Pulse Online recently shared its second podcast – a discussion with Dr Adam Daly, a consultant psychiatrist who has been using the video platform Near Me to deliver digital care for patients.
Thank you for your warm feedback on these productions.
Having established the growth of technology enabled care (TEC) in episode one, and bottomed out the aforementioned compelling example of current day use, our resident TEC podcaster Ewan Summers was keen to find out what the future holds for this tomorrow’s world technology.
This leg of Ewan’s journey of TEC discovery led him to Marianne Hayward, interim chief officer/head of health and social care for South Lanarkshire’s Health and Social Care Partnership.
In this discussion, Ewan and Marianne cover a range of issues, including digital hospital discharges, how TEC will expand in the future and how current technology can adapt to future needs.
So, relax, take a break from the screen and enjoy listening to this latest instalment in the technology enabled care podcast series.
Podcast music: ‘Roll the intro’ and ‘piano sting’ by Alexander Nakarada
Licensed under Creative Commons BY Attribution 4.0 License
Feedback
What did you think of this podcast? We would be really keen to hear your views. Email euan.duguid@lanarkshire.scot.nhs.uk
If you have any questions related to TEC, Lanarkshire’s TEC team will be delighted to support you. Email them at TEC.Programme@lanarkshire.scot.nhs.uk
Podcast transcript
Ewan (E): Hello, and welcome to the latest episode of the technology enabled care podcast. My name is Ewan Summers and I have been fascinated by the massive growth in use of technology enabled care, which is also known as TEC for short. TEC enables everything from providing a direct patient-to-healthcare staff video link, to remote monitoring using everyday text messages, and much more. Thus far, this series has had an overview of TEC with Morag Hearty as well as divulging how it’s used currently in psychiatry with Adam Daly. So, naturally, after talking about the past and present, this episode will discuss the future of technology enabled care. To do this, I spoke to Marianne Hayward who is head of health and social care for South Lanarkshire’s Health and Social Care Partnership. In this discussion, we covered a range of issues, including digital hospital discharges, how TEC will expand in the future and how current technology can adapt to future needs. So please, sit back and enjoy our conversation. And without further ado, I give you Marianne Hayward.
Marianne (M): I guess with the last 18 months hasn’t given us much opportunity to take anything else in that we would normally to try to progress and roll out. And that might be something we go back to. We also aren’t – our team in south particularly – is quite fortunate because we’re also linked into the assistive technology team, so we have a lot of new technology in relation to fall sensors and things that will do preventative work in the home. And there’s a lot of work happening in South Lanarkshire in a new intermediate care facility, which will test some of that tech going forward. We’ve done a bit of work with South Lanarkshire looking at early intervention around falls. I guess our main priorities over the last 18 months has been to keep people safe at home. And, you know, the next phase of this programme will be to look at what else is out there and how can we improve things.
E: When I spoke to Morag recently, we covered how much TEC has blown up during Covid, but how do you see the future of it beyond Covid?
M: Covid’s just given us impetus to escalate this beyond all measure, so I see this us growing on that. We also know that as services step up, we would want to continue that momentum and encourage our clinicians across in acute and community to carry on using it and expand it. So there’s a few services coming on board and heart failure and blood pressure monitoring has come on board recently. We’ve got an enormous amount of opportunity in terms of diabetes. There’s currently a pilot ongoing at the moment around Covid monitoring, which is happening quite a lot down south but not really that many places piloting up here. And I think it’s over 80 people who are now being monitored using the home health monitoring for Covid and there’ll be other services that come on board as we move forward. So psychiatry are using Near Me quite successfully at the moment and we’ll be sitting down with our acute colleagues to say ‘well, where else’ and ‘where can we go now’. So it can only get better, but I suppose we’d want every service across Lanarkshire to be putting this as a priority and start doing measuring whether they’ve actually achieved it or not. Set some targets and goals.
E: You’ve said that you’ll be sitting down with your partners and saying where now, but where do you think you’ll go?
M: Well, that’s where we’ll have to go. And, I mean, Covid’s not gone away, so we have to think of new ways of working. We can’t have that many people in our buildings anymore, and there’d be an opportunity now to actually really look at the ways that we could invest our resources in other ways. So it means more tech to support this, other things that are out there that we can build in. I saw some really interesting work at the recent digital health and care conference where they were looking at sensors for falls in new builds and housing etc and we could really be influencing those kinds of initiatives and expand on them across Lanarkshire. As I said before, we’ve still got a lot of work to do around our clinical services, our out-of-hours and there was a bit of work that we were doing with the prison prior to Covid I want to pick back up and have a look at to see if we can expand the use of clinical across the prison and our clinical services.
E: How hopeful are you that you will be able to expand it successfully?
M: Oh, yeah, I mean, it’s been well accepted across Lanarkshire that this is what we need to be doing. I don’t think we’ll have any barriers necessarily. As soon as they start working with a team and they can see the opportunities with it, it becomes a lot more easy to make those changes. I heard recently – I listening to the webinar recently about Near Me – it was fascinating to hear the learning that some of the clinicians have taken on during this, which was thinking it was almost too difficult to do at the beginning, but actually learning as they went and making sure you do a clear space to have that consultation with your patient; making sure that the waiting room areas are easily accessible and also understanding that age is not a barrier for using technologies – somebody of 91 could be using technologies just the same as someone who’s 21.
E: You’ve mentioned before about the remote Covid monitoring, and we’re obviously hoping that it won’t be around forever, so what have you learned from the Covid monitoring that you’ll be able to implement further down the line?
M: Well, I haven’t been directly involved with the pilot, but I would assume that with 85 people going through being monitored from home we’ve managed to prevent them going into hospital. Or we’ve made sure the right people go into hospital through the monitoring. And I think the monitoring at the moment is looking at pulse ox, so anyone whose oxygen saturation is dropping, they’ll be able to react quickly to it. And it makes sense because that’s the way that all the monitoring, text reminders, etc do; it’s about helping people to be safe at home. I would see it as, well, I don’t know if Covid will ever go away completely, I think that would be naïve, I think we will end up living with it. If it does go away completely, I’ll be absolutely delighted with the rest of the population. So this is a way by testing it to make sure it’s safe by using, you know, one or two practices just to see how it walks through, you can see how this would have enormous benefits to not having somebody have to trail in through a hospital or through an assessment centre, they could be monitored successfully at home.
E: What would you say has been the main health benefits for the patients from your work?
M: Well, it’s multi-factorial, and quite holistic also, because by having your consultation from your armchair, you can imagine that it’s a lot less anxious than trying to get to a hospital site for an appointment, or indeed to your GP. By sitting in your living-room, it’s also a lot less stressful than trying to find a parking space. These appointments done remotely through Near Me have saved an enormous amount of time and space and effort. The home health monitoring has saved 25,000 GP consultations have been saved using the home health monitoring – and that’s an enormous amount of time saved, but also efficiency saved. For the patient, they get the benefit of seeing someone face-to-face, even though they’re not in the room with them. They’re safe from any transmission of Covid or any other condition, and there’s the reassurance that somebody is picking up and looking after them.
E: Are you in regular communication with your patients, and what key conclusions have you managed to reach from these consultations?
M: That Near Me works, and it could be part of your day-to-day business as usual, it doesn’t have to be an add-on. Where we do need to see people face-to-face, because there’s some things that you just have to; so if you want to do a diagnostic on somebody, they have to come in and have the diagnostic. But everything else in terms of follow-up review etc, or indeed a new consultation without the diagnostics, can be done face-to-face. One of the clinicians was talking about being able to see people’s reactions, judge their facial expression which you just can’t get over the phone. Now I’m not saying it’s perfect because our physio colleagues were describing looking at somebody’s leg when they were trying to talk to them which can be a bit awkward. Adam Daly, he’s a psychiatrist, was describing having consultations with someone’s ear. So it is a learning curve for people, there are some things for physiotherapy, they said they just couldn’t do using Near Me, so we’re gonna have a look at that, we’ll walk through it with them and see if there’s anything we can do to improve that. But on the whole, most of the clinicians are singing the praises of it.
E: Do you see it as being, in the near future, being the first choice as opposed to face-to-face, in-person?
M: I think we’ve got a bit of work to go with there, but yeah, I would hope for some conditions, safety included, would be seen as the first call. I think there’s a lot of work we could be doing around diabetes, because people with diabetes are not ill, well at least most of them are not ill. They have to monitor and look after themselves, so they don’t become ill, so you can see where a lot of Near Me and the home health monitoring would directly support that. And you could have a scenario where people just don’t have to come into hospital at all in that case. There are some other work around the home health monitoring: people being supported to do injections at home, there’s a weight management service which we need to go back and revisit because it’s not been picked up quite as well, which is surprising during Covid, because you’d imagine people being stuck at home with only their fridge for company, it could be a problem. But they’re not being picked up so we need to have a look at the figures around that.
E: Would you be able to go into a bit more detail?
M: It’s about hints and tips more than anything, and signposting. So people who are wishing to reduce their weight or maintain their weight being monitored remotely using this. Florence acts in a way that would give you a hint or a signpost to some place that would support you. It’s a valuable programme, especially when you consider, say, type two diabetes, where you would want to help support someone lose weight. They can’t go to groups, or at least the groups are all being done remotely, so it could be useful. We just need to revisit why it’s not been picked up so much compared to some of the other programmes that we’re running.
E: Just finally, would you be able to give any personal highlights or stories from your time at TEC?
M: There’s a few. I love the telehealth team, the TEC team, they’re a phenomenal group of people and seeing how they’ve been valued over the last year through the organisation has been phenomenal – and recognised nationally. The team have had some high-profile awards over the last year, one of which was the national award, knocking out quite a number of councils along the way which was great. The second highlight has been around exploring how we use Near Me with delayed discharge. So as people have not been allowed to go into hospital, they’ve not been as connected to their loved one as we would like, so the team have been using Near Me on iPads to have those conversations with their loved one, prepare them for discharge and in one or two cases they’ve managed to bring them home earlier because the family has been engaged. Now we need to do some work with the wards to try and escalate that because you can see how valuable it will be. Maybe visiting will be relaxed, but I don’t think it will be for some time, so we’ve still got some challenges around connecting people in their homes to their loved one on a ward. It must be terrible not to be able to visit your loved one while they’re poorly and even more troubling when you can’t actually plan what’s happening with them. That was a real highlight, and the two people leading that are brilliant and if anybody can make it roll out across the sites, they will.
E: Perfect. Marianne, thanks a lot for joining me today.
M: That’s okay. Thank you for that.
E: Thank you very much, bye.
M: Thanks, Ewan, bye.
E: Thanks to all of you who listened. I hope this episode has provided some insight into how technology enabled care continues to grow and how it will expand in years to come. I look forward to you, our listeners, learning more about TEC as we go further on this journey of discovery in future podcasts. But for now, thank you.
