Back in 2018, Inhealthcare was chosen to be part of the Pfizer Healthcare Hub: London. Since then, the way care is delivered has changed, and digital health technology and remote patient monitoring are playing an increasingly important role in the future success and sustainability of the NHS.
At the end of last year, Inhealthcare product director, Jamie Innes, caught up with Dr Hamish Dr Graham, healthcare innovation manager at Pfizer to consider what’s changed over the last two years and what it means for digital health innovators like Inhealthcare.
Hub Manager: Welcome Jamie. You and the Inhealthcare team first came to Pfizer’s head office to pitch in 2018. Over the last three years, how have things changed for Inhealthcare?
Inhealthcare: A lot has happened in three years, not just in our organisation but also with our customers. Internally we’ve actually kept the same strategic direction, providing a platform to the NHS where they can develop lots of digital services themselves. We continue to keep things as simple as they can be for the NHS and patients by providing a single platform to support multiple pathways or conditions, rather than asking them to use a lot of disparate apps. We’ve been able to keep this strategy because it aligns with the what the NHS is looking to achieve with the Integrated Care Systems (ICS) transformation and approach of regional and digital bodies. In more mature ICSs in England, we are seeing that the strategy is paying off.
Hub Manager: Are you seeing the same in devolved nations?
Inhealthcare: Inhealthcare started working with NHS Scotland at the start of the COVID-19 pandemic as they were looking at how digital services could support the population. This spring boarded us into 14 Health Boards. Our customers’ worlds have changed and we’ve had to grow and adapt. As a small organisation deploying across national areas, with COVID challenges and everyone wanting everything immediately, there were definitely challenges.
Hub Manager: Across our interactions, we’re seeing that health systems have an increased desire for simple, effective digitisation of pathways as part of their transformation toolkit. Is it just the volume of demand you’re seeing change or are NHS teams asking something different from digitisation these days?
Inhealthcare: There’s been a big focus over the last 12-18 months on data in the backend. Data analytics and reporting have become particularly important to customers; they need to be able to report on completed activities and potential savings through digital activities so they can justify more spend in the area. For example, a lot of the COVID-19 programmes monitor people in their own homes for oximetry – NHS Digital mandated weekly reporting on these figures. Updates on patients, their results, how many alerts they’re getting are all being reported nationally. That’s a good thing because that’s how you demonstrate efficiency and effectiveness and is ultimately how you get more funding, shifting to a payment by results type model. There’s also a lot of talk about ‘prescribing digital services’ which is interesting however I can’t see it following the same process as prescribing drugs, such as the NICE approval process.
Hub Manager: Digital Prescribing and assessment of digital innovation are huge topics right now but there’s a lot we can learn from your work about where the NHS is heading. For example, are these the same people with a different ask that you’re dealing with now or has the customer for digitisation of care changed?
Inhealthcare: It’s a really interesting area; we used to see a lot of activity within acute settings, now we’re seeing more activity by community providers whilst Primary Care Networks (PCNs) are taking a more active role in digital services. For the next five years, or possibly longer, the acutes will need to focus on the COVID-19 backlog and shift a lot of activity to community and remote activities, relying on patients taking on activities that previously would have been done in hospital.
I think PCNs are becoming more powerful; we’re beginning to see they’re as large as some community providers in terms of numbers of patients and the budgets that they hold. There will be a big focus on simplicity from within primary care, largely driven by cost, so PCNs are going to become extremely involved in how digital services are delivered across the NHS.
Hub Manager: What do you think digital innovation has been able to offer that’s helped make a difference to patients over the last 18 months?
Inhealthcare: COVID-19 was a kickstart for the NHS in how they wanted to implement digital services. There was a real, rapid, change in primary care for digital uptake – they moved to a completely digital-first patient contact model. Other areas took some time to get moving, like the acute settings, but this is starting to change. The Martha Lane Fox Report for parliament, “Beyond Digital: Planning for a Hybrid World”, talked about a hybrid model of care and how going forward there will be a mix of face to face and digital. It will be about providing patients with the choice, allowing patients to have face to face appointments if they want them but also the option of digital or remote services instead.
Hub Manager: The report is a must read for anyone running a business or health service in the UK as it explores how the internet has enabled us to create hybrid lives. It has some important findings too, like how GP telephone and video consultations rose from 25% of interactions to 75% and the BMA found 9 in 10 GPs don’t want to go back.
Inhealthcare: It has brought a real change in the NHS, seeing that care can be delivered digitally, and it is an acceptable way of treating patients and giving them care. We see this in a large amount outpatient services. It’s also shifted the dynamic in other care settings, like care homes, they’ve proven that digital health can support remote monitoring of care for those individuals – I can’t see them going back to how they were before.
Hub Manager: What have you been seeing happen in care homes?
Inhealthcare: A large number of our customers couldn’t see patients face to face; these are really vulnerable individuals. Doctors and nurses were told they couldn’t go in to care homes. Some areas we work with were really struggling as approximately one third of District Nurse visits are for wound care, so we needed to find a way to support these care homes digitally. The care that residents’ needed for wound assessment and dressing was implemented by video conferencing; the District Nurse was able to guide care remotely, providing support and training to individuals within the care homes so they know how to dress and treat wounds and spot signs of infection. We have a few different initiatives with customers but this was a great example of how District Nurses, who would normally be constantly travelling, have now shifted their approach to working with technology and care home staff.
Hub Manager: What would be your message to entrepreneurs who are looking to scale?
Inhealthcare: My experience with the NHS is that you have to kiss a lot of frogs, cast your net wide and seek lots of opportunities because they can get delayed due to factors out of your control. Projects are often shelved or restarted and things can quickly change course so you need to be nimble as the market changes. No one foresaw what would happen with COVID-19 and the impact it had but some organisations have thrived because they’ve been able to be agile, adapt to the marketplace and offer what it needed. Lots of start-ups went from being tiny groups of individuals to key organisations that are an integral part of how the NHS functions. That mentality of agility means they will continue to be integral to the NHS in the following decades.
Hub Manager: So success is being driven by the entrepreneurs getting to have conversations with the right people?
Inhealthcare: Yes and they need to pivot quickly, spot gaps in the NHS and solve real problems within the Health Professionals’ world. Some have done it in the way they’ve marketed and targeted their customers; we’ve seen some interesting things in in primary care where organisations have offered digital health solutions to GPs in one pathway to get it installed into the market place and then it spreads from there to become a key part of how the NHS delivers care.
Hub Manager: Before you go, what do you think the NHS has learnt and where do you think it’s going?
Inhealthcare: There are so many different initiatives and programmes it’s difficult to know where to look sometimes! There’s so much out there, how do organisations know what’s good and what to focus on? Over the last year, we’ve seen organisations taking more risks and transforming to break down previous barriers. Internal stakeholders are always putting blockers and delays in place but companies have proven that the NHS can dramatically change the way it operates whilst still maintaining the same level of care that would be expected. This means organisations will be more willing to take forward digital services in the future. Previously they would be afraid of failure or waste funding but now they are prepared to learn from any mistakes because they see a digital future is inevitable. That’s how innovation works and how the NHS will be able to change services. We’ll start to see more of this over the next 6-12 months. For example, I’ve seen stats that the people referred to oximetry programmes over the last week has been the same as over the last 2-3 months, so the people on remote monitoring programmes is going up and up. That’s what they’re designed to do – they’re designed to scale and flex and relieve pressures in the acute setting.
Hub Manager: It sounds like digital entrepreneurs are helping in efforts to break the link between COVID-19 and hospitalisation by enabling remote monitoring from home?
Inhealthcare: Yes absolutely, just look at the South West – we have doubled the number of patients this month compared to last month on remote monitoring. This is an indication of how digital services are having a significant impact on how the NHS is managing and dealing with the pandemic and the support provided.
Hub Manager: That really brings it home, the journey you’ve been on since 2018; you’re helping transform patients’ experience of COVID-19.
When I went back to the NHS for six months last year, I experienced first-hand the impact of delivering care to patients at home who would have been in hospital 12 months ago. You’re not only helping to protect hospital capacity but also sparing patients the risk of being put with other COVID-positive patients, which can also be incredibly distressing if they deteriorate, get moved to ICU or worse. You’re helping to transform the way the NHS operates and making a real impact in tackling unmet needs for patients across the UK.