Remote and Agile working

Contents

• Connectivity problems
• Offline working applications
• Agile Working
• Securing remote working
• Our Remote Working, Agile working and remote access to records schemes will focus on
• Transformation Plan headlines
• Measures for success

The vast majority of our employees provide community health and care services across our localities. There is a frequent need for them to securely and reliably connect to our systems and service user records.

Across these services, our staff support tailored and personalised care across many settings, from service user homes, schools, nursing homes, care homes, GP practices, libraries, community centres, hospices, fire stations, police stations, shops, supported accommodation, local authorities, restaurants and high streets.

This flexibility and variability in where we deliver care provides significant benefits for our service users and assists personalised care outside of the hospital setting, however, this presents a challenge for digital support services.

Through technology we aim to ensure that our staff can offer the quality of care they need to, with access to retrieve and update the information they require, to stay safe if lone working and to keep our service user information secure, private and up to date no matter where they are.

Connectivity problems

Currently our staff are too reliant on laptops that need to be connected and online in order to retrieve and update care information for their daily activities.

If our service user records need to be accessed, regardless of the business, health or social care system being used, we typically require our staff to have some form of mobile signal, data connectivity or wireless connection to receive and update care information.

With intermittent phone and data signal strength access across all of our care settings, in particular Hampshire, Shropshire, East and North Staffordshire; connectivity in the community can be a significant hindrance to our staff in the delivery of care and their day-to-day job satisfaction.

Many staff reported working into the evenings when connected back at their home, updating their daily notes from memory and paper notes at the end of a long day on the road without connectivity.

Many unique digital approaches have been shared through our engagement sessions by staff trying to overcome the challenge of working without a network connection without resorting to the use of paper, but none are ideal. For example, laptop users without a network connection were writing progress notes in locally saved Microsoft Word documents where access to a clinical system was not possible.

“Accessibility needs to be the same wherever you are in the community”
Deborah Lloyd, Rheumatology Nurse Specialist, IPOPS East Staffordshire

There are a number of promising areas of digital innovation on the horizon to address this ongoing connectivity challenge, but there are also some immediate steps that we will take.

Firstly, we need to manage our mobile network suppliers, ensuring that we tailor the use of our mobile signal provider according to the best reported signal strength within each region. 

Our MPFT Digital Service Development department will introduce ongoing supplier management meetings for more robust supplier management. We will put pressure on our mobile network providers and highlight areas of poor connectivity that need to be addressed in the interests of improved care.

Mobile networks are continually enhancing their infrastructure to address signal strength, and through our standing as a local health and care provider with a large customer base, we will use this to gain a better quality of service wherever possible.

We will also use these formal review meetings to keep up to date with the latest innovations on mobile networks across our regions, including 5G infrastructure developments when they become available and looking forwards to 6G which is currently anticipated around 2025.

Through our staff training processes, we will make it easier for staff to understand how to gain consent and to be able to connect their devices to our service user home wireless networks.

Staff are proactively tethering their laptop devices to their smart phones to enable them to be connected wherever there is data signal, however not all staff are aware or have been able to do this. 

We will also continue to improve our IT support processes for remote workers too, ensuring that staff have clear support on how to get a network connection wherever it is possible. As an example, we will provide information on how to extend home wireless networks for home-based workers.

Our partnerships across Integrated Care Systems (ICS) and Primary Care Networks (PCNs) will also be invaluable when it comes to offering more approaches for our staff to get connected when in the community and away from their staff base or their home working environment.

We will continue our work with local authorities, libraries, GP practices, emergency services and schools for our Children’s Services to enable our wireless signals to be shared and for our staff to connect anywhere a valid wireless network is available.

“As the team work remotely from schools, network connectivity is not always available, especially since some schools have not as yet allowed WIFI accessibility.  This can limit practitioners’ administration as they are unable to use RiO.”
Baljit Nhalt, MHST Shropshire, Telford & Wrekin Trailblazer

We will look to shift the device types in use across community settings. Over the last number of years, the Trust has invested significantly in introducing smartphones to the vast majority of community-based workers. With continual revenue funding in place, we will ensure that these devices are refreshed and upgraded on an ongoing basis so they are equipped with the best possible antennas for signal, cameras for imaging and extended battery life.

There is also an increasing need to shift from laptops which can be cumbersome and perceived as a barrier between staff and service users, to more user-friendly tablet devices and larger smartphones.

With the rapid deployment of Microsoft Teams, we have been able to ensure that any member of staff with the means of using the Teams application on a Trust smartphone, personal phone or tablet device is more connected than ever before where a non-SIM enabled laptop did not enable this.

Through new equipment types we hope to maintain the approach of the right device for the right task, ensuring that our multitude of new apps in place can also be capitalised on with ease. 

“We need tablet devices for staff in the community, staff feel laptops can make communication more challenging, tablets would be easier to clean and could also potentially be used in assessments.”
Helen Whitfield, Operational Team Lead, Adult Speech and Language Therapy Services, South Staffs

Offline working applications

Aside from improving the means by which we can establish and gain access to a network connection in the community setting, the key digital innovation area that needs to be more widely deployed is offline working applications.

Despite many promising signs that network connectivity and mobile signal strength would be improved over the years this has simply proven not to be the case and consistent country-wide connectivity remains elusive, especially in rural areas.

We now design all internally developed modules with offline working capability. This means that any mobile device we provide to our staff with an app built by our MPFT Digital Application Development team, will have the means of downloading and locally storing the caseload information at the start of the day. This means it can be accessed and updated throughout the day regardless of whether there is a network connection or not.

Following visits, our central systems will be updated when our staff tablet devices are re-connected and back online.

Our recently deployed and locally developed school aged immunisations and electronic therapeutic observations applications both have been designed with offline working in place meaning a constant network connection is not required for the application to function and to capture service user data updates.

For any new applications we look to commission through our existing and new suppliers, we will ensure that all mobile applications will have both online connected functionality and offline, disconnected, local storage options.

Currently there are only a limited number of services that benefit from adopting this tablet-enabled, app approach to mobile working and remote access to care records within MPFT.

Subject to available funding, we will equip our community teams with mobile devices and the ability to download their day caseloads so that they are available offline.

The same devices will also benefit from features such as voice to text dictation, enabling staff to talk to a device and have their notes transcribed before being submitted. With offline storage where there is no connection, the main electronic health record will be updated when the signal returns and is synchronised.

This multi-faceted approach to the mobile connectivity problem will ensure that our service user notes are updated more frequently, with less impact on our staff to populate notes in their own time.

We will also explore further benefits from use of tablet devices equipped with multiple apps, such as route planning scheduling, loan working GPS detection and service user feedback surveys.

Staff will capture all health and care information digitally at the point of care, maintain accurate and up to date notes and improve their wellbeing through digital efficiency

Agile working

In addition to addressing connectivity, we also need to deliver on our agile working and blended working practises.

We will improve our home IT support offers, ensuring we have well defined equipment offers, home delivery and remote IT support services in place for those staff now working from home more frequently.

We will also make it easier for our staff to work from any of our Trust premises.

We have found that through COVID-19, our community staff in some areas are no longer permitted to visit GP practices for use of toilet facilities, and not all staff are aware of the location of our MPFT premises or feel they can work from locations that are not identified as their base.

Through the introduction of our MPFT Wiki knowledge base, we will have a fully searchable index of all of Trust sites available to staff. This will be supported by chat bot functionality to assist with access to information such as the nearest MPFT building based on postcode or current location, opening times, disabled access information and car parking information.

We aim to improve the use of our 130+ premises with bookable hot desks, meeting rooms and clinic rooms.

We will reduce reliance on staff travelling to their base, their home or buildings that they are already familiar with. Through improved awareness, we want staff to be able to work from other locations such as a nearby GP practice, library, council building, hospital, care home, or other MPFT service.

“I work remotely and across multiple sites (GPs and care homes) so digital access is essential to delivering my service”
Carrie Eckersley, Dietitian, North Newcastle PCNs

Securing remote working

The number of staff, sites, systems and devices means health and social care services have multiple vulnerabilities that need protecting. We will equip our workforce and service users with smartphones and tablets that are securely managed and encrypted.

With locally stored information for offline working capability, we will have the security in place to ensure only authorised users can access the data on the device.

Through our managed processes we are able to remotely wipe and disable any of our managed devices that may be reported missing or stolen or no longer in use.

Through use of Windows Virtual Desktop and Bring Your Own Device (BYOD) approaches, we will improve our workforce business continuity digital approaches to local device failure; offering supported and secure secondary means of accessing our systems from different devices.

Our cloud strategy also has a significant role to play for our mobile workers. We will continue moving systems from local data centres that rely upon network connections from our premises. Many remote workers currently rely upon Virtual Private Network (VPN) connected MPFT devices to access our secure systems. Through a move to cloud hosting, these same systems can be accessed from any internet connected device subject to staff passing authentication security checks. This approach will make it easier for staff without compromising on security.

“Digital promotes agile working, a more efficient use of time rather than travelling to meetings and I liaise more with my managers as we have a daily Teams call. We are also more accessible to internal and external agencies to problem solve as opposed to travelling around to the various sites my teams cover. Since working agile (home) I tend to cover more teams”
Helen Athersmith, Neighbourhood Manager, Acute Social Care South East/South West North

By linking our systems together, we also hope to create further efficiencies for our community-based staff. The administrative burden of submitting mileage claims should not be underestimated.

We will work to find means of linking our scheduling and route planning systems to mileage and travel expense systems. This will enable staff to automatically capture expense claims based on actual travel to improve data quality and reduce administrative burden. 

It is our ambition that these remote working agile processes and blended working methodologies will all collectively contribute to our sustainability objectives.

Measures for success