For patients will all types of conditions, the pandemic has led to significant challenges around their care, with treatment backlogs and elevated risks from the virus. However, particularly for those with long-term conditions, there has been notable disruption to their regular care, with stakeholders from across all aspects of the healthcare required to play a role in the recovery.Speaking with consultant rheumatologist and Chair of the British Society of Rheumatology’s Clinical Affairs Committee, Dr Elizabeth Macphie, and Todd Manning, General Manager at AbbVie UK, the scale of the challenge before us is vast, but spread disproportionately from service to service, and specialty to specialty. This has created unique challenges, but equally opportunities to innovate around the care being provided, to meet the local needs and desires of these services’ patients.Dr Macphie, who alongside her BSR role is a consultant rheumatologist based in Preston within a community rheumatology service as part of an integrated musculoskeletal (MSK) service, explains: “I’ve come into this with the local knowledge of what’s happened to our service as a result of the pandemic and how things have changed, but [myself and colleagues] have also been listening to that national voice of what is happening to colleagues and departments up and down the country.“We’re recognising that rheumatology services are very different, and the impact of services has been quite varied.“How these services are now getting back to the ‘new normal’ as we hear being talked about so often, is again very different for services up and down the country.“With respect to the NHS restart, I’ve always wanted to look at the positives. The pandemic has resulted in huge changes across the NHS, with lots of activity put on hold, but I think the change that has happened within the NHS [around new mindsets] needs recognition.“Particularly for services dealing with patients with long-term conditions, there has been so many situations where there were lots of discussions happening before the pandemic about where remote consultations fit [in the offering] for these patients. The pandemic has pressed the fast-forward button on all of that.“It has meant we’ve all had to adapt to new ways of working very rapidly, and now we must capture those new models of care.”But responsibility for those building those improvements in services doesn’t just fall on the clinicians’ shoulders. Rather, all those involved in health have a role to play; with AbbVie’s Todd Manning adding: “We believe very strongly that we have a responsibility to healthcare systems in the UK and around the world to play a really active role in the recovery coming out of the Covid-19 pandemic, to the same level we believe we played during the acute phase of the pandemic.“We have a specialisation in medicines and vaccines, but we also have a wealth of expertise in developing initiatives and tools which can help support the efficient and optimised deliver of care for patients, through existing and new channels.“We [equally] have a broad network which we can utilise, bringing stakeholders together to stimulate debate around key issues that are affecting patients. In these types of ways, I think that we can play a role beyond the rules that our medicines can play to help the NHS recover as quickly as possible for patients.”But, for all of the want to spark discussion and collaboration, what do some of the new ways of working and innovative approaches which the likes of Todd and Dr Macphie are championing look like?One recent aspect of research conducted by AbbVie was based around better understanding the impact of Covid-19 on these patients with long-term conditions, helping to understand and qualify the scale of the issue. Evidence showing a sharp drop in GP appointments, referrals and outpatient appointments were not surprising to them, Todd explains, but did demonstrate the concerning breadth of the situation.For example, using modelling techniques, there was estimated to be a staggering 124,000 patients who may have had some kind of misdiagnosis of their conditions.Importantly, as a caveat, many of these have not been given final incorrect diagnoses, but rather saw the pandemic limit further discovery, testing or appointments which might have revealed a different condition. Other patients, due to delays in treatment, have been left without a diagnosis, with many – particularly those with long-term conditions – likely to present in the future with more severe instances of their disease, having more complex care needs and potentially requiring more invasive or potent treatments.Getting the response right will directly impact these patients. As Todd emphasises: “These are patients whose lives are going to benefit from the way the NHS responds.“There is clear evidence that the earlier you treat the disease, the better outcomes that you have in the long term. So there is a risk [regardless of the pandemic] but we may see more individuals presenting with more severe forms of a condition – like rheumatoid arthritis, for example – than we would have pre-pandemic.”And one important, potentially significant way of improving the treatment provided to those patients is to involve them more extensively in their own care decisions; often utilising a method known as shared decision making. That way, for those with long-term conditions, they are choosing models of care which best meet the needs and aspects of their life which matter most to them.As Dr Macphie describes: “I think shared decision making is absolutely pivotal to any sort of healthcare professional conversation.“One of the things that we see is the ethos behind moving from that paternalistic view of medicine where, as the doctor we know best, to this concept of shared decision making that is now well-embedded, particularly in the care of long-term conditions.”Suddenly, by taking a conscious effort to involve the patient within the decision making process around their condition – particularly when most treatment plans involving long-term conditions are related to mitigation rather than curing the disease – the quality of that consultation increases, the clinician is able to provide more effective and efficient care by getting straight to addressing the root concerns which matter most to the patient, and there is a more positive experience had by the patient too.“It is about recognising that we don’t lose some of the GAME we’ve had with making sure patients are involved in shared decision making.“The other aspect is making sure that patients are provided with options in such a way that they realise the full breadth of what is available to them. Sometimes, I think it’s very difficult, as a consultant, to say to patients that one of the options is that we don’t do anything.“Yet, one of the things I’ve learned over the years as a consultant is that, actually, it’s very helpful sometimes to be very open and honest with the patient. To let them know that is an option.“It puts clinicians in a safe zone to say, ‘Look, I’m here to help guide you through the choices available to you’ and quite often some patients will come back and say ‘What do you advise? You’re the specialist, what is your advice?’ and I think if you’re very open and honest to patients, that there is a number of options, when they put that question to you, you can then assess them with [a level of trust].“But it does take a lot of confidence. I think it is something you really have to work on as a clinician. You have to be in the right mindset to be able to have those discussion with patients. We all benefit from ongoing learning in this area, and I think it is one of the things that a collaboration with industry can help with because it is something [which can improve services] across all specialties.”It was a statement echoed by Todd too, with AbbVie UK’s General Manager saying: “For shared decision making to work, you need a really dedicated clinician, a person that is going to share all of the options with the patient, and you need a willing patient for it to work too.“But when it does, it has been shown that those patients who do take an active role and take responsibility for the decisions affecting their care have more positive outcomes.“Shared decision making [and giving patients this opportunity to take responsibility for their care] is something that we’re particularly passionate about.“Pre-pandemic, I think shared decision making was quite focused on the treatment pathway, whereas post-pandemic in the recovery phase, it’s about the treatment pathway, but also about the development of care services and how that will develop into the future.”There will be a lot of changes in the near future in healthcare as we restore services and rebuild capacity, but there are also opportunities to reimagine some of our traditional ways of working, to increase the quality and efficiency of care, and to empower patients and clinicians alike. Shared decision making, particularly around long-term conditions, seems to be one of the opportunities of real growth we’re already seeing benefits from.

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Ep 23. Improving care for long-term conditions, Todd Manning & Dr Elizabeth Macphie

What leads to a digital healthcare solution being adopted?Every situation is unique across the healthcare service, but often these innovations span out of some of the simplest of circumstances. For Open Medical’s Innovation Director, Piyush Mahapatra, he remembers the instance of a cleaner accidentally wiping down a whiteboard which had been used to track orthopaedic patients. A momentary lapse in the system, which presented a sudden challenge and an opportunity for a digital alternative.“I’m a practising orthopaedic surgeon in London, and an NHS clinical entrepreneur.“Most patients who have surgery for broken bones within the NHS are often managed on systems such as Excel sheets, Word documents or physical whiteboards.“In our particular organisation, it was a physical whiteboard and, we came in one weekend and the cleaner had rubbed the whiteboard off.“After that, version one [of our trauma digital solution] was created. It was a fairly simple database system at that point, designed to help manage those lists of patients in a better way.“Since then, things have really moved on [at Open Medical]. We became a cloud native platform in 2017, and things really escalated. Now, we’re helping about 70 NHS trusts around the country manage their patients.“We’ve got over a million patients on our systems today.Through Open Medical, Piyush and the team have been able to leverage their own personal clinical experiences to develop a solution which addresses a significant need felt in the NHS, with patient management, pathways, and efficiencies. It has been built to address a need Piyush and his colleagues themselves feel in their regular NHS roles, and allows the team to talk clinically with partners, as well as technologically.“One of the things that I tell everyone is that I use [our Open Medical system] when I’m working clinically. We all use our systems quite a lot.“We get a real understanding of what it is like to utilise the platform, so if things are not user-friendly or don’t work as well as they should, we can adapt and change them.“We can get that feeling if something doesn’t provide the functionality clinicians need, because we see it from that perspective too.” 

Ep 22. Improving care through interoperable data-driven systems, Piyush Mahapatra

On Episode 22 of NHE's Finger on the Pulse podcast, host Matt Roberts speaks with Open Medical's Innovation Director, Piyush Mahapatra, to discuss who data-driven systems and technologies can help us improve care, particularly in surgery, orthopaedics and dermatology.

On Episode 21 of NHE's Finger on the Pulse podcast, host Matt Roberts is joined by Matt Inada-Kim, Irem Patel and Catherine Dale to discuss how pulse oximetry was identified and scaled out during the pandemic to support the pandemic response. Matt, Irem and Catherine offer a range of different perspective, brought together by the Health Innovation Network South London.

Ep 21. The power of pulse oximetry during the pandemic, Matt Inada-Kim, Irem Patel & Catherine Dale

On Episode 20 of NHE's Finger on the Pulse podcast, Dr Shanti Vijayaraghavan of Barts Health NHS Trust and Will Warburton, Director of Improvement at the Health Foundation, join host Matt Roberts to discuss the innovative work on video consultations that Shanti and her team have been carrying out for a number of years in Newham, in London.

Ep 20. Early pioneers of video consultations, Dr Shanti Vijayaraghavan & Will Warburton

On Episode 19 of NHE’s Finger on the Pulse podcast, host Matt Roberts is joined by Annie Laverty, Chief Experience Officer at Northumbria Healthcare NHS Foundation Trust, and Will Warburton, Director of Improvement at the Health Foundation, discussing an innovative ‘Corona Voice’ staff wellbeing programme being ran at the trust.

Ep 19. A structured but tailored offer of support, Annie Laverty & Will Warburton

Dr Anshumen Bhagat, Founder and Chief Medical Officer of GPDQ - alongside continuing to be a practicing NHS GP - joined us on episode 18 of NHE’s Finger on the Pulse podcast, talking us through primary care, its challenges over the last 12 months and his visions for its future. We talk difficulties, solutions and ambitions in this insightful episode of the podcast.

Ep 18. Innovation in primary care has never happened so fast, Dr Anshu Bhagat

Matt Roberts sat down with Antonis Papasolomontos, Director of External Affairs, AbbVie, Rachel Power, Chief Executive, Patients Association and David Pilbury, Lead Physiotherapist & Clinical Specialist Physiotherapist, Pennine MSK Partnership to discuss shared decision making on Episode 17 of NHE's Finger on the Pulse podcast

Ep 17. Patient Power, Antonis Papasolomontos, Rachel Power & David Pilbury

On Episode 16 of NHE's Finger on the Pulse podcast, host Matt Roberts is joined by SilverCloud Health's Head of Europe Dr Lloyd Humphreys as we discuss mental health, Covid-19 and digital mental health services. As a leading digital mental health service provider, SilverCloud Health saw a significant uptick in people using their digital mental health service; was that anticipated, and what are the implications longer-term?

Ep 16. A completely normal reaction to an abnormal situation, Dr Lloyd Humphreys

On Episode 15 of NHE's Finger on the Pulse podcast, brought to you by Brother UK, regular host Matt Roberts is joined by Ged Cairns and Matt Jones of Brother UK to discuss how IT and technology can directly impact and improve patient care - the only real "currency" which matters across the health sector, as Matt Jones explains.

Ep 15. A better understanding of tech benefits the patient, Ged Cairns & Matt Jones

On Episode 14 of NHE's Finger on the Pulse podcast, we're joined by Professor Craig Jackson, Professor of Occupational Health Psychology Birmingham City University to discuss the coronavirus pandemic, the health messaging around it and how those in power have missed a trick by overlooking the key role of psychology in informing the public of restrictions, measures and the ever-changing situation

Ep 14. Health messaging is a science, Professor Craig Jackson

On Episode 13 of NHE's Finger on the Pulse podcast, we're delighted to be joined by Anthea Hockly, Associate Director of Workforce Development and Learning at Essex Partnership University NHS FT, to discuss a recently established Health and Care Academy in Essex which the trust has heavily involved in.

Ep 13. Accessing the full range of careers available, Anthea Hockly

On Episode 12 of NHE's Finger on the Pulse podcast, I'm joined by Michelle Nix of Parking Eye as we discuss the ways their car park solutions can assist healthcare providers in improving revenues, creating a better user experience and allowing greater accessibility and the introduction of touchless and cashless technologies.

Ep 12. The key words: 'cashless, user experience and revenue', Michelle Nix

On this episode of NHE's Finger on the Pulse podcast, host Matt Roberts is joined by Darren Atkins, Chief Technology Officer (Artificial Intelligence & Automation) at East Suffolk and North Essex NHS Foundation Trust to talk about digital technology, automation and AI and how it all fits into the modern health sector.

Ep 11. Using automation technology to make time matter, Darren Atkins

Mental health has always been an area of significant discussion in the health sector, from clinicians to solution through to prevention. But, on Episode 10 of NHE's Finger on the Pulse podcast host Matt Roberts chats with Nicholas Rowley of the Manchester branch of Andy's Man Club, a mental health charity aimed at supporting men to talk about their mental health problems and overcome some of the stigma, to understand what services are out there to address mental health provision beyond the traditional clinical settings.

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