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  • June 23, 2021
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How the NHS Moved to Remote Work


For many, Digital transformation has become a bit of a buzzword. With full-scale home working just a button’s click away for most, it’s easy to forget that larger, more monolithic organisations transformation projects can take years, sometimes decades. 

In the NHS, one of the world’s largest employers, decades worth of transformation has happened over a matter of months due, in part, to the COVID-19 pandemic. The transformation that has seen millions of NHS staff moved out of hospitals and into their homes. 

In this article, we brought together many of the NHS Tech Leaders who have worked through the mass migration to efficient and effective remote working to share their stories and challenges. 

Annette Scott, Digital Programme Manager at Liverpool Heart and Chest Hospital NHS Foundation Trust

Annette Scott is the Digital Programme Manager at Liverpool Heart and Chest Hospital. Joining the Trust in July last year, Annette has been at the Trust for 16 months of her 15 year NHS career. Annette joined the NHS after working as a temporary staff member at Warrington PCT, before joining them on a permanent basis, swiftly moving to a position in the LIS as the NPfIT Training Manager.

Now leading her team on the delivery of several key, digital projects for LHCH, we asked Annette to reflect on the beginning of the pandemic and how herself and her team handled the mass migration to home working. 

The Home Element is Very Strong

Those who are effective working from home are those who strike a balance between their home life and their professional life. Keeping them physically and psychologically separated will help you switch off and focus on whatever needs your attention. 

This was the challenge for Annette, who is the first to admit that she initially struggled with the change.

“When you go to work you put your ‘costume’ on. You straighten your hair, put on your makeup and head out the door looking smart and preparing for the day. When I first started working from home, I didn’t do any of that and I struggled to switch off after the workday because there wasn’t that clear line between the two. I used to spend the journey home reflecting on work and preparing for home – that ceased to happen.”

With two children and a husband, Annette’s household has been very busy. And, without a dedicated workspace, both her and her husband were sharing the dining room table. This image will be a familiar one to many professionals who weren’t really set up for home working. 

Despite this, Annette was quickly able to set up a routine and opportunities for her team to benefit from the social capital that a home-working setting can lack. 

“Those ad-hoc conversations that add value to your day without you even realising. Those are key. I felt it was important to capture those moments in the best we could.”

In addition to regular 1:1s, Annette set up chat sessions through teams to try and capture that ad-hoc support and found that it helped the team, especially when welcoming a new staff member. 

There’s An Opportunity To Give People Flexibility

We wanted to ask each of our contributors what they thought the future held for the NHS and whether they thought distributed working was here to stay. 

For Annette, who is full of cautious optimism, the future is full of opportunity but needs to be handled on a case-by-case basis.

“We’ve seen the value of home working but we’ve also seen the detriment. There’s an opportunity to give people flexibility so they can go where they need to go to get the job done. The best part is that there are savings to be made for the NHS by responding to these needs.”

Andrew Carter, Head of IT at Liverpool Heart and Chest

Andrew Carter is the Head of IT at Liverpool Heart and Chest. Entering the NHS straight from University, Andrew is now approaching his fifteenth year in the NHS.

Spending his entire career in IT in the NHS, Andrew has seen the entire spectrum when it comes to the general perception around IT. The past few months, however, have seen a massive shift. 

“Digital services have been thrust into the limelight. Whereas before we were seen as a support service, we are now leading transformation and enablement. We’ve become a focal point and it’s given us a platform to drive more change.”

We Were Caught Off Guard Initially 

As the Pandemic took hold and the thousands of staff in the Trust’s area began to move to working from home, Andrew and his team were given the mammoth task of getting them up and running.

“We suddenly needed a lot more kit. For us, it was about getting the priority people settled then scrambling for a bit more kit. Once we got over the initial rush with kit, there were more challenges waiting for us.”

With everyone now set up from home and accessing the same systems, the bandwidth strain became a big problem. Andrew and his team quickly set up split tunnelling for traffic to flow down the VPN link securely. 

“None of this could be predicted because everything was just coming in so quickly.”

The Majority Weren’t Used to Remote Working

Usually, when it comes to digital transformation there are three major fronts – people, process and technology. With technology firmly under control, Andrew and his team now turned to the people. 

“There aren’t that many people who are used to home working and have the right set up for it. The majority weren’t used it it at all.”

Seeking to provide more than just the technology solutions, Andrew and his team set about creating ‘packages’ that came along with the kit. These packages included guidance on remote working practices.

“It was difficult to get everyone into a happy place. That was the real big challenge for us. So we really had to help them transition quite quickly over to a different mentality which people sometimes do for years before they’re really used to it.”

The Culture Around Video Conferencing has Changed

Since the pandemic hit, Zoom, FaceTime, Houseparty, Microsoft Teams and all manner of other video-calling apps have become so ingrained in our lives. As one of the only safe ways to communicate, it’s hard to imagine living without them. None of these has taken off quite like Zoom. At the end of December, the app reported a maximum of 10 million daily users. By March, 200 million people were on it each day to work, socialise, view lessons and lectures, sing in choirs, attend church, birthday parties and weddings, meet new babies, say final words to dying family members and observe Ramadan and Easter.

So ingrained into our everyday lives has video calling become that it seems a stretch to even imagine a world without it. But, as Andrew recalls, it wasn’t always the case. 

“I remember Lancashire Care. This is going back 10 years now, but we were rolling out Office Communicator. We were giving out webcams, providing training and more but no one would go on webcam. Obviously, the technology has improved, but I think the big part is our perceptions.”

This shift in perception has helped compound the work that Andrew and his team have done as more and more staff buy into the technology solutions. Now normalised and part of everyday life, Andrew is keen to see the digital transformation work continue past video calling. 

“It’s something that we’ve been trying to push for because there’s a lot of time and money to be saved from getting this right. It’s so important we carry this momentum forwards.”

Our Talent Pool Has Expanded

Amongst all the hard work enabling the work of those on the front and backline of the NHS, there has been no end of benefits to the digital transformation work that Andrew and his team have delivered. 

One particular benefit that flies somewhat under the radar is how the remote working capability of the NHS will impact the talent pool from which is draws its technical candidates. For Andrew, it’s a very exciting time to be in a hiring position. 

“Why limit ourselves to the Liverpool area for candidates or the northwestern area? As long as we’re getting the right person, and they’ve got the scope and ability to work remote – we can hire from anywhere.”

Lin Horley, Senior Program Manager at Manchester University NHS Foundation Trust

Lin Horley is the Senior Program Manager at Manchester University NHS Foundation Trust (MFT), where she is taking a leading role on the Epic EPR HIVE Programme. Lin is working on the  Epic Program covering the third party vendors which are necessary to support the overall deployment in a major transformational programme for one of the largest UK NHS Trust which comprises  9 hospitals, soon to be 10. 

With significant experience in EPR solutions, Lin worked for many years as an NHS employee before moving to work on a contractual basis. 

Lin joined MFT at the end of the first lock down period working on-site initially, however more recently during the second lockdown has been working remotely.

The Culture Has Changed For Everyone

With a long and distinguished career in the NHS, Lin has worked with many different teams across the country. One of the biggest changes she has witnessed during this lockdown period has been around the perceptions people have on what is possible while working from home. 

“One of my clinical colleagues was telling me about how the culture has changed for him. He’s working with very, very sick patients with immune disorders and he’s found a balance, caring for some patients remotely over digital solutions and some on site.”

Lin has also seen the culture shift from what used to be quite a difficult process to something that is fun and engaging. 

“It’s quite interesting, when you’re a leader, to bring people in remotely and make sure they still feel valued. Sometimes they feel like just another number but now, with the technology we have, we can make it fun and enjoyable.”


We Need to be Cognizant of Everyone’s Needs and Circumstances

The team at MFT is currently being established to meet the demands of the growing HIVE project during a difficult lockdown period.  Lin reflected on past experience from her 5 years experience at University College Hospitals London where she worked on the Epic program during the first lockdown.  She emphasised the need to understand the varying needs of the people on the team. 

“There are a number of people who are not in a great position for working from home. I’ve had people who live alone and need that social interaction in the office. I’ve also had people who are living out of bedsits. We just need to recognise everyone’s circumstances before making decisions.”

Including more than just the physical space in which people work in, consideration also needs to be given to the emotional and psychological space people work in too. 

“As leaders, we need to recognise that people will react to this situation differently. They might struggle to find focus, they might lose discipline or they might work ridiculous hours. We need to make sure we’re communicating more than ever and giving support and praise where needed.”

It’s Never Going to Go Back To The Way It Was Before

We wanted to ask each of our contributors what they thought the future held for the NHS and whether they thought distributed working was here to stay. 

For Lin, the future for the NHS is a more connected one, where both patients and staff will enjoy the benefits of more flexibility supported by technology.

“It’s never going to go back to what it was before. So I don’t think we’ll ever go back to having all patients attending busy outpatient clinics on-site, I think they’ll be a mix of virtual and on-site attendances, which I think is probably a positive thing. Because number one, it saves patients  the costs and time necessary to commute and it provides hospitals with a more efficient way of working.”

Paul Morris, Associate Director of Informatics at NHS Bolton CCG

Paul Morris is the Associate Director of Informatics at NHS Bolton CCG. Having worked in informatics for 18 years and the NHS for 21, Paul has significant experience in handling both the technical requirements of his role and the intricacies of the NHS as an organisation. 

In a similar fashion to Andrew, Paul was also responsible for the delivery of kit to almost 2000 members of staff in his area almost overnight. A massive task, Paul and his team were able to overcome that challenge with savvy use of suppliers and good old fashioned hard work.

We’re Always Looking at Rationalising

One of the rather unique challenges that Paul is facing as a result of the move to remote working comes in the form of the various estates in the Bolton Area. With many empty spaces and a growing number of spaces with reduced capacity, Paul is looking at cutting down. 

“We can make better use of our space and save the system some money, which is ultimately what we need at the minute.”

A restructure of this nature may well reduce the capacity of these locations and, with more investment in agile technology solutions, enable more employees to work remotely. But, like with most of the contributors in this article, Paul is aware that working from home isn’t for everyone. 

“I do think there are benefits to working from home. You can sometimes focus on a single task better and you are more flexible with how you spend your time. But, on the flip side, the isolation from your team and your colleagues can have a detrimental effect. For us, it’s about finding the balance.”

We’ve Proven That We Can Respond Quickly

Sometimes unfairly, the NHS is lumbered with a reputation for being slow on the uptake when it comes to technology. The past few months, however, have proved that the NHS can mobilise quickly and there’s no sign they’re slowing down. 

“The changes are here for good and I don’t think there’s much choice about that for NHS staff. We shouldn’t be going back to having 25 people in a room so we can have a conversation. Think of everything we’ll cut down on like Parking spaces and Expenses and all the productivity we’ll gain from video conferencing alone. There is absolutely no reason we can’t make it work.”

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