Removing barriers to create digital healthcare services that work for everyone

Removing barriers to create digital healthcare services that work for everyone
© iStock/everythingpossible

Trilly Chatterjee of NHS Digital outlines the benefits of digital healthcare services in improving delivery of care.

For several years preceding the COVID-19 pandemic, and as demonstrated throughout it, NHS Digital has been evolving how it designs and delivers digital healthcare services for citizens, patients and NHS staff. However, achieving this is not just a matter of deploying exciting new digital technologies to solve pressing problems or improving technical or design standards (though this is happening) – it goes to the very heart of how our people and organisations work together.

The recent Wade-Gery review on the role of data, digital & tech in the NHS has not only acknowledged the potential of understanding ‘digital’ in this way but prompted the impending merger of several central NHS organisations. This merger includes NHS Digital, the former NHSX, Health Education England and NHS England & Improvement – to support better system-wide collaboration in transforming the NHS for the future.

The merger comes at the same time as the wider NHS moving to a new set of commissioning structures in the form of Integrated Care Systems (ICS). The system aims to bring together coalitions of NHS providers and other partners in local areas to better commission and coordinate local healthcare services.

Whilst institutional change of this scope and scale is fraught with many kinds of risk, many will have valid reasons for scepticism. As someone who has seen the evolution of NHS Digital’s work from within over the last half-decade, I find the scale of the opportunity this presents all of us, the healthcare system, its workforce, patients and the wider public, difficult to understate.

The coming change in systemic and organisational relationships offers us a chance to tackle long-standing practical and cultural barriers that have limited our ability to improve the delivery of digital healthcare services. It is a journey we have been on for at least as long as I have worked at NHS Digital (I joined in late 2016) – and a mission we now have the opportunity (and privilege) to bring to the heart of the NHS.

However, the envisions in the Wade-Grey review can only be achieved by ensuring we bring everyone together around a shared set of purposes, philosophy of change and practical approach to delivering services. In the rest of this article, I will explain more about this philosophy and approach and how it can help create a healthcare system that works for everyone.

Designing digital healthcare services

Our approach to designing digital healthcare services has been one of the most fundamental shifts in our organisation over the last few years. Firstly, we recognise the wide range of expertise required to deliver high-quality digital healthcare services. To do this, we bring designers, developers, and researchers together in multidisciplinary teams, working closely with clinical, policy and operational experts. Increasingly, we work across organisational boundaries where needed. We do this because we know everyone who makes decisions that affect how a service is delivered is in some way ‘designing’ it – even if that word is not part of their job title.

Next, we ensure those teams have essential tools and skills to develop a deep understanding of those who use or are affected by our services. User research can involve anything from visiting healthcare settings to understand how they operate to testing prototype services with users to inform their design and ensure they meet their needs, whether these are clinical, practical, or emotional. Wherever possible, we integrate and enhance this understanding with insights from clinical and other data that NHS Digital maintains on behalf of the system.

The most important thing here is that we prioritise the time needed to build this deep understanding because we know this creates a solid foundation for collective design decisions and ultimately increases our chances of successfully delivering digital healthcare services.

Finally, we ensure teams are supported to be productive and have a clear direction. Product managers help teams gain clarity on problems their services need to solve for users and prioritise the work that matters most. Delivery managers support their teams to self-organise and remove practical barriers to progress. At higher levels, these roles support product strategy and the effective organisation of their team and programmes to achieve their aims.

Throughout this, close, continuous collaboration and a relentless focus on user needs are at the heart of what enables our teams to deliver better digital healthcare services for and from the NHS.

Putting digital into practice

Talk of roles and practices can seem quite abstract if you do not work in a digital delivery team – however, the impact of the work our teams do can be felt in big and small ways across the NHS and indeed the country.

Our Product Delivery directorate designs and delivers new products and services to help citizens, patients, and healthcare professionals across primary, secondary, and social care – including the NHS website, NHS App and 111 Online.

Our Data Services directorate acts as the data custodian for the health and care system, driving data quality and providing reliable statistics and insights to support decision-making at all levels across the NHS.

Our Platforms directorate provides the core platforms that underpin many services critical to delivering healthcare in the NHS – including those that handle millions of daily interactions like the NHS Spine and the Personal Demographics Service (PDS).

Our work touches the lives of millions every day. Whether it is someone with a darker skin tone visiting the NHS website, a hospital administrator producing reports on screening test results or an NHS provider looking for an easier way to notify their patients digitally. In light of the breadth and depth of our work across the system, it is perhaps unsurprising that our organisational motto is: ‘What we do matters’.

© iStock/sturti
User research can involve anything from visiting healthcare settings to understand how they operate, to testing prototype services with users to inform their design and ensure they meet their needs – whether these are clinical, practical, or emotional.

Digital delivery in a time of crisis

During the two years of global emergency, NHS Digital has been at the heart of our national pandemic response. From supporting COVID testing nationwide, identifying populations more vulnerable to coronavirus, or facilitating the largest vaccination programme in NHS history – the responsiveness of our approaches were tested under some of the most extreme conditions imaginable.

Throughout the pandemic, we have worked in often intense collaboration with NHS service and systems providers, government, academia, and research organisations to rapidly develop and continuously improve digital healthcare services that evolved with the demands of the national response.

In March 2020, the first national lockdown commenced, and the demand for 111 Online reached unprecedented levels. As the vaccination programme rolled out, the NHS App became the vehicle for the NHS COVID Pass.

Behind each of these digital healthcare services are multidisciplinary teams working intensively to maintain a deep understanding of their users, what they need, how to meet those needs and future improvements. It is vital that the teams are open and share these insights with those whose decisions ultimately inform how services are delivered.

© iStock/steven hatton
NHS Digital has been at the heart of our national pandemic response. Whether it was supporting COVID testing nationwide, identifying populations more vulnerable to coronavirus, or facilitating the largest vaccination programme in NHS history.

The NHS as a network of compassion

While it is common for us to refer in the vernacular to ‘the NHS’ as if it were a single entity, in practice, it has always been a vast network of great diversity. Hospitals, GP practices, ambulances, pharmacies, dentists and other providers and partners we work with demonstrate that healthcare has long been an interdisciplinary endeavour. However, when it comes to delivering digital healthcare services, we have not always worked in ways that allow us to fully capitalise on the wealth of experience and expertise that exists across that network.

Whilst the diversity of needs and pressures within the NHS can present challenges to making effective design decisions, it encourages the current systemic trend toward enabling better ‘integration’ and ‘collaboration’ vital for the future of the NHS. Delivering better-integrated health and social care services nationally demands widespread collaboration between NHS professionals and service providers of all stripes.

To improve the quality of patient care whilst reducing burdens on healthcare workers, we must also understand the limits of what is achievable with technology alone. A rich understanding of people’s lived experiences is vital to navigating this landscape successfully – and needs to take its place at the heart of how we decide where and how to employ digital healthcare services and solutions.

What we have collectively managed to achieve during the COVID-19 pandemic proves that when it matters, we can approach how we work differently, especially if doing so enhances our chances of delivering better outcomes for the NHS and those it serves. Our goal here – as my colleague Matt Edgar so eloquently put it – is to create a ‘compassionate national infrastructure’ that preserves and enhances humanity in the delivery of healthcare wherever possible.

The coming changes within the NHS present us with the chance to more effectively organise around that shared purpose. What we make of that opportunity will be up to all of us.

Trilly Chatterjee
Senior Product Manager
NHS Digital
Camp Digital 2022 speaker

This article is from issue 22 of Health Europa Quarterly. Click here to get your free subscription today.

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