Coronavirus (COVID-19) digital health and care response: 2021 update

Accelerating and Extending Access

Remote Health Pathways

The Remote Health Pathways (RHP) programme has been adapting and expanding since the first wave of the COVID-19 response. The RHP programme builds on the national TEC Home and Mobile Health Monitoring workstream. More recently, particularly in our response to COVID-19, it includes work undertaken with the Modernising Patient Pathways Programme and the Primary Care Directorate.

While the foundations of this work have been to support people with long-term health conditions, during the past year the RHP team considered how existing technologies can be re-purposed; used the rapid procurement process; worked closely with Clinical Advisory Groups and technology providers to ensure the developments are anchored in sustainable governance. In addition, they have applied these capabilities and developed new services in different areas.

Key priorities for Remote Health Pathways include:

• Testing and rolling out COVID-19 response and recovery initiatives.
• Maintaining and supporting further adoption of national scale-up of BP (hypertension) management.
• Ensuring continued support for key work programmes.
• Nurturing the pipeline of emerging opportunities.
• Formalising the programme and transitioning the governance arrangements to align with the Digital Citizen Delivery Board.

The Remote Health Pathway's work came into sharper focus when the Scottish Programme for Government was published in September 2020, which reinforced the intention to support people who are dealing with a diagnosis of, and longer-term effects of, COVID-19. The RHP team have also contributed to the digital support for the Long COVID Cross-Directorate workstream led by the Scottish Government Clinical Priorities Team.

Contributions to the COVID-19 response

• Completed the emergency procurement of a Remote Health Monitoring solution (InHealthcare).
• Developed a tele-COVID-19 self-monitoring pathway (for patients at risk of deterioration to self-monitor at home).
• Implemented a remote perinatal care pathway.
• Approved funding to expand digital dermatology asynchronous appointments.
• Approved funding for Phase 1 scale-up of Dynamic Scot in NHS Greater Glasgow and Clyde.
• Approved tests of change using the vCreate platform and using the vCreate platform for remote neurological consultations and for families of care home residents.
• Agreed priority areas with the Modern Patient Pathway programme (MPP) to support national and local mobilisation and recovery plans: COVID-19 symptoms, heart failure, respiratory (asthma and COPD) and peri-operative assessment.
• Established Clinical Advisory Groups (CAGs) for each of the priority pathways.
• Increased service development capacity by training 'Pathway Developers' using the InHealthcare platform, and established the governance and flow for the new platform delivery.
• The team have supported the RHP Community of Practice to share good practice and review progress.

Following the first phase of the COVID-19 response, the RHP team have refreshed the national initiative – the Scale Up BP programme, working with GP Practices across Scotland to diagnose, treat and monitor hypertension.

This initiative has exceeded the current target, with over 25,000 people recruited and over 50% of general practices participating.

The procurement of an upgraded Remote Health Monitoring and Communications System is being completed. This will enable further adoption and scale as part of local service redesign and remobilisation activities.

More information is available about the RHP programme on the TEC website.

Digital Mental Health

The demand to provide tools to support mental health services has been substantial during the pandemic response. The scale up of digital mental health programmes has included the expansion of computerised Cognitive Behavioural Therapy (cCBT) and deployment of Internet-enabled CBT (ieCBT) services across all territorial Health Boards.

In Spring 2020, the first national Digital Mental Health Advisor was appointed to the Scottish Government's Mental Health Directorate. This role has provided an opportunity to work strategically on the planning and implementation of digitally enabled mental health services.

As a result, digitally enabled services to support mental health, for staff working in health and care and for people using health and care services, have been a consistent feature of the response to COVID-19.

As part of this new role, a Digital Mental Health programme has been established which addresses the increased demand for mental health services by taking full advantage of technological solutions to provide greater choice to people accessing treatment options.

The Digital Mental Health programme consists of five parallel workstreams covering:

• Development of digital therapy.
• Self-management and video-enabled therapy.
• Development of infrastructure, innovation, management, governance, and long-term sustainability of digital within mental health setting.
• Establishing a Test of Change Programme of digital mental health.

Contributions to the COVID-19 response

• The rapid expansion of Computerised Cognitive Behavioural Therapy (cCBT) in all territorial Health Boards and the introduction of self-referral options.
• Deployment of Internet-enabled CBT services across all territorial Health Boards.
• Development of national programme governance structures.

In addition, working with partners to identify areas of demand has resulted in new work being initiated in relation to:

• Suicide prevention.
• Post-COVID-19 recovery.
• Development of young person services.
• Remote one-to-one and group therapy.

Digital Mental Health has also seen significant growth of cCBT and deployment of Internet-enabled CBT services across all territorial Boards.

• The total number of cCBT treatment increased from a single treatment in 2019 to 14 in 2020.
• The expansion of access to cCBT has resulted in the growth in the number of referrals to (currently) over 3,900 per month.
• A total of 40,718 referrals were made to the digital therapy services (ieCBT and cCBT), an increase of 16,203.
• Access to self-help and self-management resources for people in Scotland is now more standardised, with clear access on national platforms: NHS Inform and the national Wellbeing Hub for staff.
• A total of 308,834 self-help guides on mental health have been accessed through NHS Inform and over of 4,600 health and care staff have access cCBT support through self-referral.
• Continued development and promotion of cCBT services has taken place at local levels.
• The development and monitoring of clinical and service monitoring and developing clinical and service structures for the Test of Change programme which is active in eight Health Boards. The projects which are part of the programme include digitally enabled services for: anxiety disorder, perinatal conditions, and insomnia.
  • The Young Person cCBT service is now available in five Health Board areas
  • Perinatal cCBT is being rolled out to five Health Board areas
  • Over the next period the potential for expansion and mainstreaming of individual Test of Change projects will be examined.
• Continued ieCBT national roll-out. This facility is now available in 13 of the 14 Health Board areas with 240 referrals being received a month.
• Complete programme infrastructure development through introduction of national programme board.

In parallel with the initiatives described in this snapshot update, the work to appraise the potential of the impact of digital in priority mental health areas will continue.

Learning from ongoing work and the establishment of a national evaluation reference group is a requirement for the Digital Mental Health programme.

Creating a space to assess new opportunities for digital mental health will be achieved with the establishment of an innovation hub. Further information about the Digital Mental Health programme can be found on the TEC website.

Near Me Video Consultation

Near Me is a video consulting service which enables people to attend health and care appointments from home or wherever is convenient. To participate, a patient requires a device such as a tablet, laptop or smartphone and an internet connection. It is a secure form of video consulting approved for use by the Scottish Government.

The Near Me video consulting service has been developed over several years and was undergoing a gradual expansion at the beginning of 2020. The delivery of video-enabled consultation has been transformed by the rapid scale up of this service because of the refocusing priorities at the beginning of the COVID-19 pandemic.

The acceleration of roll out plans, in collaboration with an expanded team involving Healthcare Improvement, NHS National Services Scotland, and the Access Collaborative, has changed the model of video-enabled access across Scotland. Working initially with Health Boards, General Practice teams and many secondary care services, social work teams and care homes and social care partners, has resulted in the growth of Near Me consultations, from a starting point of around 300 a week in February 2020, to around 1,400 a week by May 2020 and to around 20,000 a week by April 2021.

Contributions to the COVID-19 response

• The Near Me Covid-19 Response National Group led the roll-out and awareness raising in General Practice (in collaboration with Healthcare Improvement Scotland).
• Work with care homes and support their use of Near Me (in collaboration with the Care Inspectorate).
• Focus was agreed on key outpatient priority areas in secondary care – haematology, oncology, mental health, obstetrics, paediatrics and respiratory illness.
• An awareness with citizens about access to services using Near Me was undertaken utilising the public-facing website.
• Guidance and training materials were developed for primary care, care homes, outpatients, inpatients, prisons and telepsychiatry.
• In May 2020, a Vision statement for the future of Near Me was agreed by the Cabinet Secretary, with detailed requirements to embed use of Near Me in routine delivery.
• In June 2020, a summary of the 12-week scale-up was produced.
• In collaboration with NHS Education for Scotland and the Digital NMAHP Network, a programme of webinars which targeted staff working in different settings was delivered. The webinars were attended or viewed by over 5,000 NMAHPs.
• Additional resources to support the implementation and guidance for different uses of video consultation were developed and added to the TEC website to disseminate.
• A public consultation was completed, in parallel with the development of an Equalities Impact Assessment (EQIA), both of which inform the next steps in the roll out of Near Me.
• In July 2020, the initial evaluation report of the video consulting programme was published. Fieldwork for the evaluation was completed prior to COVID and the rapid scale-up.
• In November 2020 a licence extension was agreed along with a wider Public Services Roll-out, in collaboration with COSLA and the Local Government Digital Office. Providing free access to the platform across all public services.

From January 2021 the expansion focused on a wider roll-out across a range of public services. Including:

• Work with Citizen Advice Scotland has been progressed with a pathfinder group of Citizens Advice Bureaux.
• In March 2021, the additional evaluation of the Near Me COVID roll-out period commissioned to follow up on the pre-COVID data collection, was published.
• In April 2021, additional resources, including a leaflet about using Near Me aimed at children developed by NHS Lothian, were disseminated.
• Continued working with the national Redesign of Urgent Care programme to direct urgent care requests to the 111 service, supporting the roll-out of Near Me within Minor Injury Units, Emergency Department and Assessment Units.
• Work continued with the Office of the Chief Social Worker (OSCWA) to roll out use of Near Me in order to care home residents (where appropriate).
• Work with the Office of the Chief Social Worker and Iriss, has accelerated to support the roll-out of Near Me within Social Care.
• Workstream 3 of the Redesign of Urgent Care Programme was completed.

Further information about the Near Me programme can be found on the TEC website.