In the second and final part of a feature on Alison Kenyon of the Leeds and York Partnership NHS Foundation Trust the digitisation of the NHS is under the spotlight. As the lessons from the Covid-19 pandemic are learnt the way technology is used by the NHS can help to deliver more services in a timely and convenient way for both doctor and patient.
For all its shortfalls, there have been a large number of instances where digital technology has proven useful and indeed effective in keeping mental health services running, as Kenyon explained.
She said: “Research into how we have changed our delivery of services is showing that a lot of what has been switched to remote delivery is doing quite well, and it does help to get around some of the typical challenges of face-to-face interventions. We have to remember in our profession that not every form of intervention may require or be suitable for the face-to-face contact. During the pandemic where these sorts of interventions have had to occur, either or both parties - clinician and patient - have had to wear a face covering and that can make reading visual and non-verbal cues more difficult which intimidates some patients with certain conditions. That can impact that relationship of trust between the clinician and patient which is essential. Clinicians have also had to undertake risk assessments too when looking to see patients face-to-face so this has brought in a whole new discussion and a whole new admin burden. Remote delivery, where such an approach is appropriate, does help get round these issues.”
Kenyon went on to discuss how remote provision has also had other benefits for the patient, such as being more convenient for them and removing the anxieties of having to physically present themselves on site and potentially risk contracting the virus from someone else.
“Some of our service users have been afraid of the prospect of face-to-face consultation and want to keep themselves in self-isolation. Others have also been shielding. For these people, as well as those who would prefer to come in but cannot because of restrictions, remote provision is ideal. We have still been able to operate our in-person service but at a reduced capacity in order to comply with Covid-secure rules. We could not see as many people in the building, but with technology and other steps we have taken, we have managed to avoid a work backlog.”
Keeping on top of the workload
As well as bringing forward a digital agenda, Kenyon revealed another way that the mental health service has been able to free-up capacity, which came about through working more closely with third sector partners and distributing work.
“With our community mental health teams, we decided that we would be prioritising higher risk users, and for those who are medium or lesser risks we’ve worked with one of our third sector partners and rapidly commissioned a new service to ensure that third sector personnel are able to provide support to those individuals who don’t fall into our highest risk category. So the third sector has been able to take on the responsibility of calling in to speak to the lesser risk users and taking time out to help them with shopping and other things, and that has freed up capacity for us to focus on the more acutely ill.
“Service users have really valued this new service as well, and it is something that we’ll look to continue with, so we are actually learning all the time through this about how we can deliver services more effectively. So, there are good things to come out of this whole situation too.”
Reset versus revert and the challenges of the future
Echoing the words of fellow health experts Prof Adrian Banning and Dr Antoni Chan, with whom we spoke earlier this week, Kenyon informed us that some within the NHS are determined to use the pandemic as an opportunity to reset and re-evaluate pathways in order to make the health service more effective, rather than seek to commandeer as swift a return as possible to maximum capacity under the pre-pandemic model over 2021.
“We have been using the word ‘reset’. Every health service is undergoing a process of re-evaluation, looking at things that have worked through the pandemic and other aspects that haven’t, so that we can take some things forward. We are not just standing back up post-Covid, we are resetting how we deliver our services in the long-term and improving on what was there before.
“I think in future we will see a much more agile health service. We have been able to respond to this pandemic at phenomenal speed and change how we deliver services, doing things in days and weeks that would probably have taken months. However, the problem here is that such speed of change is not sustainable and healthcare staff will inevitably feel the strain as they become tired and burnt out. Even though they are taking annual leave, working for the NHS is a very different way of living a working life. With winter pressures on the horizon, there will be more challenges to come until we can shrug off Covid as an immediate and present danger, and then we must look at the financial challenges ahead. We are going to have to be thrifty in the next year, because even though we have had extra funding to get to this point, we cannot keep spending money hand over fist without any recourse. There will be some difficult conversations to be had with providers as we naturally try to fight for as much resource as we possibly can.”
‘People are our greatest asset’
When asked more specifically about the impact that the pandemic has had on healthcare staff having mentioned that many are suffering with fatigue, Kenyon was clear that NHS staff are the health service’s most valuable asset and said that she wanted to see more support from leaders in the sector to help them cope both through the remainder of the pandemic and through the aftermath, in order to avoid them becoming extra victims of the looming mental health deterioration.
“The early onset of the pandemic was a huge challenge for staff. Many were testing positive and having to go into isolation and everybody had to adjust with new precautions including shielding, more stringent cleanliness procedures and PPE, and now this is settling and people know how to protect themselves the initial shock and anxiety as a result of the unknown has eased.
“In my view, the problem is going to be fuelled by what healthcare staff have been witnessing. Covid patients can become extremely ill and staff are being exposed to a lot of people in critical condition and can easily succumb to mental health problems because of these traumas. In many areas of the country, we have been working and researching to try to predict where incidences of mental illness could crop up across the population, and one of the groups we have monitored closely are people working in health and social care. We have grounds to believe that the future number of mental health issues linked to conditions like PTSD in Leeds alone could be tremendous just among social care workers because of what they have experienced.
“We need to prepare for this looming mental health crisis and take care of our staff and help them find ways to cope. Some of this comes down to good leadership and knowing when things are not right and giving people who are suffering the access to the right kind of support. We need to think of what work we can do on leadership development, maybe in the early part of 2021, and explore how to help leaders be on top of their game in spotting these issues and addressing them.”
Once more reiterating a point raised by Prof Adrian Banning, Kenyon explained that some clinicians and health workers may be suffering from being unable to socialise as they typically would with some of their work colleagues, which has compromised an important coping mechanism.
“I think for clinicians, what they are missing most is that time where they can sit with colleagues over a coffee and socialise over their shared experiences and traumas. That camaraderie and support that comes with that is gone and the way we run meetings remotely now, it is very much straight down to business and there is not the social exchange of human conversation anymore. That again will take a toll on people.
“For example, I am able to do my job from home and since the end of March I have spent four days in the office. The whole reason I decided to go in over those days was because I wanted to see my colleagues in-person. In those rare instances I could go in and speak to my manager and other colleagues and that is uplifting and will buoy me up going forward. We need to provide those opportunities safely in the short-term and leaders need to be aware of the importance of this as well as being self-aware of where they are at because they are not immune to the same struggles either.
“I have seen this pandemic bring out the best in my colleagues in the NHS. My whole career since the age of 18 has been in the NHS, it is my life. Our people are our greatest asset, and we need to make sure we look after and support them through what will be an exceedingly difficult time to come.”
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