Transforming care pathways

Following on from the success of the NHSX digital playbooks, Lisa Hollins, Director of Innovation at NHSX explains how the 35 winners of the new £6.5 million Adoption Fund will support the recovery and sustainability of services, while improving patient experience.

NHS and care services have been using digital technology in new ways to find creative solutions to the pressures, backlogs and waiting lists created by the COVID pandemic. Virtual wards have enabled people to recover at home with remote clinical supervision, creating inpatient capacity for those that need to stay in hospital. Digital and video based tools are already helping to ensure any post-op rehab programme and exercises are completed correctly and that the rehab plan is clear ahead of the day of surgery.

Building on these sorts of innovations will play a key part in the restoration and sustainability of services. Digital transformation is also driving entirely new care pathways that are better for patients and that save time for clinical and administrative teams.

In the next three years, we expect that:

• all high volume specialties will have agreed an established digital pathway offering choice for patients and making sure that clinicians are able to concentrate time with those patients with more complex conditions
• there will be support for patients to monitor their long term condition at home, with access to guidance to support self-care
• the most complex long term conditions will be monitored using digital platforms and
• there are effective flows of data between clinical systems, supported by technical standards, to make sure that clinical teams have the data to make decisions along the clinical pathway

This week we have announced the organisations that have been successful in bidding for funds that will deliver new digital clinical pathways for patients in some of the highest volume specialties.

In total we are providing over £6.5 million of funding to the 35 applications, which have been whittled down from 138 applications by a review panel including regional teams, charities, expert clinicians and researchers.

The first area of funding was to support the development of new cardiac networks. These networks aim to better support people with heart failure through improved access to diagnostics and multidisciplinary teams. Remote care technologies allow clinicians to diagnose and treat patients by monitoring their condition at home and being notified early if the patient's condition deteriorates. These technologies also open the opportunity for faster review by specialist clinicians and better management of the patients journey across primary, secondary and tertiary care. We have made available £1.5 million to fund two networks to take forward the work on digital cardiac networks.

Our second area of focus is on increasing access to services for patients who need musculoskeletal (MSK), gastroenterology and perioperative care. We know that patients are waiting longer as the NHS deals with the impact of the pandemic and for some patients this has resulted in an exacerbation of their symptoms. The winning bids aim to reduce waiting times and delays.

For example, the waits for endoscopy services are one of the most significant delays to care. A non-invasive stool test, vital in the modern management of inflammatory bowel disease, can reduce the need for people to undertake an endoscopy in the first place. Not only that, but prior to the advent of home tests (based on smartphone apps), people living with these long-term conditions would have to take their test samples to the hospital or put them in the post and wait anything up to six weeks for a result. People feeling otherwise well at home would still be obliged to come into hospital for an appointment, just to tell their care team that they were doing ok. By taking tests and uploading results at home, patients are given control, can share immediate test results and engage in remote communication with clinical teams.

Another example is that 25% of colonoscopies fail due to inadequate patient preparation; leading to another round of prep, another couple of trips to the hospital for the patient and another appointment for colonoscopy that could have been used for someone else. Digital advice for patients can ensure their preparation for colonoscopy or endoscopy is undertaken and the procedure goes well.

In MSK, technologies can support self-management through the use of evidence-based decision support tools that help those living with long-term conditions to decide when they need to be seen and initiate their own follow-up care. Where orthopaedic surgery is necessary, technology can help to support shared decision-making, prehabilitation closer to home and encourage physical activity and smoking cessation so that patients are as good as they can be in readiness for surgery. Finally, technology can enhance recovery, reduce length of stay and monitor rehabilitation at home through the remote capture of patient-reported outcome and experience measures.

The final area for funding and the one that we hope offers the opportunity for the greatest learning is the Digital Inequalities Pioneers project, jointly delivered by NHSX’s Innovation Team and NHS England's Health Inequalities team. Ten integrated care schemes will work with Thrive by Design (formerly mHabitat) to better understand how we can deliver inclusive digital pathways by design and offer learning for all pathways. All applications demonstrated how they will reduce health inequalities and promote sustainability towards a Greener NHS.

To support the implementation of the technology NHSX will be convening a Community of Practice across all successful bidders; whereby implementation will be supported with national problem solving and ICSs will share learning between each other.

See our information about the Adoption Fund to find out more about the winners.