Secondary care

The new outpatient crisis: Why are we settling?

Tina Marshall

<span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text" >The new outpatient crisis: Why are we settling?</span>

The response of the NHS in the covid-19 crisis has been truly monumental and worthy of every single applause. However, the pandemic brought to light just how critical the everyday business-as-usual operations of the NHS is. Yet, public health is at a turning point where it is imperative to make a lasting change to skid away from the not-so-long-term impact of essentially postponing healthcare.

The consensus regarding the last months is that, in the face of the novel coronavirus, the sharp shift in focus almost exclusively on covid-19 patients was the only way to tackle the pandemic. But as the crisis turns into ‘the new normal’, we are starting to pay attention to what was overlooked and how it may unfold.

The latest numbers showing up in the news are worrying – to say the least: Cancer referrals have decreased more than half in April 2020. [1]. Waiting times for referrals now extend to 12.2 weeks [2]– the longest they have been in a decade – and 1 million patients have to wait more than 18 weeks [2]. More than 460,000 are now in need of diagnosis [2]. – a staggering number, especially compared to January this year, when the same number was at 5,741. The NHS Confederation estimates that, by the end of the year, 10 million patients will be on the waiting list for surgery [3]. Cancer research estimates that, during the pandemic, 23,000 cancer cases have gone undiagnosed [3].

Even with these numbers looming, there is no other way to look at the people that keep the NHS in motion with anything other than empathy. NHS staff are the ones that have to tackle this unprecedented backlog after having been through a pandemic – with scarce resources on top of that. It is evident: the NHS requires a systematic change. Even before the pandemic, one of the main objectives of the Long Term Plan was to address the increase in outpatient visits, turning to virtual consultations with the ambition of transferring 30 million outpatient appointments visits in 5 years. To this day, outpatient appointments are inaccessible as requests by patients and on the discretion of the healthcare professionals, resulting in one of the higher DNA rates in this appointment type [4].

With the new status, the digital healthcare community is on standby, advocating to address this issue and extending their hand – to different degrees of success. Healthcare professionals and patients are on board – so is research on virtual consultations: A study on video outpatient consultations by Greenhalgh et al.* showed that:

  • consultation times are shorter
  • the meeting is more efficient
  • the attendance rate increases

Moreover, and contrary to the popular initial reaction, online consultations work best for:

  • chronically ill patients
  • healthcare professionals and patients with a pre-existing relationship

So, why do online consultations feel like a stuck cog? Where is the bump on the road and what is stopping the NHS from a seamless digital flow?

During the lockdown, the shift to online consultations was prompt and the voices of doubt did not receive the same attention – it became apparent that this is a necessity. For a large number of users from the healthcare and the patient side alike, the lockdown prompted them to have their first virtual appointment and the majority’s impression ranges from positive to enthusiastic. The same research from Greenhalgh et al. pointed out that scaling up virtual consultations in a Trust turns out to be far more complex due to lack of resources and information governance challenges, which lead to abandoning the technology or a failure to scale up or sustain the same pace.

Backing out from online consultations is not an option anymore – but most importantly, neither is failing. The Great Uptake of online consultations, however, has revealed shortcomings in digital healthcare. Security breaches have been reported repeatedly to a beyond worrying extent, technical issues are disrupting the consultations, centrally deployed platforms have not performed as they should. With these numbers looming over healthcare, the NHS simply cannot afford to make the wrong choice in digital transformation. With the new direction we hope the NHS takes overall, this is what we hope will change in digital healthcare in the UK as well – so that the NHS can tackle the backlog, get back on its feet, and provide safe and quality care to patients digitally – now and in the future:

Local mandate and choice

A platform that fits the local needs of the healthcare provider. Each organisation knows their patients’ and their needs best and one size does not fit all – no centrally imposed technology can fully address them in any way. It is time to give the mandate locally to healthcare providers so that they can make the right choice for them.

Usability & accessibility

Adding the patient to the digital equation is probably one of the most fundamental changes required by the NHS. Having the same DNA rate in outpatient appointments is not manageable post-covid-19 and patients should have the conditions to not only attend their appointments but have a say on how and when they take place too. An intuitive, accessible portal with aggregated online healthcare services is included in these conditions, to guarantee the necessary uptake and continuation of the digital path in outpatient appointments.

Security & trust

Conventional video tools have proven either non-secure, too disruptive of the healthcare workflow, or too sparse for the patients to keep up with. Virtual clinic solutions have also seen numerous security and capacity issues, with breaches and otherwise unacceptable downtimes. Patients deserve the protection of their data; their safety and consultation time simply cannot be compromised. The technology for virtual consultations should be developed ethically, with the right amount of technical know-how, the necessary quality and validation procedures, according to the requirements of the healthcare industry and be managed by the NHS. Bits of outpatient appointments just cannot be outsourced and choosing the right tool for digitalising outpatient appointments is crucial for moving past the outpatient crisis – now and in the long run.

How do you go about selecting the right tool for digital healthcare? Read our guide!

We are all looking forward to returning to life as we know it – but it seems like this will not be as easy for the NHS. The pandemic is still ongoing, and it will affect healthcare operations for months, if not years. Healthcare providers now need to enable the fundamental change that will allow the already stretched out healthcare professionals on the field to address both COVID-19 as well as every other condition. The pandemic has lifted the veil off of pressing issues that have been swept under the carpet: Resources are not scarce – they are simply inadequate; The NHS culture turns a blind eye to discrimination against its own people as well as patients; Top-down decisions are stifling the NHS staff, adding yet another burden on their backs. It is time for healthcare professionals to receive the best possible tools, conditions, and leadership so that they can feel empowered and bring the health of our population down to a manageable level – there is no room for quick fixes or half-hearted approaches.

Visiba Care is committed to supporting the NHS move forward – the right way and for the long term. Contact us to learn more about how Visiba Care can support healthcare professionals to go digital with outpatient appointments.

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*Greenhalgh T, Shaw S, Wherton J, et al. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res. 2018;20(4):e150. Published 2018 Apr 17. doi:10.2196/jmir.9897

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