Tech Revolution: making connections

Scotland’s digital health and care strategy could be a once in a lifetime chance to reshape physiotherapy services. And it’s crucial that members are involved in the plans. Gill Hitchcock reports.

Scotland’s physiotherapy staff can expect a seismic shift in service delivery. They will experience it as part of the Scottish government’s digital health and care strategy. Published this summer, the strategy promises that digital technologies will be at the heart of everything physio staff do. Over the next decade, digital will become not only the first point of contact physiotherapy services for many people, but also how they choose to engage with those services.
‘It is aimed at opening ourselves up to engaging with patients in a way that they want,’ says Lesley Holdsworth, physiotherapist and the Scottish government’s clinical lead for digital health and care.
She believes it makes economic sense too, arguing that the health and care workforce cannot meet the rising demand it faces. But digital transformation means services can do far more with existing resources.
Given the troubled history of NHS IT, this is an ambitious strategy. It also recognises that success will depend on developing the digital skills of physiotherapists and others. Equally, it includes an awareness that physiotherapists must be fully digitally connected wherever they are working. 
Ms Holdsworth points out that some services are already innovating. ‘There are physiotherapists who conduct team meetings or continuing professional development activities via videoconferencing platforms like Zoom.
‘Instead of having to travel long distances to come together, they can sit in the workplace and access all sorts of stuff and learn together.’
She says that a podiatry service in Glasgow with 900 staff no longer has face-to-face consultations after 3pm. Instead, the service has phone or video consultations with patients, who may then be invited to clinics, or to continue their care remotely over the phone, via Skype or FaceTime.
‘What this means is that throughput is much improved, the service can see far more people and in a way that they want to be seen.’  

National data platform

After the WannaCry ransomware attack on NHS services in May 2017, it is no surprise that the Scottish government takes cyber security seriously. It wants a national approach to information security. Of course, patients expect their personal information to be safe and secure. But this approach also seeks to eliminate inconsistencies in regulations, or misunderstandings about them, which impede new ways of working. 
‘We have approaches which are not proportionate to risk and prevent some of our physios and other staff from really getting engaged with technology,’ says Ms Holdsworth.
‘Data protection and security have been devolved to local boards, who then make their own interpretations. Some services are allowed to email patients, others are not. But under this strategy we will have national standards for those kinds of things.
‘If physios want to maintain an email correspondence to see how patients are progressing, or with the parents of children they are treating, it will be straightforward.’
A national data platform, giving physiotherapists real-time access to decision-critical information in electronic patient records, is a priority. Ms Holdsworth describes one problem the platform will overcome: ‘Many physio services are not linked into GP systems. If you see a patient, you cannot see their medical history and are relying on what someone has written on a piece of paper or included in a referral. 
‘The idea is that everyone will have access to whatever they need, including lab results and scans. But within the platform will be a patient portal and patients will be able to go in and look at their appointments, results or medication.’ 

An app in action

Empowering citizens to manage their own health and wellbeing is key to the strategy. By allowing people to access their own health records, the government aims to enable them to be more actively engaged in their own care.
Self-management will not replace physiotherapy, Ms Holdsworth points out. But physiotherapy staff will use technology to enhance their services.
One example is Scotland’s NHS 24 MSK Help app, which was developed with the help of physiotherapists, doctors and patients. Available to download through Google Play or the App Store, it provides people with a way to self-manage common muscle, back and joint problems. It includes exercises and video clips, and helps people to keep a note of their progress.
An obstacle to digital improvement has been the NHS’s reliance on a small number of technology suppliers and an abundance of closed, disparate systems. The government recognises that there needs to be a ‘more open and flexible approach’. 
To make this a reality, the strategy promises ‘local co-designed service transformation’. This means building on the knowledge and skills within local NHS physiotherapy services to support and deliver key digital developments. For physiotherapy staff, there will be opportunities to play a part in the remote monitoring of long-term conditions, the use of video consultations with people at home and more.
Making all this happen is part of Ms Holdsworth’s challenging remit. One of the mechanisms she uses is to engage with physiotherapists through Scotland’s national network for allied health professionals, nurses and midwives. Hundreds of physiotherapists are already involved in this way, she says.
‘What I say to physiotherapists is that the strategy is an open door. Be involved. Be vocal. If you are not part of it, join our network. That way you will get your voice heard, and when you hear about innovation in other places you can see the implications for your own services.’  

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Gill Hitchcock

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