way of contacting the NHS, reducing demand on the telephone service, and helping to ensure that the people who need to speak with a clinician most can do so. And the major phone companies have worked with us to make access to NHS website  content free from everyone’s mobiles.

Secretary of State for Health and Social Care,  Matt Hancock, has said that the NHS needs to move to digital appointments by default, wherever it is clinically possible.  So we’re putting in place the technology needed. For example, working with NHS England and NHS Improvement we’ve made video consultations available to every NHS trust by centrally procuring a solution for areas where capability is required.  We’ve ensured that GPs can do video consultations on their own systems, using one of a small number of specialist products, or through universal apps like WhatsApp. All this will mean that a huge number of clinicians can now continue to provide services to patients, remotely. 

And we’re standing up wholly new capabilities. 

Those most vulnerable in self-isolation are receiving information and support via text messaging thanks to close working with NHS Business Services Authority and NHS Digital.  We’ve launched a challenge to the tech sector to identify technologies to help those the elderly, vulnerable, and self-isolating, in partnership with Public and the Health Innovation Network.  We had over 1600 applicants, and a number of providers have been selected covering a range of remote care, mental health and staffing and volunteering needs. We will be working with Academic Health Science Networks and others to test these innovations in local areas.

We have delivered the capability to do isolation notes digitally, providing proof of coronavirus-related absence from work. And we’re building digital services to support the massive increase in testing capability which is on the way - ensuring that kits and test results get where they’re needed as quickly as possible. This is not the time to be sending letters by default.

Finally, NHSX is building a contact-tracing app. As we explore it, we are determined to do so in a privacy-friendly and ethical way. We have worked with the Information Commissioner's Office, the Centre for Data Ethics and Innovation, and others, ensuring anything we do gives confidence to the public. The app would store anonymous proximity information securely on your phone, and will only share that information with the NHS when you allow it to. The data will only ever be used in the interests of providing care, public health management, and relevant research. Users will always have the right to delete the app, and their data. 

Openness

At a time of national crisis like this, we inevitably end up moving at a great speed and working in new ways.  This understandably gives rise to concerns, some of which have already been eloquently expressed. So to reassure - we are determined to work openly, to respect privacy, and to consult the guardians of the standards as we go. We are in close contact with the National Data Guardian, and the Information Commissioner, and would not act without their support.

When we roll out new technologies throughout this outbreak, we will open source the code wherever possible, enabling the tech community to suggest improvements and help us protect against vulnerabilities, and enabling those with concerns to see exactly what our systems do and how they work. And we will continue to encourage our teams to blog openly, and to be led by a real understanding of user needs.

Finally, we will be as transparent as possible about how patient data is used throughout the outbreak, and about any changes to the use of data for the specific purpose of tackling the spread of COVID-19. 

Working together

In building all of these processes, NHSX, NHS Digital, NHS Business Services Authority , NHS England and NHS Improvement, and the rest of the system have come together to work as one. 

  • NHSX has been leading the commissioning of systems, and stood up a few. 

  • NHS Digital has built and operates critical national products, like NHS 111 online and the NHS website, and provided the data to enable 1.5 million of our most vulnerable citizens to be contacted and supported. 

  • NHS Business Services Authority are standing up teams to support NHS workers and to automate processes. 

We will continue to do all we can together to support our colleagues on the front line, and the citizens we all serve.