Professor Andrew Menzies-Gow, NHS England's National Clinical Director for Respiratory, discusses the importance of digital services for the NHS and how COVID-19 has shown just how vital it is to be able to offer digital consultations.
By the time I start my clinic in the morning, Winston and his wife, Rose, have already spent the night in London, having travelled for hours to get to their appointment. Winston, 65, has severe asthma, and lives in West Sussex. Following his diagnosis in 2010, he has had to travel to London for his consultations at least twice a year.
For one hospital appointment, Winston and Rose have to buy railcards, spend money on train fares, meals and a hotel. As Winston’s condition has developed, he now cannot walk more than 30 or 40 yards without coughing and feeling out of breath, so they often have to pay for a taxi fare too. Travelling during rush hour is a challenge, and unable to get appointments in the afternoon, Winston and Rose have had to invest time and effort into getting the support Winston needs, spending at least £200 each time. For Winston and Rose, seeing the specialist respiratory team face to face is both an emotional and financial commitment.
Debates around the effectiveness of remote consultations have been a hot topic over the last few years. For many people in Britain, having a personal relationship with their doctor or specialist consultant is crucial. Patients sometimes worry that switching to a video link will mean that doctors are less likely to understand their needs and that they won’t get the same level of treatment that they do now.
But these worries and concerns, many of which seemed insurmountable before we experienced the reality of a global pandemic, may now be viewed in a new light. I believe that Covid-19 is going to have a dramatic long-term impact on the way I work with my patients. Shielding and social distancing has already meant that we have quickly learned how to make remote consultations as effective as possible and we are now entering a world where remote consultation, on a video link, will be the norm rather than the exception.
Of course, patients have a right to be concerned about this move. Not everyone may have the appropriate tools to manage a video consultation – they may not be used to using a computer or smartphone and they may worry that it’s not something they will be able to learn to navigate. There’s also the concern of technology failing. After all, we have all experienced a broken internet connection, ending up in a call where important information is suddenly conveyed as if underwater.
But the advantages of this form of treatment – for those who may wish to access it – are hard to argue with. We are all adapting to a state of ‘new normal’. Everyone, no matter how uncomfortable they may be with technology, has now had to think about living their lives remotely and we have had to adapt the way that we deliver consultations and maintain excellent patient care. .
A digital consultation means that people like Rose and Winston would not need to travel for hours, spending money to sit in a waiting room. For now, Winston is self-shielding, and has had a phone consultation scheduled in, which is a sign of how things are already changing.
People who have relatives or close friends living in a different part of the country or abroad, can invite them to support them in appointments. If the person you want with you is normally at work, all they need to do is to find a quiet room and join you on their smart phone or laptop – rather than having to take the day off to physically come with you.
We have made rapid progress in our remote offering. We have moved our medicines to home administration where possible, are working to enable people to have some tests in the safety of their homes and are trialling home measurement of lung function for some respiratory conditions.
What we need now is an effective understanding of the limitations of digital services in the NHS and how people feel about them. We want to make sure that people feel as supported as possible and that digital consultations aid patients effectively so that everyone is assured they are getting the best possible level of care available.