NHS England - Transformation Directorate

The reality of using video call technology during COVID-19

It goes without saying, the coronavirus pandemic has had a profound impact on health and care services including speech and language therapy. Kelly Brow tells us about the reality of using video technology during these challenging times and how the NHSX Information governance guidance has helped.

I am a Speech and Language Therapist in the adult community and mental health team. I specialise in dementia and mental health.

As a team we assess, diagnose and treat acquired speech, language, communication and swallowing difficulties, providing support to people based on their needs. For example, in patients who are recovering from a stroke, the aim is to help the person to regain as much independence and quality of life as possible by finding ways to support their communication difficulties.

This may be working on strategies to assist word finding or providing communication aids so the person can communicate their needs to family, friends and carers. 

A person with schizophrenia may need a therapy plan to help them eat and drink safely, minimising the risks of them choking or aspirating.  Where a patient has a progressive illness such as dementia, Parkinson’s disease or Huntington’s disease, we want to help them to retain as much independence and function for as long as possible. This means regularly assessing their cognitive and communication skills as well as their ability to swallow food and drink safely, adjusting their diets to meet their needs. I tended to see my patients in a wide-range of settings including health centres, hospitals, nursing homes and within their own home. 

Returning from maternity leave at the start of a major pandemic, I did expect to see fundamental changes. My first week back started with a session to fit my PPE. I was also told I’d take a video-first approach to my patients, providing care and assessments using video calls where this was possible. Home visits were only to be completed where there were no other options and full PPE needed to be worn.

So what are the challenges?

We needed to get to grips with video calling tools. In terms of the actual call, while we had made basic video calls before, we needed to get more comfortable with video calling tools and how they worked. A working party was set up and therapists looked at the materials provided from NHSX and others, to develop easy read instructions for therapists and patients to use. NHSX has guidance about the use of video conferencing tools to help staff and trusts to quickly recognise that we are covered appropriately to use video calling tools. Also, it’s clear that by accepting the invite the patient is giving their consent to have their call by video. This means that there isn’t a need for myself or our service to lose time that can be spent with our patients issuing and chasing individual video call consent forms. 

I have provided videocare to service users ranging in age and level of disability. Many people (and their carers or family where necessary) have been able to navigate their video appointment following initial support to connect them to the software and following the easy read instructions provided.

A lot of pre-planning is needed to ensure that communication assessments are adapted to this new delivery method and shared with the patient before their appointment. A lot of support is needed from family or carers to feedback on the patient’s responses to certain aspects of the communication assessment, such as the individual’s ability to follow commands during their comprehension assessment. 

Furthermore, in-depth video and telephone triage of swallowing problems allows therapists to give instant advice over the phone in some cases, and make a follow up call more quickly to see if the issue has resolved.

Use of peer-to-peer support

Our trust has been using Microsoft Teams and I have found our internal staff communications and online member-networks really helpful. Staff across the NHS have really pulled together to securely share tools, resources and advice. This saves a lot of staff a lot of time. Instead of starting from scratch to develop tools and assessments that are well suited to a video appointment, we can use or adapt the tools and resources that have been proven to work. I can also easily share tools and exercises with my patients for them to use or refer to between appointments too.

Video clinics and the future

While travel and the number of home and clinical calls have been drastically reduced, we have continued to visit our most vulnerable patients at home or another care or health setting wherever the clinical need outweighs the potential risks.

When we do have to use video there are clear benefits. This includes a reduction in the need to wait-in for a visit and agreeing appointment times in advance that are no longer dependent on traffic. It also reduces the need to travel for patients, staff and carers. Face masks can negatively impact our communication, making it very difficult for patients to see and read my facial expressions, read my lips and clearly hear my instructions. The use of video also means that patients can see the therapist's face, which is important for communication assessments.

Due to these benefits I see a long-term value in using video for Speech and Language Therapy, long after this pandemic is over.