Remote consultations transform how patients access OUH care

Thousands of Oxford University Hospitals (OUH) patients have been able to continue accessing specialist services during the COVID-19 lockdown without having to attend hospital, thanks to the growing use of video consultations.

Before the pandemic, very few departments at Oxford University Hospitals (OUH) were using technology to conduct remote consultations with patients. But since its launch in the middle of March 2020, 4,267 such consultations have been carried out using the Attend Anywhere (AA) platform.

In the week of 18 May 2020, there were 882 video appointments, allowing clinical teams - from cancer to paediatrics, from haemophilia to antenatal care - to continue delivering vital services to patients, despite lockdown.

"These are unprecedented times and it has been very challenging for both clinical and support staff, and of course for our patients," said David Walliker, OUH's Chief Digital and Partnerships Officer.

"But these challenges have presented us with an opportunity to transform and make it more receptive to patients' needs. I've been delighted that close working between our clinical Divisions and digital teams, and NHS England and NHS Improvement, has enabled us to deploy this functionality quickly, and delighted with the way our staff have embraced more agile ways of working."

OUH is a major regional and national centre for many specialties, so its patients often come not just from Oxfordshire and the wider Thames Valley area, but also from other parts of the country. In a time of lockdown, video consulting technology has allowed those patients, as well as those closer to the hospitals, to continue to access vital services.

Ahead of the widespread adoption of AA, the Oxford Sarcoma Service - one of only five National Specialist Bone and Soft Tissue Sarcoma Services in England - carried out a study into the technology.

"Patients often have to travel significant distances for ongoing treatment - as far away as Cornwall and the south coast. The disease process and time away from work for appointments can have a significant effect, as well as being extremely costly, especially for those with malignant disease," said Dr Thomas Cosker, the Consultant Orthopaedic Oncology Surgeon who led the study.

He said patients were "extremely happy with video consultation", in particular those who work or are house-bound, noting that it was generally a younger working population who took up the offer.

While the quality of the conference is very dependent on network connections at both ends, audits carried out by some of the services that have used AA show that most patients have been enthusiastic and have found it quick and easy to access the system, and many are keen to continue using remote consultations once lockdown is lifted in particular for those who have to travel often long distances for relatively short appointments.

The most frequent users of AA during the COVID-19 emergency have been children's services. Dr Konrad Jacobs, Consultant Clinical Paediatric Psychologist, says engagement and communicating clearly is essential when dealing with young people and their families: "We know that if we don't engage with children and teenagers, we're not going to get anywhere. Using video is immediate, and easier than engaging with them over the phone. Video is not ideal, but it is the next best thing to face-to-face consultations."

Angela Shanly, Consultant Clinical Psychologist and Family Therapist in paediatrics, whose patients include young adults with cancer, says it's important that her consultation involved the family: "Although some patients prefer the telephone, video consultation is usually more effective, especially if you want to see more than one person. I was keen to keep seeing families as much as possible - and that includes both parents. With face-to-face consultations, it's often the parent who looks after the child who attends, especially if the other parent is working. Using this there is greater possibility of including both parents."

Another area that piloted the use of Attend Anywhere, was the Oxford Centre for Enablement (OCE), whose specialist rehabilitation teams serve the South East of England and cover as far as Dorset and the Isle of Wight.

Dr Anton Pick, Clinical Lead at OCE, said it was not just a priority for the service to hold consultations and deliver rehabilitation interventions remotely, it was also useful to have innovative ways to connect with health partners, such as hospitals across the region from which patients might be referred to OCE.

"Whereas previously our clinicians had to travel to places such as Milton Keynes, Swindon, Reading or Winchester to review patients, and relied on phone conversations with clinicians in places further afield, such as Southampton and the Isle of Wight, now we are able to remotely review patients over the platform. It saved significant clinician time and provided a much more timely service to our health partners."

During the COVID-19 emergency, OCE had been holding medical clinics, delivering physiotherapy, speech and language therapy, neuropsychology and occupational therapy interventions using the platform.

"The pandemic really catapulted us, along with much of the rest of the health service, into a new digital age," Dr Pick said.

Most of the clinicians who have used the system say that face-to-face meetings are preferable. But given that this has not been possible, video is the next best option.

Louise Warnock, a cystic fibrosis physiotherapist, says the visual aspect of the platform is important for her to assess her patients: "Given our patients have chronic respiratory disease, we are proactively contacting them to identify any concerns early and hopefully avoid the need for admission.

"Being able to see patients over video makes it much easier to assess how unwell they might be and to observe them performing their physiotherapy. Whilst it is not the same as a treatment in person, I can advise them more confidently how to adjust this.

"Attend Anywhere has made it much easier to have open, honest conversations with patients about how they are coping. Patients have been overwhelmingly appreciative of our calls and are valuing this service. It has allowed me to identify patients that are less well and struggling with their treatment," she explained.

Will remote consulting change the way NHS services look when we emerge from the lockdown? Many clinicians believe that it will become a useful tool for them, for example in triaging new patients, and conducting shorter follow-up appointments, especially those that live a long way from the hospitals.

Kathy Bailey, a Consultant Paediatric Rheumatologist who has been using AA, said: "It's been good to be able to access a lot of patients, and we have been able to run most of our clinics virtually, but it's not the same as seeing a patient face to face, both in terms of their medical management but also around the relationships that you build and the use of a multidisciplinary team.

"Video consultations have an important part to play - it helps with accessing patients who live a long distance away, with supporting new patients on new treatments and with those patients where you just need regular brief catch-ups, meaning they don't have to take time out of work or school."

David Walliker says the restrictions under which OUH and the rest of the NHS has been operating in recent weeks has forced it to think about how it delivers its services in future: "Part of the recovery process will be resuming the services that have had to be stopped or scaled back to cope with the anticipated impact of the pandemic.

"I want to see us delivering the best patient outcomes from whatever setting, and not think that we necessarily have to run services from our hospital sites. We have proved over the past few weeks that we can work in an agile and innovative way - albeit in circumstances none of us would have wanted. We now need to make the most of the technologies available to us to deliver a first-class service that is responsive to patients' needs."

Read more about how specialist clinical teams have been using video consultations.