<span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text" >Livewell Southwest: managing the demand for online consultations</span>

Integrated care

Livewell Southwest: managing the demand for online consultations

Åsa Söderlund

Livewell Southwest is an integrated health and social care provider covering the areas of Plymouth, South Hams, and West Devon. Their remit extends to specialist services in parts of Cornwall and Devon. The organisation is a provider of NHS services and also delivers adult social care in Plymouth. It is the largest community health and social care enterprise in the UK. Livewell Southwest partnered with Visiba Care to launch their virtual clinic in early 2020 with a clear vision and goals. The demand for online consultations has risen since March 2020 and Livewell Southwest are quickly scaling up their digital operations. We spoke with Michael Oliver, Project Manager at Livewell Southwest, about their digital transformation journey and how it unfolds amidst COVID-19.

Livewell’s initial motivation for starting a virtual clinic in January was not far from any other healthcare provider during that time: To check off the NHS Long Term Plan deadline for providing online and video consultations by April 2020 and April 2021 respectively. As he mentioned, what Livewell Southwest was trying to address with their new virtual clinic were two quite pressing issues in many healthcare providers – the DNA rate and the cost of real estate.

As demand on our services increases, our demands on our estate increase. Some of the buildings we operate from have high rental tariffs. If we are able to deliver care remotely, we can reduce the size of our estate and the costs associated with it.

Another aim was our desire to reduce DNA rates (‘did not attend’). The Plymouth Options Service has a DNA rate of around 15%, so reducing this will help to take some pressure off of the waiting lists and reduce waiting times. Additionally, we aim to reduce our carbon footprint. As a social enterprise, we want to reduce our carbon footprint by 30%, and see virtual consultations as a perfect mechanism to support this aim.

Their digital vision has another side: Livewell Southwest also set out to use their new virtual clinic with First Response crisis intervention – the police and housing. The goal with this endeavour is to reduce emergency hospital admissions, providing prompt support to people in crisis, relieving pressure from NHS trusts and primary care, and offer a tool for quick and easy access to front line workers responding to a crisis.

With these goals in mind, Livewell Southwest started searching for a virtual clinic solution. Initially, what made Visiba Care stand out among other suppliers was the Visiba Care platform itself.

The simplicity of the product is one of the major things that we like. It does exactly what it’s advertised to do,. We have had many self-confessed technophobes come onto the training courses, but by the end of the training, they have been ready and able to use the system with confidence. The fact that we can brand it and call it Livewell Connect as well, that’s a huge thing for us too.

However, after the collaboration with Visiba Care began, Michael started noting other winning points:

Throughout the time that we have been working with Visiba Care, they have always given the impression that we are their most important customer. Right from the off, nothing has been too difficult for them to sort out. They have been available when we need to discuss any aspect of the app and have been happy to look into and implement development requests where appropriate. They made the process of designing and publishing the app very straightforward, and importantly, very fast.

Prelude: The board is set

After training and deployment, Livewell Southwest started using their virtual clinic for healthcare-initiated video consultations with patients they have already met. Michael explains the starting point of their digital services and the gradual expansion:

The initial plan was that most of our consultations would be related to mental health since they do not need to provide hands-on care. However, we have seen that our physical health staff find value in online consultations too and now they are using it as well, particularly the occupational therapists.

Nevertheless, no digital transformation journey is without bumps on the road. The organisation faced a frequently discussed challenge – getting the staff on board with the new virtual clinic. Michael describes:

You can give solutions, give the training and, but the hardest thing is to convince staff that this is a good medium to use to have consultations with people, and assuring them that ‘this is ok to use, you can have a go with it’. This has been the most challenging part of the journey, but it has been worth the effort.

Michael Oliver was very engaged in addressing this challenge and doing his best to solve it. His solution was being there for the staff, encouraging them, and answering all of their questions. He adds though another known potent ingredient in the mix: Ambassadors. In his own words:

Lots of encouragement, trying to be there and support them with every single problem they had, staying in touch with the team often, dangling the carrot in front of them and really encourage them to use it. Fortunately, in the pilot area, there were two people that were really keen to take the mantle, so I tried to use them as examples to everybody else to show that this is a good system and it works.

Speeding up: Digital growth as a COVID-19 response

However, things changed quickly in the entire globe with the spread of SARS-CoV-2. The pandemic led the UK to a national lockdown and, with people in quarantine, the need for remote consultations became more urgent than ever. The uptake at Livewell Southwest was prompt. Michael narrates the organisation’s mobilisation:

With the COVID-19 crisis we have increased the number of users 27 times; we’ve had over 750 registered users now, whereas 3 weeks ago, we only had 20. Visiba Care has come at an absolutely perfect time for us.

The speed that Visiba has worked during the COVID-19 crisis has been incredible. Within hours, we had a new reception set up called Rapid Connect that we are using for staff across our organisation when they are unable to deliver face-to-face assessments and interventions. In the space of 2 weeks, we trained over 600 people to use the system. Visiba supported us with training materials. We delivered the sessions online as we were unable to deliver them face-to-face

When people can’t come to us, we can still support them virtually – and this is a standard offer now, we can at least see you and talk to you face-to-face. Amidst COVID-19, that gives them the vibe that we’re doing the best we can do. I am encouraging the district nursing team to try and get patients to use it as well. So if, for example, the patients have wounds, they can put the smartphone at the wound and the nurse can give really good advice as well. Our use cases have grown in the past few weeks; we’ve had 70 consultations at the moment and now hopefully, next week we’ll go through 100 and keep growing from there.

Michael goes on to point out what few in the eye of the storm have considered, namely how this crisis can be turned into an opportunity for accelerating the transition to digital-first in the future.

We are making more progress in two weeks than we would have done in 6 months in terms of staff engagement with virtual consultations. From this crisis we are going to give lots of people a view of virtual clinics as well and get them to think about how they are going to use it when this is all done and things are back to normal.

The future and lessons-learned

For Livewell Southwest, it was a combination of strong, present leadership, an apt crisis response, and a platform that is simple-to-use and responds to the organisation’s requirements.

As Michael tells us, after using the platform briefly, the staff were surprised with how easy to use the platform was and they are now on board. Michael sent us over some testimonials from the staff at Livewell Southwest:

I’ve just completed my first video consultation with one of my community patients and it couldn’t have gone better. My patient suffers from some mental health issues so being able to talk to her face to face was brilliant and she said how it felt like she was speaking to someone real as she could see me.

– Therapy Support Worker at Livewell Southwest

I have just successfully done my first video consultation with a client – bless her, she was an absolute star. I was able to see what chair she had, what the problems were with it, make sure she was seated correctly in it and establish what we need to put it right. This has saved a duty visit which I would have needed to put through. I am feeling very chuffed with myself.

– Specialist Occupational Therapist at Livewell Southwest

The organisation is also planning on expanding their virtual clinic services. When asked about the future of their virtual clinic, Livewell Connect, Michael shares his aspirations for expanding the function as well as cultivating a digital-first culture with a great initiative:

Going forward I think it will be a mix of absolutely everything. I am urging staff to use the messaging function so that they can send information through that and do screenshots as well. I would like to start developing receptions for the areas that are working really well in the next few weeks and months, particularly therapy teams. They are really starting to see the value of using Visiba Care so getting them to develop their own receptions, customise the questionnaires a little bit more, use the full potential of the system. At the moment, we started with a bit of a light touch just to get them going quickly. (…) One of the things we are going to start doing next week is to ask for such stories. I’ve also set up a team on Microsoft Teams, and I am trying to get them to talk about their experiences as well, share their ideas and collaborate on them.

We asked Michael if he has any advice for other healthcare providers who want to get started with their virtual clinic and he offered a unique perspective that would be unlikely to discover in any other point in time:

In terms of delivering training, it works really well to deliver it virtually because there is no limit to the number of people you can have on training. I had 55 in one session yesterday. It’s really worth training online because you can go through the presentation, demonstrate the system online and show them how it works. They’ve picked up on it really well, so I’d say that it’s not necessary to have a face-to-face training with this, especially if you need to get a large number of users trained in a short period of time.