All good things must come to an end ...

Almost exactly four years ago I joined the team at NHS England to help launch a new NHS App to practices across the country. It had been beta tested with a small group of GP practices and over the next six months was to go in to every one of over 6,500 practices and be available to everyone living in England. Thanks to a stellar team including Polly, Alan, Rhod and Pip the rollout was successful, though little did we then know how crucial it was to prove.

Quite a bit has happened since then! Including the creation of NHSX, a global pandemic accelerating the spread of digital health solutions beyond anything any of us could have imagined, 34m people with the NHS App on their phone and - the thing I am proudest of in my career so far - new pathways enabling hundreds of thousands of people to receive their care at home, thanks to digital.

With poetic timing, yesterday it was announced that an incredible 100,000 people and their families have benefited from care in a Virtual Ward in the NHS in England over the past year.

Virtual wards have supported 100,000 people in the last year

So how did it all begin?

At the very start of the pandemic, in March 2020, my boss Matthew (Gould) was contacted by another Matthew (Knight). He was running one of the largest virtual wards in the country and they were starting to see people with Covid. He asked us whether there was any technology that could help them, as they had none at all, and helped by a kind probono offer from a tech provider, four very hectic weeks later the first tech-enabled virtual ward in England was supporting patients.

It felt pretty amazing to be contributing so directly to something that could make such a difference - our team remembers this period particularly vividly, and Lisa and Chris led the work at great pace. It was intense but joyful to be helping people practically at such a strange time, and from the first the patient feedback was very positive. Since then Matthew Knight has been made an MBE in recognition of the importance of this work and the service at West Herts with Niall and Andy has gone on from strength to strength, recently being referenced by the Prime Minister and visited by the Secretary of State for Health and Care.

Three years on, the scale of digital home care across England is pretty extraordinary, especially considering the NHS started from a low base.

Every single ICS has a Digital Home Care service. Many have more than one.

The NHS in England is now organised into 42 districts called Integrated Care Systems that bring together both health and social care locally. Every one of the ICS in England now has one or more tech enabled home care services, and many have several examples, making a real difference to patients, every day. Three years ago there was only a tiny presence of these services within the NHS in very pioneering sites.

Digital Home Care services include - supporting those with long term conditions stay well at home, health monitoring for care home residents to avoid unnecessary trips to hospital, enabling people with serious mental illness (SMI) have an annual health check, or picking up early signs of kidney damage through home testing - through our programme alone we know that over half a million people have benefited from these different types of digital home care this year, which are in addition to the fantastic results we are seeing across virtual wards.

We are proud that 50,000 people with an SMI had their annual health check thanks to our programme. That, on its own, will save many lives and help close the 20 year life expectancy that exists.

There are now 162 tech-enabled virtual wards across the country providing hospital level care in peoples' homes;

These virtual wards cover as a minimum acute respiratory infection and frailty and many also extending to other conditions. We have been approached by leaders of health services in many other countries - most recently the Netherlands, Canada and Singapore - who are keen to emulate the NHS’ speed of delivery of this new model of digital home care.

I am grateful to Matthew G for backing digital home care from the start alongside my supportive colleagues across the leadership team at NHSX such as Iain, Sonia, Simon E, Dave and Tim and to Amanda P, David S, Julian and Tim F for spotting the potential of virtual wards and partnering a national mandate with serious investment.

If you want to know why it really matters that we are successfully scaling this model, watch this excellent short film about the experience of Rachel and her dad Alan made by Kent Community Health NHS Foundation Trust. To think that there have been 100,000 people like Alan really is something.

Impact

When people ask me what the best thing about working in a national role is, I say there are two things - the impact and the people. The impact is about reach, outcomes and patient feedback, and it has been a particular privilege to get almost constant feedback from patients and carers about what a difference it makes to have their care at home rather than in hospital. It is then incredibly satisfying to see that alongside this experience improvement comes greater control of symptoms and exacerbations. Radically improving the experience of patients, their ability to have agency over their care and therefore increase control of disease has been at the heart of what we have done and why we have done it.

The team and I have tried hard to document the findings of the work and publicise them across the lively community of members of the Innovation Collaborative for Digital Health and producing films and podcasts to share the learning in a range of ways. I have also been publishing regular articles on Linkedin over the past year and found it to be a brilliant platform for sharing and getting feedback; thank you to all readers and sharers!

A recent one outlined how we have been seeking to hit the five aspects of the Quintuple Aim which in addition to improving the experience of care and health outcomes and reducing cost, also seek to improve the experience of staff and narrow the health inequality divide. In these blogs I have aimed to combine what we are learning about impact - for example the 50% reduction in admissions in patients supported with digital home care for their COPD in Airedale or their Heart Failure in Imperial - just imagine the impact of this if available everywhere - with the perspective of patients.

The people

The team I have worked with has been just fantastic and because we have been working on scale I firmly count our regional, ICS and frontline colleagues within this.

Some of you will have spotted a recent HSJ article warning “Innovation is being squeezed out of the NHS” by Health Foundation colleagues Dr Malte Gerhold and Tim Horton where our Regional Scale Programme was commended and cited as the best practice example of a programme that used all the evidence we have on the implementation of innovation to generate rapid scale. They conclude "The way out of the crisis [...] is in the effective implementation of solutions already at hand" and I couldn't agree more.

So a shout out to Breid, Lisa, Rhod, Lauren, Karen, Tim C, Mike, Richard, Matt G, Tony, Inara, Dimitri, Chris, Donna, Yinka, Zharain and their teams and please take a bow Eddie, Jane, Luke, Janet, Steve F and Steve T and your teams as well as the wonderful frontline teams in Trusts and ICSs across England doing the hard work to make this change happen and build it into routine NHS care.

Thanks also to Matt W and the 15 AHSNs across the AHSN Network for their support locally to spread these new digitally supported care models, evaluate and hold events bringing people together to share.

To our terrific Remote Care Board members David P, Jo S, Wajid, Peter T, Carolyn, Linn and many more. We held our final board this week and you may have seen David's well liked tweet about it.

Steal with pride

It is great to see that the Innovation Collaborative for Digital Health will endure to provide a crucial community of practice for frontline teams under the leadership of Sonia, Jade and Donna and that scale of digital vital sign monitoring and acoustic monitoring in care homes will very much continue under the leadership of Alice, Peter and Emma. A special thanks to the wonderful, endlessly cheerful and amazingly efficient Gabby who has made my working life such a pleasure.

A team of teams

It has been terrific working with the teams on Virtual Wards, NHS@Home as well as colleagues leading work on reducing Health Inequalities with a focus on CVD and BP@Home - Steph, David R, Jane, Shelagh, Adrian, Amanda D, Matthew W, James S, Tim S, Bola and Shahed. This, I am confident, will continue its great success in scale and be a key part of building a sustainable NHS that will be able to weather storms in the future.

At the excellent Virtual Wards Clinical Summit held yesterday David Sloman referenced a great article from the New York Times "Your Next Hospital Bed Might Be at Home" and said that while digital home care is clearly a global phenomenon but he wants us to continue to lead the way as a country.?

Telling the story

As anyone who knows me knows well, I think it is incredibly important we take the public as well as NHS staff with us on this journey so we must communicate using every opportunity we have. It is great then that we are now getting real national coverage of the benefits of digital home care in all forms of media.

My favourite headline of the week was the 91-year-old hospital patient 'over the moon' to be treated in new virtual ward - on ITV News, but it is a joy that there are now so many to choose from as there has now been coverage of digital home care by the BBC, Sky News, on Radio 4 as well as other stations and in pretty much every daily newspaper. TV doctors Dr Ranj and Dr Chris Van Tulleken have done great slots about how these types of service work and have encouraged people to try them. Next stop, EastEnders? That would be wonderful. (Anyone who can help DM me!)

It has been an exhilarating time and an honour to work with such excellent colleagues on work that genuinely has national scale. But it also feels the right time to move on - although having just two more days in the NHS really is quite a thought after 30 years!?

So I will leave you with closing words from patients Collette, David and Leigh who put it so well - “It changed my life!”, “The hospital is brilliant, but it’s not like being at home”, “Game-changing, this is technology at it’s best!”