Remote care and monitoring

Contents

• Virtual wards
• Digital self-management
• Our Remote Care schemes will focus on
• Transformation Plan headlines
• Measures for success

Remote care offers have been discussed for a number of years to help support people with an already identified health or care need that have an existing referral to MPFT care services.

Video and telephone consultations, self-admissions, pre-assessment reviews, home testing and remote outpatients for advice and guidance, follow up to acute discharges and ongoing support of Long-Term Conditions (LTCs) can all be supported through digital enablement where appropriate.

Throughout the COVID-19 pandemic many NHS trusts have had to rapidly accelerate the deployment of new technologies and reduce face-to-face contact in order to manage demand and keep service users and staff safe.

There are no benefits to a global pandemic that has contributed to the deaths of hundreds of thousands of UK residents. The rapid adoption of technology through the pandemic has allowed us to respond effectively and has significantly accelerated our digital transformation plans and enhanced our care offers at a difficult time for many.

Despite the substantial progress of service user and staff adoption of digital approaches throughout the pandemic, there is still a significant amount of transformation to undertake with our remote care and monitoring ambitions.

"Clearly during COVID-19, technology has revolutionised our working life, this revolution now is needed for our patients"
Paul Garner, Palliative Nurse Consultant, Palliative Care Services

Following numerous rapid deployments of new solutions such as video consultation technology and Microsoft Teams collaboration approaches, we now need to take more time to complete evaluations. We will ensure that any future deployments are fully co-designed and customised to service user and staff requirements and priorities now that the emergency response to the pandemic has been delivered.

The NHS Long Term Plan and more recently the Integrated Care Systems (ICS) and Primary Care Networks (PCNs) strategies all make it clear that the NHS needs to focus on reducing acute admissions, improving wellbeing and ensuring that we can care for as many service users as possible within community settings.

MPFT is one of the main community care providers in the region and has a key role to play for the localities that we serve.

We will work with our partners and 3rd sector colleagues to collaborate on digital remote services, ensuring that wherever possible our technology choices and security standards align.

Digital has a significant role to play and MPFT will further enhance our remote care offers where it is appropriate for us to do so. However, we know that digital solutions are not appropriate for all care needs and this is highlighted within our Choice and Access and Digital Inclusion and Equalities themes within this strategy.

The deployment of our virtual consultation platform has seen over 80,000 virtual consultations between March 2020 and November 2021 across the vast majority of our care services. These were all from a standing start, having not undertaken a single video consultation prior to the pandemic. Where the platform was suitable, it has excelled, offering greater flexibility for both our service users and our workforce.

“We’re seeing more service users than ever before and the outcomes for the drug and alcohol services have never been better than when working with digital technologies in the last 12months”
Tracy Braddock, Inclusion One Recovery Bucks: Substance Misuse Service Lead

There is still work to be done on our video consultation platform. We need to ensure accessibility needs are addressed, performance and reliability is enhanced, and further features are all introduced, including:

• multidisciplinary consultations
• group therapies
• screen sharing
• session recording and transcription
• closed captions
• translation services
• background screen blurring
• direct SMS links to secure virtual waiting rooms

These are all on the roadmap for the near future, ensuring we make video consultations as simple and effective as possible.

"OneConsultation is being used for initial assessments, this has reduced wait lists for initial assessments and be more flexible in offering appointments to suit people's needs and more accessible. Mother's that have just had babies do not need to drive 30 minutes, get their babies out of the car to attend a quick appointment"
Jo Lees, Nursing Lead, Community Perinatal Service Shropshire

We also need to deploy platforms that enable service users to securely share images of wounds and conditions with our staff across a large number of services such as tissue viability, district nursing, podiatry services and sexual health services.

We need to be able to offer service users with the option to initiate secure conversations with our services reducing the reliance on emails and phone calls to generic telephone numbers, which are often known as “access points” within MPFT.

Our use of Assistive Technology and Telemedicine within community settings and inpatients is also in need of increased maturity and wider, more consistent adoption.

MPFT currently adopts various remote monitoring systems in a number of care settings, which we aim to increase in the future.

Current examples of these in use include:

• glucose blood monitors that link to smart phones
• clinician accessible portals for our diabetes services
• sensors within service user homes to ensure monitoring of simple activities like use of microwaves fridges and kettles for our community dementia and memory services

“I believe use of digital is our new way of working now, we can provide immediate decisions on patient's care by using digital technology to the best of our ability” 
Tracey Fallows, Diabetes Nurse Lead, Diabetes Nursing Team

We need to assess use cases and deploy further use of our Flo SMS system which serves as a service user reminder and secure self-assessment and readings submission approach through text messaging.

We also need to learn from the success of our Chat Health approach which provides service users and carers with secure and fast text message access to our health professionals in 0-19 wellbeing services.

These approaches are all in use within pockets of excellence across the Trust. We need to get better at sharing learning and scaling adoption to other similar services within our organisation. We will ensure we do not introduce too many isolated niche solutions within different services.

“For our wellbeing apps and digital therapeutic offers we need to assess the elements of these multiple approaches that we want to build into our wellbeing offers long-term. Sometimes too much choice is no choice. We need to house-clean this.” 
Kieran Doherty, Quality Lead Inclusion Services

The Trust has worked in partnership with regional colleagues across Staffordshire and won a Health Service Journal (HSJ) award for ‘Driving Efficiency through Technology for Tele-monitoring of patients recovering from heart failure’. This approach combined self-assessed health through use of interactive texts, social prescribing and education of support groups in the county and access to a digital library for content filled with relevant advice and guidance.

Virtual wards

In the coming years we will collate a functional specification to capture remote monitoring needs of all LTCs supported across the Trust including arthritis, diabetes, heart disease, and respiratory, in an attempt to source a consolidated and joint physical observations and remote monitoring platform that can support multiple conditions.

We need to source platforms that are simple to use for our service users and simple to access for our staff through integration with our key clinical and care systems. This will reduce acute admission and re-admissions by empowering self-management, readings submission, real time monitoring and support by exception for larger caseload management.

The concept of community “virtual wards” is nothing new, and with a consolidated, set of platforms in place we will deploy a fully supported, trained and funded approach to remote care monitoring.

Digital self-management

Digital self-management can be achieved in many forms, including mobile applications and web assessment forms.

Our Integrated Care System (ICS) work on the Frail and Elderly care pathways will be digitally enabled through the Comprehensive Geriatric Assessment Tool (CGA). This enables the mild-frail to assess their physical, socioeconomic, functional, mobility, psychological and medication to proactively track wellbeing online.

A similar approach will be introduced for our musculo-skeletal services through a Rheumatology portal and also for our mental health patients through an application that captures digital mood diaries.

Service users having the ability to track their own thoughts and feelings over periods of time, access proactive advice, guidance and self-initiated Cognitive Behavioural Therapy (CBT) approaches outside of a clinic or assessment will improve the frequency of support.

“A mood diary app could be recommended on referral but before first appointment to then determine if that service user is deteriorating and perhaps needs to be re-prioritised.”
Fiona Mills, Peer Support Worker, Step on Team

Wider deployment of our e-therapeutics approaches will also take place, deploying a platform with clinically designed best practice modules, advice and guidance for service users to follow at their own leisure via website, smartphone or tablet device.

This is already successfully deployed across our Drug and Alcohol and Improving Access to Psychological Therapies (IAPT) services within our Specialist and Staffordshire Care Groups, with further opportunities to be explored in the near future following evaluation. 

These approaches will improve the data available for our assessment of Patient Related Outcome Measures (PROMS), increase service user autonomy and reduce the impact on our service users for Referral to Treatment (RTT) times and waiting lists through earlier access to potentially useful materials whilst awaiting a first formal assessment. Unlike waiting for an appointment, a key advantage to a digitised app approach is that care information, advice and guidance is available at any time.

Our Digital Upskilling and Digital Inclusion themes are cross-cutting, and for remote care options we need to ensure that each use case is carefully assessed, that service users are confident and happy to adopt self-management approaches and that they understand how to use the technology provided.

Through training, advice and guidance, we will ensure that all remote care offers are fully supported, that our staff are confident in identifying which solution is appropriate for which individual and ensuring that they are equipped with the training materials to support initial use and ongoing adoption.

“Trying to get people engaged and signed up with digital can be a real challenge and they can be very suspicious of technology. We need to get to the point where we are supporting service users adopt more technology in their care.” 
Becky Beal, Operational Lead, Staying Well Service, South Staffordshire

Our remote care ambitions also serve to help achieve our sustainability ambitions with reduced service user and staff travel required through successful adoption of remote care approaches. The Centre for Sustainable Healthcare (CSH) identifies prevention, patient empowerment and self-care, lean systems and pathways and use of technologies and interventions as the four key principles, all of which align to this theme and the Wellbeing and Prevention theme.

Measures for success