By Dylan Powell, Research Analyst, Deloitte
Since its inception in 1948, the National Health Service (NHS) has transformed and evolved to be one of the biggest employers globally (1.5 million employees).1 However, despite this, over the past 22 months of the pandemic has had a significant impact on many aspects of healthcare delivery and exposed the limitations and fragility of the current volume-based healthcare system. It is a system that is struggling to meet the increasing demand and expectations of society, government, staff and most importantly patients. One of the most visible outcomes of this struggle is the increase in waiting times for both emergency treatment and elective surgery. Today, an estimated 5.6 million people are waiting for routine elective procedures, a number that is expected to grow to some 13 million people in a few years unless new ways of working are adopted.2 This week’s blog, by our new analyst Dylan Powell, considers how the use of digital technology and a more preventative self-management model is changing physiotherapy and could help to manage healthcare pressures effectively.
What has changed?
The COVID-19 pandemic has made hybrid working a necessity rather than a choice for many health practitioners and patients. Improvements in the scalability of digital technologies such as wearables is changing the extent to which health outcomes can be monitored.3 For example, Apple Health Records have linked up with numerous NHS trusts to reinforce the partnership between consumer and private health technology companies.4 These developments will be critical in contributing to objective assessment and personalised healthcare which can also drive a shift to preventative self-management care or more proactive care like falls prevention, enabling more focus to be given to full and active lifestyle management.
The timely roll out of the 5G infrastructure by telecommunication companies is facilitating new methods of virtual consultations and assessment.5 This is exemplified in the recent alliance between Vodafone and Deloitte (Vodafone Centre for Health with Deloitte).6 More reliable, fast, internet connection provides the ability for real time assessment or support for calls with medical staff for those relying on home care services or for new care models to be developed to support community recovery. This proactive support has the potential to reduce the number of unplanned admissions and/or hospital contacts.7 These advancements may also increase patients’ ease of access to services whilst also contributing to reducing the carbon footprint through reducing the need to travel.
Where might these technologies have a measurable impact?
Initial assessment of musculoskeletal Injuries
Clinicians working as first responders in the community or in sport often have the challenge of making rapid decisions on the severity of an injury - deciding on whether the patient needs to be sent to A&E for further assessment. As a physiotherapist working in rugby and football, I have first-hand experience of the challenges of solo working, whereby decisions for complex injuries or life-threatening injuries are made on the information available at the time and clinical judgement. More widespread use of digital technologies and 5G-enabled telemedicine can enable real-time multidisciplinary decision making involving doctors, first responders and sports professionals.8 By relaying vital signs and live images to trauma centres second opinions can be used to help triage and prioritise those with the most urgent clinical need for hospital intervention, while enabling those with less severe clinical need to be monitored in alternative settings.9 This may help reduce the risk of unnecessary A&E assessment while improving the reassurance provided to patients.
Pre- and post-surgery assessment and remote rehabilitation
Before the pandemic, roughly three out of ten patients would go home the same day after elective knee surgeries in one health trust and this has risen to nine out of ten patients in October 2021.10 This marked change in early discharge has been made easier through the rise in telemedicine and remote consultations. For example, the roll-out of the telehealth platform Attend Anywhere was expanded rapidly during the pandemic as part of Scotland’s ‘NHS Near Me’ primary care virtual consultation system and now facilitates 20,000 consultations each week.11 Likewise in England, the Attend Anywhere platform was made available to hospital outpatient departments to support virtual outpatient clinics for both pre-assessment and post-discharge consultation.
Indeed, the pandemic has accelerated the adoption of a number of telehealth platforms across primary and secondary care and digital technologies such as wearables are being used to provide patients with real-time feedback on pre-surgery and post-surgery (rehabilitation) targets and can include information on activity levels, gait assessment (walking) or rehabilitation exercises.12 This can help free up the use of hospital beds and make more effective use of clinical time.
This trend can also be expanded more widely to enable a move towards more efficient, holistic, and objective care, using wearables to augment the monitoring of chronic health conditions and illnesses. Which, in turn, may provide more choice and greater satisfaction to patients regarding the mode of interaction with their healthcare providers, whilst also providing longitudinal monitoring to aid clinicians’ decision making and providing patients with an ongoing understanding of their prognosis and/or responsiveness to treatments giving them a truly personalised experience of care.
Conclusion and Next Steps
Digital technologies and remote monitoring provide a unique opportunity to change fundamentally how care is measured, received, and deployed whilst being mindful not to drive digital inequalities. This expansion of remote monitoring may increase patient activation and involvement in their own care resulting in greater instances of co-created healthcare with interventions based on agreed outcomes between the patient and clinician leading to more personalised models of care for individuals. The combination of remote monitoring and patient activation may also facilitate and empower patients in self-management, preventing deterioration and optimising the timing of any active intervention required.
However, the adoption of data informed healthcare decisions, aided by digital technology (software as a medical device) will require a cultural shift that builds trust, supports a learning health system, and better connects and supports healthcare professionals and patients. Future success will be dependent on balancing the best use of data to optimise patient outcomes together with safeguarding patient privacy. If this can be achieved, then the future may be much brighter.