This performance report is structured around the objectives and achievements of each of our key delivery directorates in 2019-20. Our performance analysis and governance statement set out our purpose, operating environment and the issues and risks affecting delivery over the past year. In this section, we focus specifically on the response to coronavirus across all parts of the organisation from the beginning of the year.
Our digital channels for citizens have been at the frontline of the system’s response from the earliest days of the outbreak, with millions of people using the NHS website, NHS 111 online and the NHS App to access information and guidance to self-manage and to find the most appropriate care. This has helped minimise contact that would have spread the virus and has reduced burdens on clinical staff.
Our NHS 111 online platform has acted as a digital ‘front door’ to the NHS, allowing millions of people to check symptoms, determine whether they need in-person care, and, through integration with NHS 111 telephony, receive clinical call-backs when required. Use of NHS 111 online peaked at almost 950,000 sessions a day in mid-March, about 95 times the average daily volume before the outbreak.
As advice and guidance about the virus evolved, we delivered regular updates to NHS Pathways, the core clinical decision support system that underpins the remote assessment and triage of callers to urgent and emergency care by NHS 111, 999 services and NHS 111 online.
Dedicated coronavirus content on the NHS website was accessed about 80 million times between the start of February and mid-May. This was complemented by a social media campaign that included advice and guidance videos on YouTube, which have been viewed more than 7 million times.
A ‘wrapper’ was introduced for the NHS App to provide access to the NHS 111 online self-triage functions without requiring identity verification and therefore making these immediately accessible to hundreds of thousands of users. The NHS App was downloaded 1.3 million times between the start of February and mid-May, while 440,000 registrations were completed over the same period. For registered users, with access to the app’s full capability, we introduced new functions supporting patient-practice messaging, digital triage and the ability to nominate pharmacies for electronic prescriptions.
A new self-isolation notes service was launched in March, allowing patients to create certificates to inform employers that they are off work due to coronavirus without needing to contact their GP. About 1.3 million notes had been generated by mid-May, significantly reducing the burdens on general practice.
All of these systems’ infrastructure was rapidly strengthened in March in response to unprecedented loads and has remained resilient despite subsequent spikes in user volumes. The number of people applying to register on the NHS App increased threefold in mid-March and has remained high. We increased capacity to verify these new users and redeployed staff from across NHS Digital to clear a temporary backlog.
We also supported remote and collaborative care and increased access to patient information for clinicians. Additional information from about 50 million patients’ GP records – including details about long-term conditions, reasons for prescribing medication, coronavirus status flags, and whether a patient has been advised to shield – is now shared through the Summary Care Record and available to clinicians and other authorised staff outside GP settings including pharmacists, social care professionals and paramedics. This information has been used widely. For example, between 3 April and 26 May, information about shielding status on the Summary Care Record was viewed more than 650,000 times.
We were able to share these details because of the adoption of an implied consent model for the use of some data during the outbreak. This model was not applied for patients who had previously said that their data should not be shared outside their practice.
A national data sharing agreement, in place for the duration of the outbreak, is also supporting record-sharing and appointment booking across GP practices and NHS 111 services through our GP Connect programme. Participating GPs can view the full patient records of people registered with other practices and 111 call centres can make bookings into GP practices and automatically communicate coronavirus information from 111 triage back to GP systems.
Planned work on extending the Electronic Prescription Service (EPS) has been accelerated to reduce patient contact and improve efficiency. Major achievements since the beginning of February have included:
- enabling EPS for over 600 non-GP primary care sites (for example, urgent care), which removed the need for paper prescriptions for about 12,000 community pharmacies
- implementing changes that allowed new medicines to be delivered to vulnerable patients (for example, those in care homes)
- improving identity services so that more than 6,000 locum pharmacists and 200 pharmacy technicians could work across multiple locations
- allowing prescriptions to be easily fulfilled at an alternative location if a nominated pharmacy had to close due to coronavirus
We also supported remote care by:
- speeding up the assurance of video consultation suppliers for primary care, resulting in a nationwide roll-out in under two weeks
- supporting the deployment of Microsoft Teams to 1.2 million users across health and social care for uses ranging from patient consultations, clinical group therapy sessions, antenatal classes, and complex multi-disciplinary team assessments
- enabling the deployment and supporting the implementation of outpatient video consultation capabilities in 183 trusts
We provided infrastructure to support coronavirus testing, working with partners to build and deploy a digital platform for new capacity including drive-through centres, roaming test vans and home testing services. Specifically, we built systems to support self-referral, appointment booking, the ordering of home testing kits and the integration of services with the NHS website and NHS 111 online. Support was initially provided for testing essential workers and then expanded to all symptomatic patients.
We also supported the Nightingale hospitals and other new capacity created across health and social care in response to the virus. Our Access and Logistics Hub helped get the right communications in place for more than 1,000 sites through network migrations and bandwidth upgrades and provided remote access solutions for returning clinicians and other users working from alternative locations. We distributed more than 84,000 physical smartcards and 26,000 smartcard readers and a new, virtual smartcard solution was introduced to reduce contamination risk and support authentication in virtual desktop infrastructure (VDI) and complex IT ecosystems. 30,000 licenses were bought and are now being introduced across about 50 sites. We are moving to the next stage, which is to increase the number of suppliers for virtual smartcards and to deliver the enhanced digital signatures required for electronic prescribing.
Our Cyber Security Operations Centre provided dedicated cyber security support to the Nightingale hospitals and other priority health and care organisations as phishing and other cyber criminality increased during the crisis. We set up new sources of live intelligence on evolving threats, provided integrated technical and cyber incident support for local organisations involving all the key national agencies, and distributed information and materials to respond to specific areas of risk such as home working and returning staff.
We also established a temporary security operation centre to provide protective monitoring and cybersecurity capabilities, including security incident response, across the cross-departmental effort to deliver testing and contact tracing services.
The Shielded Patients List has played a vital role in protecting more than 2 million people who are highly vulnerable to coronavirus. We developed the algorithm, based on criteria defined by the Chief Medical Officer, that underpins the list. It is generated each week and issued to agencies across national and local government responsible for supporting shielded patients. It incorporates feedback from GPs, specialist trusts and self-referral by vulnerable individuals.
NHS Digital has published the algorithm and methodology used to create the list and published aggregated open data and dashboards that show distribution by age, gender and location to support planning and research at local and national level.
We have provided data, analysis, dashboards and tools to help the health and care system understand the prevalence of infection, manage capacity and plan the response.
To ensure we continue to protect sensitive patient information while rapidly responding to urgent system needs, we have accelerated our data access approvals process and doubled the frequency of the Independent Group Advising on the Release of Data’s (IGARD) meetings.
Key contributions from our data services have included:
- providing analysis of the relationships between ethnicity and poorer coronavirus outcomes in black, Asian and minority ethnic (BAME) individuals in response to requests from Health Data Research UK, the Chief Medical Officer and others
- linking National Diabetes Audit data with intensive care data to enable analysis of diabetes as a coronavirus risk factor
- developing a machine learning tool in partnership with researchers at Cambridge University to predict demand for ventilators, beds and equipment in intensive care units
- publishing coronavirus triage information collected from NHS 111, NHS 111 online and 999 services as open data and in dashboards to support self-service planning
At the end of May, responding to a request from the British Medical Association and the Royal College of General Practitioners, we centralised the collection of patients’ data from general practice, becoming the single body disseminating GP data for research and planning during the epidemic. This relieved pressure on GPs that were being overwhelmed by complex requests for data, allowed us to ensure that the highest standards of information governance were maintained, and improved the availability of data for researchers.
We have continued to fulfil data requests submitted through the Data Access Request Service (DARS) and have established a separate prioritisation mechanism for high-impact research identified by HDR UK and the National Institute for Health Research (NIHR). For example, we supported the identification of patients for recruitment into the Convalescent Plasma trial led by NHS Blood and Transplant (NHSBT), which is assessing the effectiveness of convalescent plasma for critically ill patients.
We also provided the research platform, data, information governance, data management, and data analysis expertise to support research prioritised by the National Institute for Cardiovascular Outcomes Research (NICOR) and the British Heart Foundation investigating the impact of the virus on patients with acute coronary syndrome and whether some medicines increased susceptibility. Insights from this work were reported to the Science Advisory Group for Emergencies (SAGE) and NHS England and informed the system’s response.
We have developed a Trusted Research Environment to help researchers working on the virus. This is already being used to support cardiovascular work and is being expanded to other research communities.
Our Information Governance team has been a key function throughout the pandemic because complying with data protection law on the use of data is critical to maintaining public trust. Our team provided advice on a wide range of urgent initiatives and issues including provision of coronavirus online isolation notes, the national roll out of GP Connect, the Shielded Patient List, including additional information on the Summary Care Record, using GP data for planning and research, sharing of child protection plan data with school nurses and health visitors, and coronavirus testing for key workers and members of the public. We contributed to the first Control of Patient Information (COPI) notice, new COVID-19 directions and Section 255 requests with the devolved nations, and advised on a large number of urgent and complex data collection, analysis and dissemination requests from across the health and social care system and the science and research communities. This required advice to be provided at pace through a new coronavirus ‘Red Team’. We have produced a number of new transparency notices to explain to the public how we are using and sharing their data and we have published examples of what we are doing on our web pages to help keep people informed.
Our coronavirus response has continued into 2020-21 and we are currently working with colleagues across the system to prioritise our portfolio for the coming year.