“Let’s embrace the complexity and apply what we know”

Shot of a doctor showing a patient some information on a digital tablet

Digital health adoption is the focus of a newly published set of journal papers, jointly curated by the HIN’s executive director of digital transformation Amanda Begley. Here she reflects on the role of complexity and evidence on digital health adoption and the practical steps available.

With thanks to Frontiers, my co-editors Yiannis KyratsisHarry Scarbrough and Jean-Louis Denis and our 74 authors, we have just completed the editorial for our Research Topic Digital Health Adoption: Looking Beyond the Role of Technology | Frontiers Research Topic (frontiersin.org).

With 50,000 views already and the research topic being in the top three in the journal section, digital health adoption is clearly a hot topic. So, I thought it important to let you know about the open-access articles available to read.

Do read our short editorial – it provides brief summaries of all the articles and has embedded links to help you navigate to which of the 10 in the research topic are of most relevance to your work and thinking.

The editorial also describes four key non-technology related aspects of digital health adoption (co-creation, stakeholder management, ethical and social factors and the need for transparency), and five key levers to adoption:

  1. Understanding and responding to the needs and preferences of diverse individuals and communities
  2. Early and active stakeholder engagement in both design and technology use
  3. Building the capability and confidence of all actors to acknowledge and raise quality, privacy, security and safety concerns
  4. Adopting a holistic, rather than a piecemeal approach to build a supportive ecosystem
  5. Considering seriously the wider ethical implications.

I don’t want to repeat the content of the editorial here, so am instead sharing a couple of reflections:

  • Let’s embrace the complexity: We are increasingly realising the breadth of considerations and capabilities required to implement digital health technologies ethically, equitably, efficaciously, and economically. Although this may feel at times overwhelming, one of the many things I love about the health and care system is that it’s complex, requires careful thought and partnerships – change can be unpredictable, hard won, and takes time. With the growing research and practical insights accumulating, we are now better informed about how to enable technology adoption. Also, national policy work continues, like NHS England and National Institute for Health and Care Excellence’s (NICE) current work on a policy framework for defining the assurance pathway for digital health technologies and NICE’s Early Value Assessment
  • Let’s apply what we know. As an assistant and trainee clinical psychologist and when completing my PhD, reviewing the evidence-base was second nature to me. However, as I moved into commissioning and operational management, I got so busy fire-fighting that I forgot to draw on the evidence (like implementation-, complexity- and behavioural sciences) to inform my efforts to implement innovation and transform care. It’s only been in the last 15 years that I’ve drawn on the rigorously captured findings of the authors included in this series and utilised the vast knowledge that sits in our open access journals like Frontiers, BMJ Open and Implementation Science to name but a few. I know how hard it is to make time for this but doing so gives greater rigour to our efforts.

So digital transformation is not easy, quick or straightforward – but perhaps I’d be bored if it were… 

However, if we continue listening to our users and staff, openly sharing and actively learning from others, and working with colleagues across care settings and sectors then anything’s possible – including digital health adoption at scale for our patients, populations and staff.

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Making mental health a priority starts with our workforce

Andy Scott-Lee recently joined our Mental Health team, having spent most of his career with front-line mental health roles. We speak to him about his reflections on his first few months at the Health Innovation Network and what his experiences have made him think about how we could protect and improve the mental health of our nation.

Every week, so it seems, a new worry is added to the list of issues affecting society. Between the housing crisis, the climate crisis, and the cost-of-living crisis, there seem to be more factors than ever making life difficult for ordinary people.

In a world where everyone is affected by these issues differently, where do we start when it comes to finding common ground for improving our nation’s mental health and wellbeing?

In my opinion, it all begins with looking out for the people looking after our mental health.

Most clinical teams working in mental health are under significant pressure at the moment. I think awareness of those stresses probably peaked during Covid-19, where we saw a significant increase in mental health issues experienced by NHS staff, but it’s so important that we don’t slip into thinking those operational pressures have gone away.

People working in the NHS need to feel they are valued and that they and their services are supported by their organisation to do the job they were trained to do. I've worked on the front lines of mental health, and so often have found that the times where I delivered the best care were when I felt my health and wellbeing were being prioritised.

To be authentic and consistent in my care for others, I needed to first feel good about myself.

Making time to change our culture

Improving the way we look after our workforce is a responsibility for everyone working in mental health. 

Many mental health professionals already take a mindful approach to their own wellbeing, and I feel this is something we should continue to encourage. Certainly, the mantra of "be gentle on yourself" was something that I repeated to myself when treating many of my patients with trauma, and there is a wealth of insight and guidance on effective self-compassion dating back as far as Buddha. But self-help is only a part of the solution. 

One of the biggest things I’ve noticed since joining the HIN is that wellbeing isn’t just listed as an “organisational priority” – it is something that everyone actually invests time and effort into. 

Finding everyone represented in health and wellbeing conversations has been a relieving and refreshing experience. At all levels, it is acknowledged that the time and effort that goes into improving our wellbeing is reflected in the quality of the work that we do. Dedicated wellbeing champions lead the way, and it is great to see staff from all backgrounds and seniorities consistently taking advantage of activities designed to improve our physical and mental health. 

Of course, the HIN does have significant organisational differences to a Trust providing clinical care. But I think the essence of what we have here – senior leadership buy-in, dedicated champions and advocacy across the organisation for wellbeing as a priority – could be applied anywhere. 

Practical action, not policies 

Health and wellbeing isn’t a new topic within the NHS; NHS England’s People Plan from 2020 is full of sound thinking on the issue. 

But despite “islands of improvement” we haven’t made enough progress as a system, and perhaps we’ve fallen into the trap of talking too much and acting too little. 

So my challenge to people working in mental health is this – what can you do to improve the wellbeing of our workforce, and in turn improve the care that we provide? 

Can you find a way to reduce the workload of someone so that their “wellbeing champion” objective becomes part of their core responsibilities rather than an add-on to do in their personal time? 

Can you be the senior leader who always makes time to attend a wellbeing walk or other activity? 

Can you be the person who takes the initiative to learn from what’s working elsewhere? 

I believe you can. 

Evaluating remote consultations in mental health: creating a positive legacy from the pandemic

Covid-19 catalysed huge changes for mental health services, with many appointments switched from face-to-face to video or telephone consultations almost overnight. More than two years on from the start of the pandemic Dr Stuart Adams (Consultant Psychiatrist and Chief Clinical Information Officer at South West London & St. George’s Mental Health NHS Trust) discusses the lasting legacy of these changes – and how a new evaluation tool will be a vital enabler for further improvements to the service user experience.

The pandemic has been exceptionally difficult for everyone involved in mental health – service users, clinicians and managers have all had to deal with situations that I think most of us hoped we would never experience.

Whilst nobody will look back on the past two years fondly, I think it is important that we do what we can to ensure that we learn from such testing times, and maintain momentum on some of the accelerated transformation work enforced by the pandemic. One of the areas where I think we have a real opportunity to create a positive legacy is the use of remote consultations in mental health.

Starting in 2021, we partnered with the Health Innovation Network, experts by experience, and other local stakeholders on a large-scale evaluation of the rapid adoption of remote consultation technologies. Over the course of that evaluation we spoke to thousands of mental health service users and staff about what the switch from face-to-face to telephone or video consultations had meant for them.

Whilst the evaluation identified some complex challenges around the adoption of remote consultations by mental health services – not least ensuring digitally excluded people were not “left behind” – there were also many positive themes in our final report.

People we spoke to in our evaluation often talked about the convenience of remote consultations, saving time and money on travel to appointments. Writing at a time of an emerging cost of living crisis and a renewed focus on making the NHS as environmentally sustainable as possible, the convenience factor seems more relevant than ever.

Managing the transition from transformation to business-as-usual

Two years on from the start of the pandemic, it has been positive to see that people are continuing to make the most of remote consultations as an option for accessing care. About 12% of all our consultations at South West London and St George’s are now conducted remotely, with much higher take-up in some services such as CAMHS.

So – with a robust evaluation in the books and uptake seemingly in a steady state, is this “mission accomplished” for remote consultations?

Not from where I’m standing, if we want to really make the most of the potential of these innovations.

We’ve come a long way in terms of technology from those first days of the pandemic, from shaky connections and clunky interfaces, through to more dependable solutions with functionality that helps rather than hinders the therapeutic alliance. But – anybody who has been a part of a remote consultation knows there’s still room for technological improvement.

We’re also still understanding the answers to some big questions around implementation – for example the benefits and drawbacks of phone versus video-based remote consultations.

And finally, as with any service, we must commit to interrogating our delivery of remote consultations to ensure we are providing service users with the best (and most effective) choices and services. This brave new world contains many exciting opportunities for Quality Improvement, and we have only just scratched the surface of what might be possible.

Meaningful evaluation underpins progress in all of those areas, which is why I am pleased that our partnership has produced a new appointment survey, designed to help Trusts understand service user experiences of remote consultations on an ongoing basis.

The free tool can be easily adopted by any NHS service and delivered through a variety of platforms. Along with other project resources from the partnership, we hope it will be useful for clinicians and managers hoping to further develop remote consultations as an option for their service users.

Here’s to continuing to drive progress that benefits services users, clinicians and systems – with robust evaluation illuminating the road ahead for all of us.