‘There’s no way back after this’:

Inside the unexpected tech revolution

at the NHS
BY OWEN HUGHES

Digital solutions have proven invaluable in helping the

NHS cope with the demands of COVID-19. But will support
for new ways of working survive beyond the pandemic?
T
echnology has been absolutely vital in helping the NHS manage the overwhelming pressure
placed on its services since the start of the COVID-19 pandemic. Everything from video confer-
encing and remote appointments with GPs through to artificial intelligence systems designed to
understand the demand for hospital beds, has been used to help keep healthcare services operating
throughout the pandemic.
In the early days of the coronavirus crisis, NHS Digital, which is responsible for a number of key digital
services for health and social care in the UK, quickly found itself under strain as people began search-
ing for information on COVID-19. In the first week of March alone, the organisation fielded an additional
120,000 calls to its NHS 111 hotline, forcing it to quickly increase capacity and set up an online system
where people could check COVID-19 symptoms and get advice.
Within a week, more than one million people had used the service; at its peak, NHS 111 online experi-
enced 95 times its highest ever use, with over 818,000 accessing the service in a single day.
“No CIO prepares for that,” says Sarah Wilkinson, CEO of NHS Digital.
The experience was testing for NHS Digital, which had to rapidly scale up services at a pace that,
while necessary, Wilkinson admits felt “too fast for comfort” at times. “We’ve really lived by the seat of
our pants on some of the things we’ve done in the last few
months,” she says.
But Wilkinson says that how NHS Digital has respond-
ed to COVID-19 has shown that agility, even from one of
the largest organisations on the planet, is still possible.
“The interesting thing for me has been two big things: one,
we’ve been able to show both the power of digital and

Image: NHS Digital

data in serving the health and care system, and what we
can do with the stuff we have at our fingertips,” she says.
Wilkinson believes the crisis has also shown just what
NHS Digital is capable of as an organisation: its ability
to deliver secure products and services at great speed. Sarah Wilkinson, CEO at NHS Digital.
“That, I think, has been really confidence-building for us,”
she adds.
Deploying new tools so quickly has come with its challenges, including having to very quickly fix up
the NHS’s technical plumbing. This includes introducing massively improved connectivity to different
parts of the healthcare system, creating tens of thousands of new NHSmail users in social care, band-
width upgrades and new virtual smartcard authentication systems.
“The infrastructure demand has been incredibly high, in ways that I really don’t think we could have
predicted at the outset of this,” says Wilkinson.

1
 The call for data has also been “extraordinary”,
she adds. NHS Digital and NHSX have been work-
ing on a number of data initiatives throughout the
pandemic aimed at capturing and making sense of
COVID-19 data from across the health system, strik-
ing up partnerships with industry partners includ-
ing AWS, Google and Microsoft in the process.
NHS Digital is now seeing an unprecedented
demand from NHS organisations that want to ac-
cess and connect this data, Wilkinson says: “We
throw up a dashboard, and by the end of the day
we have hundreds of people wanting access to it.
We’re trying to make as much of that as open as
we can.”
Perhaps unexpectedly, one of the most signif-
icant technology deployments of the pandemic
has been Microsoft Teams, which was rolled out
to every NHS organisation across England and
Scotland in the days following bans on business-
es and non-essential travel in the UK. The soft-
ware proved instrumental in allowing NHS teams
to coordinate their responses to the crisis and
continue their all-important work in the face of a
global health crisis.
“The Teams deployment had a huge impact
on the productivity of the service,” says Wilkinson.
“That scale of deployment in that time with that
resilience was phenomenal.”
Embracing digital health
There’s no contesting the argument that tech-
nology has the potential to transform healthcare.
According to a recent study by the Institute for
Public Policy Research (IPPR), greater use of digi-
tal tools within the NHS could save up to 20,000
additional lives each year, at an estimated £10bn
saving to the health service.
Several attempts have been made to overhaul
the NHS’s IT infrastructure over the years, with lim-
ited success. Perhaps the most infamous example
is the National Programme for IT (NPfIT), which ran
from 2002 to 2011 and set out to create a single,
integrated health record across the whole of sec-
ondary care that would allow patient data to be
shared across regional boundaries.
While it was credited for establishing a few key
pieces of national infrastructure, it ultimately failed
to achieve its goals after being hobbled by top-
down decision-making that ignored local needs,
and was eventually scrapped. Renewed attempts
to join-up the UK’s health and care system are un-
derway as part of the Local Health and Care Re-
cord Exemplar (LHCRE) programme, which aims
to join-up care records across primary, secondary
and social care settings across regional geogra-
phies.
Innovation in the public health system has oc-
curred in small pockets, though it has typically
been GPs and doctors at the forefront, with hospi-
tals and social care lagging behind. For instance,
nearly all GPs now use electronic health records
and computers in their day-to-day interactions
with patients, while many hospitals still rely heavi-
ly on paper-based processes and other outdated
formats.
The expansion of appointment booking and
remote consultation apps has also created disrup-
tion in this space, giving patients more freedom
over how to interact with their doctors and their
data, while at the same time offering GP practices
2
a means of reducing in-person

Image: Lighthouse Medical

visits and prioritising only the
most important cases.
Progress towards “digital-first”
primary care has skyrocketed
during the COVID-19 pandemic.
A national rollout of the eConsult
platform, for example – which
planned to target around 1,200
GP practices by the end of June
– had already been deployed The Dermicus Teledermatology Assessment Service has reduced the
number of patients needing in-person appointments on the Isle of Wight.
to more than 2,200 GP surger-
ies by April. According to data
“The support that it’s provided means that we
from NHS England, 99% of GP practices are now
are still completely within all of our targets for the
actively using remote-consultation platforms as
cancer wait times,” Poyner says.
a safer way to talk to patients, with NHS bosses
“We haven’t fallen behind at all during
now assessing how progress in this space can be
COVID-19, because the teledermatology service
“locked in”.
has enabled us to continue while reducing unnec-
It isn’t just GPs benefitting from the telehealth
essary patient contact.”
boom: on the Isle of Wight, Lighthouse Medical
The Dermicus Teledermatology Service had
has been running a teledermatology clinic for the
already reduced the number of patients needing
past year that allows patients with suspected skin
in-person appointments prior to the COVID-19
cancer to be diagnosed more quickly.
outbreak. In a sense, then, nothing has changed,
Using a platform called Dermicus by Swedish
though Poyner says the appetite for using digital
company Gnosco, staff can capture high-quality
services in this time has grown noticeably.
images of patients’ skin abnormality and send
“The main thing that has changed is that pa-
them to a specialist dermatology team for review.
tients have been using eConsult with their GP sur-
Based on the images, doctors can determine if
geries and sending in images themselves, which
any further action, such as a biopsy, is needed.
in itself is a version of teledermatology,” she adds.
Amy Poyner, GP and former clinical director at
In some ways, the coronavirus pandemic has
Lighthouse Medical, tells ZDNet the technology
improved access to GP services on the island: with
has been “completely essential” in allowing the
doctors directing patients away from their surger-
clinic to continue running cancer services that
ies and to virtual services instead, routine wait-
might otherwise have been paused – as they have
ing times have nosedived. Where patients might
elsewhere in the country – as COVID-19 spread.

3
have had to wait up to three weeks for a physical
appointment, those using eConsult are generally
able to speak to a healthcare professional within
48 hours: “a game-changer”, according to Poyner.
“There has been a sea change in the patients
themselves, because a lot of them don’t want
to physically see us or go to a GP, because of
COVID-19 shielding. They are going out of their
way to work out how they can get a photo to us,”
she adds.
“I think it has completely revolutionised how
we’ve been able to deal with COVID, and reduc-
ing face-to-face contact to anyone that is abso-
lutely clinically necessary.”
Maintaining the human touch
COVID-19 has also accelerated the introduction of
watching from a meeting room, where the video
is projected onto a screen. Following the success
of this initiative, it’s now being used across all 14
of Royal Surrey’s adult in-patient wards, in its com-
munity hospitals and in other departments.
Claire Richardson, a nurse specialist who has
been using the Ascom handsets, says the mobile
technology has had a huge impact on patient
wellbeing during the crisis – and given back pre-
cious time that had been lost to COVID-19.
“Human contact and family contact is huge
to patients’ recovery,” she explains. “When they
were isolated, it was so difficult for patients and
for their loved ones, so we wanted to have some
way of bridging that gap.
Image: Ascom

virtual consultations at Royal Surrey NHS Founda-

tion Trust, where nurses and ICU staff have been
using specially designed smartphones coupled
with telehealth software to safeguard patients
and staff, as well as conserve precious personal
protective equipment (PPE).
More than 40 intensive care staff at the hos-
pital have been using smartphones designed by
Swiss company Ascom to conduct remote ward
rounds. The handsets, which are designed spe-
cifically for healthcare environments and can be
easily sanitised, feature Attend Anywhere’s vid-
eo-consultation platform and a single sign-on sys-
tem from Imprivata.
Where four doctors clad in PPE might have
attended each ward round before, a single doc- Staff at Royal Surrey NHS Foundation Trust have
been using Myco smartphones designed by Ascom to
tor will now enter the quarantine sector of the conduct virtual ward rounds and enable virtual visits
between patients and relatives.
ICU and coordinate the round with other doctors

4
 “I would be the first to say an actual visit is bet-
ter than a virtual visit; but if an actual visit is not
possible, a virtual visit is the second best thing.”
Richardson points out that even beyond coro-
navirus, there will always be value in technology
that removes geographic or physical barriers, par-
ticularly if it’s designed in a way that puts its users
– namely, clinicians – at the centre.
“Nurses are not always the first to embrace
new technology – but I think when even a nurse
can see that something is going to make a big
difference to your patients, then that’s your moti-
vation to embrace it and take it on,” she says.
“I don’t see this stopping at the end of
COVID-19, because there will always be people
in hospital who can’t have a visit from their loved
one, for whatever reason. I suspect we will look at
other ways that we can use the technology.”
Adoption by necessity
While large parts of the health system have em-
braced digital with open arms, a few pockets of
resistance have made overall progress slow.
COVID-19 has nudged the digital dial forward,
simply because there hasn’t been much of an op-
tion to do otherwise.
“What’s happened is awful, but it’s forced us
to adopt it,” says Mandy Griffin, CIO at Calderdale
and Huddersfield NHS Foundation Trust.
“It’s developed some confidence from people
that maybe would have taken a bit longer, had
they had a choice.”
Griffin points out that much of the technology
that’s seen widespread adoption over the past
few months has been out of the necessity of lim-
iting person-to-person contact. At Calderdale and
Huddersfield, this has ranged from restricting how
patients move through the hospital, to the intro-
duction of voice-recognition technology to limit
how often clinical staff have to touch keyboards
and physical devices.
Hospitals were not exempt from the rapid shift
to remote working caused by COVID-19 either.
Roughly a third of the staff at Calderdale and Hud-
dersfield were forced to work from home due to
the virus, Griffin explains: a situation which, like
many organisations, it never envisioned.
Microsoft Teams has ensured staff remain con-
nected during this time. Not only has it allowed
the hospital to offer virtual visits and video con-
sultations in some of its specialty clinics, but the
software has also improved communication with
Calderdale’s care home workers.
“We’ve been able to rapidly roll out Teams and
gave them the hardware to do it to 38 care homes
in Calderdale to make sure our community teams
could work with the care home team – to make
sure patients were OK, but also, to make sure
they were OK,” says Griffin.
The communication conundrum
While hospitals are increasingly adopting mobile
working, digital communication remains a chal-
lenge for the NHS. Outdated and heavily-siloed
communication has hampered the NHS for years,
something not least demonstrated by the fact it
still relies heavily on pagers and fax machines.
This issue received increased focus in the af-
termath of 2016’s WannaCry ransomware out-
break, with a report from the National Audit Office
5
warning that poor communications early on left
many organisations without a clear picture of how
the event unfolded. The problem was compound-
ed when staff were locked out of IT systems, leav-
ing many to fall back on consumer services like
WhatsApp to communicate.
In many ways, the COVID-19 crisis has opened
the doors to a lot of digital tools that had been
around for a while and simply waiting for their time
to shine. Hospify, a clinical-messaging platform
that became the first to be approved by the NHS
App Library in March this year, has seen its user
base quadruple as a result of being fast-tracked
by NHS organisations looking to keep staff in
communication with each other in difficult circum-
stances.
Cardiff and Vale University Local Health Board
(UHB) approved Hospify in early March, just be-
fore the UK went into full lockdown. The health or-
ganisation is one of the largest in Europe, employ-
ing more than 14,500 staff and providing health
and care services to a
Image: Hospify
abilities. Goodwin, a senior clinical engineer and
pre-reg clinical scientist within the service, has
been using Hospify as a means of speeding up
admin work and transferring sensitive patient data
while protecting more vulnerable colleagues.
“During this crazy time, a lot of our team are
obviously shielded and they can’t come in, so
we’ve been covering other peoples’ roles,” Good-
win tells ZDNet. “It’s meant our teams have not
had to come in, they’ve not had to collect patient
files or anything like that.”
It has also been a boon for staff who have been
forced to work from home, yet don’t have the nec-
essary set-ups to do so, Goodwin says. “Hospify
has worked really well for us in that a lot of our
admin staff didn’t have home working, or any way
of accessing their emails, so it was a really quick
way of getting them to have a way that we could
then transfer patient-sensitive data securely, and
in a way that’s approved by the trust – which is a
major thing for us.”

population totalling in
the region of 475,000.
Rachel Goodwin is
one of around 20 staff at
Cardiff and Vale UHB’s
Artificial Limb & Appli-
ance Service, which
provides assistive tech-
nology and communica-
tion devices as part of
a community rehabilita-
tion service and for indi- Hospify, an NHS-approved clinical-messaging app, has seen usage
skyrocket during the coronavirus pandemic.
viduals with serious dis-

6
 It’s not just clinicians that have changed their
attitude to digital health, says James Flint, CEO
of Hospify – patients have, too. “There’s been a
huge rise in the proportion of people now happy
to consult with their doctor using phone, messag-
ing or video, when even as recently as last Jan-
uary it felt like a fairly risky and even slightly sus-
pect thing to do,” Flint tells ZDNet.
“Because the digital tools in question are now
reasonably mature whole areas of the industry
have been able to switch to new ways of working
relatively seamlessly, and now that this is happen-
ing very few people seem to want to go back to
the old ways of working, regardless of what hap-
pens with COVID.”
Goodwin agrees. “I think this whole period,
of the last few months, has really forced people
to get used to using technology – people who
would never have touched it before have had to
do it,” she says.
“When you approach the idea with them of
having to do a video call, you don’t have that re-
sistance that you had before and they’re much
more willing to do it.
“I know as a service we won’t be going back-
wards with that, because we can use that time
much more wisely.”
Hospify is by no means the only app to have
seen its user base skyrocket since the beginning
of March – other digital health services have seen
a similar surge of interest.
Joost Bruggeman, founder and CEO of clini-
cal-messaging app Siilo, suggests COVID-19 has
once again highlighted the need for modern mes-
saging services that allow NHS teams to quickly
and safely exchange information, using the devic-
es they have in their pocket.
This has become especially important during
a time in which doctors, nurses and other health
and care staff need to be able to share informa-
tion with colleagues as quickly as possible.
“Before the COVID crisis, we had to actual-
ly explain this to IT managers in hospital trusts,”
Bruggeman says.
According to a recent study
by the Institute for Public
Policy Research (IPPR), greater
use of digital tools within the
NHS could save up to 20,000
additional lives each year, at
an estimated £10bn saving to
the health service.
“In a normal situation, you have to arm twist or
educate a little bit more to make sure everyone is
on the same page – the classic enterprise sales
motion you have to go through. All of a sudden,
that is gone, because everybody is looking at the
same [problem]”.
For Bruggeman, COVID-19 has brought what
he calls “the WhatsApp problem in healthcare”
back to center-stage. Except this time, there is “a
clear vision on how to move forward”.
7
 “The voice that became super-clear during the
crisis is BYOD,” he says.
“Instant, asynchronous communications tools,
such as a messenger application, suddenly
makes clear sense to everybody. There’s no way
back after this, because everybody understands
that that’s the new normal.”
Speed and scale
Digital innovation has never moved at great pace
within the NHS – a problem faced by practically all
public-sector organisations. Aside from the huge
considerations for information governance and
data privacy, the complexity of the UK health sys-
tem, both technically and bureaucratically, makes
rapid change difficult.
NHSX’s troubled COVID-19 contact-tracing app
is a perfect example of this. The delays that have
plagued the app are well documented, ranging
from vague notions of when it might be launched,
to an array of privacy concerns and technical com-
Image: NHS Digital
NHS Digital’s own app is designed to be a digital front door
to primary care services in the UK - not to be confused with
NHSX’s contact-tracing app.
plications that eventually culminated in a complete
U-turn by NHSX, when it announced that it would
ditch the centralised approach it had staunchly
defended for so long in favour of the model pro-
posed by Apple and Google. At the time of writing,
we still don’t know when it’s coming.
Even NHS Digital has felt knock-on effects from
the confusion surrounding the app. Wilkinson
tells ZDNet that users seeking out NHSX’s con-
tact-tracing app have mistakenly been download-
ing the NHS App instead – a service designed
by NHS Digital that is completely separate from
that developed by NHSX and allows patients to
access primary care services though their smart-
phone. “We had quite a lot of people being really
confused by that,” says Wilkinson.
“To some extent I think this is our fault because
we gave our products really simple names – NHS.
UK, the NHS App – it’s been easy for those names
to be used differently.”
NHS Digital wants “as many people as pos-
sible” to download the NHS App, which
Wilkinson labelled a “critical entry point” to
NHS primary care.
“One of the things we’re trying to achieve
in our big digitisation of the system agenda
is that every citizen in the UK has an NHS
login and they are able to use that for the
app, and to access all the other services
we want to put closer to the citizen,” says
Wilkinson.
“Now we’re working with suppliers
across the space to get them to use that as
the standard authentication mechanism, so
8
anybody going into any NHS services will be au- ernment, funding for digital looks uncertain as we
thenticated through that one login. It’s also mas- emerge from COVID-19. Andy Webster, chief clin-
sively driven up our standardisation of an identity ical information officer (CCIO) of Leeds Teaching
and authentication strategy.” Hospitals NHS Foundation Trust, points out that
while funding channels for projects aimed at mit-
Sustaining the momentum igating COVID-19’s impact have been opened in
As the UK slowly comes out the other side of lock-
recent months, tech budgets will soon be com-
down, the momentum we’ve seen around digital
peting against other demands, such as putting in
adoption in recent months is likely to slow as ser-
extra capacity to deal with longer waiting lists.
vice demand returns to normal. But the progress
“There are obviously going to be pressures
that’s been made, and the lessons that have been
throughout all sectors of health and social care,”
learnt during this period, won’t be forgotten. For
says Webster.
many clinicians and NHS staff, digital health has
Looking ahead, the Leeds CCIO says invest-
won the all-important hearts and minds game.
ment in tech should be prioritised for projects that
Whether the funding will be there to support
enable a so-called “left shift” in the delivery of
sustained transformation is, as always, far less
healthcare: namely, reducing the reliance of the
certain, particularly as healthcare services face
traditional hospital model, enabling more care in
up to the mountain of unmet needs that have ac-
the community and only sending patients to hos-
cumulated in recent months. A King’s Fund re-
pital when they absolutely need to.
port prepared ahead of the COVID-19 pandemic
Patient-facing digital health services are the
had already concluded that the planned £140.4bn
key here, says Webster. “I think the message be-
spending by the Department of Health and So-
fore COVID was that we need to use technology
cial Care in 2019/20 would not be enough to de-
to help empower patients to improve their health...
liver the widespread changes needed to trans-
things like patient portals to provide the ability for
form care in the NHS, or improve its performance
them to be better informed and enable self-care,
against key waiting-time targets.
the wider use of data to pick up patients earlier in
A report from the UK’s National Audit Office in
the course of their illness to provide proactive, not
May also highlighted the struggle the NHS faces
reactive, care,” he says.
in its digital transformation ambitions, putting the
“This needs to continue... Hopefully, invest-
estimated cost of doing so at £8.1bn and question-
ments we make will be evidence-based and
ing whether hospitals could afford the £3.1bn they
shown to be effective and be a part of a health
were expected to contribute themselves towards
and wellbeing strategy.”
new technology.
Certainly at Lighthouse Medical, where the
With this in mind, and despite more than £6bn
benefits of teledermatology have been proven,
in emergency response money from the UK gov-

9
moving backwards is not an option. “The one
thing I would say is that primary care has trans-
formed itself, literally, within eight weeks,” says
Poyner.
“Our telephone and video consulting has
worked so well, and been so well received by pa-
tients, there is no way we’re going back.”
This sentiment is echoed by NHS Digital’s
Wilkinson, who likens the recent uptake of digital
health tools to “opening up the floodgates”.
She adds: “What’s really great is that we’re see-
ing so many more people in the system who have
a hunger for digital products and direct, hands-on
access to data... I don’t think that’s going to go
away, because I think it’s a cultural revolution.”
The role of innovation
Innovation will undoubtedly have a role in helping
the NHS overcome the challenges that lie ahead,
such as working through huge backlogs in patient
appointments for critical services.
Machine-learning algorithms could be put to
use here. Since April, NHS Digital has been ex-
perimenting with an AI platform designed to
help hospitals anticipate demand for beds and
other vital equipment by COVID-19 patients, which
could in the future be developed into broader
frameworks.
Wilkinson suggests this is an area NHS Digital
will continue to explore: “You do these things in a
crisis because you have to, and one of the great
things about it is it gives you real confidence in
the power of them. And then you keep going with
them,” she says.
“We want people to focus on digital tools that
make the lives of clinicians and patients much
easier and systems that allow us to get value out
of all the phenomenal data we have, and systems
that allow us to support clinical research,” says
Wilkinson.
“That’s where the energy should be, and that’s
where the focus of the system should be.”
About Owen Hughes
Owen Hughes is
a London-based
reporter at ZDNet.
10
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