The NHS Long Term Plan (LTP) 2019, sets out the ambition for digital innovation to be part of all services; that people will increasingly be cared for and supported at home using remote monitoring (via wearable devices), e-services and digital tools. This ambition is further articulated in the Department of Health & Social Care vision for the generation of more digital services designed around user need and adhering to key principles of privacy, security, interoperability and inclusion, as set out in their guide to good practice for digital and data-driven technologies

The National Institute for Health and Care Excellence (NICE) also recognises that digital interventions, along with the more traditional face-to-face therapy, can offer people with mild to moderate anxiety and depression a flexible, but guided way of helping them get better. As part of the IAPT programme, NICE has therefore been assessing digital applications or computer programmes which will sit alongside face-to-face, phone and online therapy via its medicines and technologies programme.

A review of the digital readiness of IAPT services was conducted in January 2020 by the London Digital IAPT team with the Organisation for the Review of Care and Health Apps (ORCHA). This baseline report provided a general understanding of how comfortable staff are in the digital environment of work, their willingness to learn and seek new developmental opportunities to perform tasks quickly and effectively and openness to try new things.

The onset of COVID-19 pandemic and the resultant social distancing measures have since necessitated remote working for some health and social care staff and the rapid adoption of digital health technologies (DHT) in the provision of services across the NHS, including IAPT.

Digital Competencies Framework for IAPT Professionals

In May 2020, Healthy London Partnership (HLP) partnered with Royal Holloway University of London and Health Education England (HEE) to develop a Digital Competencies Framework for IAPT Professionals. The framework outlined the competencies required to support the development of digital practice skills by setting standards for digital practice which should inform curriculum design and the definition of learning outcomes in relation to digital practice. This framework will support the wider work that HEE have already undertaken in providing digital literacy resources for healthcare professionals.

Data on consultation mediums for IAPT appointments during COVID, produced by the national IAPT team, provides some evidence that IAPT services may be ready for a wider adoption of DHTs compared to the pre-COVID era.

• Video consultation went up by 850%
• Phone consultation increased by 260%
• All other mediums up by 28%
• And face-to face down by 94%

Some of the DHTs providing computerised cognitive behavioural therapies (cCBT) in London IAPT services to varying extents, are SilverCloud,  Minddistrict,  ieso digital health and ICS Digital Therapies.

IAPT service examples

Greenwich

IAPT service have used SilverCloud as an option for Step 2 interventions. Psychological Wellbeing Practitioners (PWPs) spend half an hour a week supporting patients to use SilverCloud – reading what patients have been doing on it and replying constructively. Recovery rates of 70% and over have been reported. They are trialling using it in Step 3, using it alongside therapy, and also with those on the Step 3 waiting list.

Bedfordshire

IAPT service upon working remotely discovered that a digital solution wasn’t readily available or workable for everyone.  They had to consider how to best utilise software for those who were digitally enabled, but also to have an offer for those who were not.  They developed an ‘IT Suite’ at one of their hubs – this was a dedicated room in a safe NHS setting where a client could come into the service, and use an easy to operate computer to dial into remote treatment with their therapist who was still working from home. This meant that those without IT at home, with no applicable IT skills or those with an unsafe/unsuitable home environment could still come into a safe place to receive their treatment without being digitally excluded.

Further challenges include marketing – as community spaces/GP surgeries are currently used less it is tougher to reach some populations, especially those who are not able to be reached through digital marketing.