Harnessing immersive technologies to save NHS staff time and improve patient and staff experiences

Neesa Mangalaparathy , Extended Reality Programme Delivery Lead, and  Peter Treeby , Extended Reality Project Manager, from the NHS Transformation Directorate’s Digital Productivity programme share what they have learnt about the current state of immersive technology use in healthcare, and what needs to be addressed to benefit from its evolving capabilities. 

The NHS Digital Productivity programme uses evidence-based research to identify the greatest benefit-realising digital technologies that improve productivity and efficiency to release valuable staff time to patient care. 

This includes established technologies such as Robotic Process Automation (RPA), as well as emerging technologies such as extended reality (XR). XR is an umbrella term for immersive technologies that blend the digital world with the real world. This can be on a small scale - like visual overlays that interact with your current, real environment – to entire simulated worlds. Examples of XR technologies include assisted reality, virtual reality (VR), augmented reality (AR), and mixed reality (MR).

Image 1: This image shows the spectrum of immersion experienced through different extended reality technologies. The pandemic highlighted the real human value of XR across health and care  

During the Covid-19 pandemic, an increasing number of people across the world turned to XR for social connection, distraction and exercise. NHS providers also looked to XR to support alternative ways of working and delivery of care. 

Imperial College Healthcare NHS Trust introduced mixed reality headsets onto wards treating COVID-19 patients. Healthcare teams could see what the doctor was seeing over a secure live video feed without having to be on the ward in person. This led to staff spending up to 83% less time in high risk areas and reduced the need for PPE, potentially by 700 items a week.

During national lockdown, a Staffordshire based NHS funded project provided 240 patients with chronic lung conditions to use virtual reality headsets and carry out supervised pulmonary rehabilitation exercises. Patients appreciated the shorter waiting times for treatment, the convenience of being able to complete their exercises at home, and how this helped them to cope better with restrictions. They also reported improvements in their conditions, better mobility, and improved energy levels and sleep.

XR can benefit both patients and staff across the NHS 

Our team has been working to understand the capabilities of XR, and its current use in the NHS and healthcare internationally. 

We found that XR was being used in a multitude of ways across the NHS and social care. The top four areas using XR were: 

• Education and training for patients and staff 
• Mental health and wellbeing 
• Physiotherapy and rehabilitation 
• Pain management 

Other areas such as 3D visualisation of images or scans for pre-surgical planning, image guided surgeries and remote connections (for example for community nurses) were also mentioned.  

The benefits associated with XR across these areas included: 

• saving staff time 
• improving staff experience 
• increasing accessibility  
• improving efficiency of services  
• increased positive patient outcomes

  "The XR Discovery report highlights the current scale and tremendous potential of immersive simulative solutions, and how they can directly reduce the time and improve the vital training and education for healthcare physicians."

Jade Ackers, Programme Director for Digital Productivity

Jade Ackers, Programme Director for Digital Productivity in the NHS Transformation Directorate commented: "These benefits align with key commitments outlined in the NHS 2022-23 business plan around delivery of more elective care, improving mental health services for everyone, and improving productivity across the health system.

The purpose of our Discovery work into immersive technologies was to explore transformative opportunities to deliver health and care services in more innovative, efficient ways that are sustainable, and that improve patient and staff experience.   

Our team has gathered exciting evidence to show how extended realities (XR) as a treatment and experience can revolutionise the traditional ways of delivering healthcare services, enabling the health and care sector to shape the future through technology, improving productivity and experience for our workforce and service users alike.  

The XR Discovery report highlights the current scale and tremendous potential of immersive simulative solutions, and how they can directly reduce the time and improve the vital training and education for healthcare physicians."

Some NHS organisations are already seeing benefits from XR 

There are multiple use cases and case studies that evidence the benefits and potential of XR across health and care, including some within the NHS. In 2019 Northumberland, Tyne and Wear NHS Foundation Trust completed a study involving immersive VR treatment of children with autism related phobias, with results showing that nearly 45% of patients remained phobia free six months after treatment.

At East Suffolk and North Essex NHS Foundation Trust trainee doctors are using virtual reality training equipment to practise endoscopy skills in an immersive and realistic way. Teachers are able to accurately assess students’ progress with the aim of maximising patient safety in real operations.

Is the NHS ready to adopt widespread XR?  

Our discussions with NHS providers, researchers and industry raised several barriers to adoption of XR. The most common barrier raised by NHS providers and XR suppliers was the lack of quantitative and qualitative evidence of the value that XR can bring.  

Other common barriers identified by NHS providers, researchers and XR suppliers included: 

• High initial costs for the technology 
• Difficulties gaining stakeholder approval 
• The absence of a clear route to market 
• A lack of clarity on regulatory requirements, with unique challenges brought by XR particularly around clinical safety, privacy and data protection 
• Usability and accessibility issues for specific user groups in healthcare  

Without robust data demonstrating efficacy, safety and return on investment, this can make obtaining buy-in a more difficult and lengthy process. The need for more robust data for XR in healthcare is becoming increasingly important.  

Farhan Ismail, Associate Director for the Office for Digital Health, at the National Institute for Health and Care Excellence (NICE) commented: “The rapid emergence of digital health technologies (DHT), including XR-based products, offers new opportunities for the delivery of health and care interventions, yet simultaneously poses new challenges in terms of health technology assessment. NICE has developed the Evidence Standards Framework (ESF) to support greater consistency in the generation of evidence for, and improved adoption of DHTs by, the health and care system. This will help innovators understand how to demonstrate the effectiveness and value proposition of their technologies, and help evaluators and decision-makers in taking better-informed decisions when purchasing technologies. This is especially important where there are direct implications for clinical outcomes, which many of these technologies are capable of influencing.”

We carried out a mapping exercise that revealed that compared to pre-pandemic levels, around 13 times as many NHS providers are using XR. Based on current interest levels from NHS providers, we expect the appetite for adoption of this technology to grow as organisations begin to use XR to address important challenges to delivery of care and benefits become clearer. Our team will work with the system to capture this information and share knowledge and learnings throughout this early adoption phase. 

Recently NHS England shared news of an upcoming innovative pilot that intends to use virtual reality style headsets to transcribe the appointment directly to electronic records - with patient consent - to reduce time-consuming admin for clinical staff. This is expected to expand clinical capacity, giving staff more time for valuable clinical tasks that only a human can do, such as checking blood pressure, dressing wounds and assessing patient’s relevant health needs.

Image 2: This image uses the My Maps function on Google to show a snapshot of XR activity in England across clinical skills and education (blue pins), patient education (orange pins), mental health and wellbeing (black pins) physiotherapy and rehabilitation (green pins), pain management (purple pins), data analysis (yellow pins), remote connections (maroon pins), and research (brown pins). The geographical black borders refer to each of the NHS Integrated Care Systems. The snapshot was taken in July 2022. This map and its data can be accessed by emailing us at england.digital.productivity@nhs.net.

Accelerating the use of XR in health and care by building an evidence base 

In order to address barriers identified in our research, 12 recommendations were made in a discovery report. Work has already begun to address some of the short term recommendations in collaboration with colleagues across the NHS, government, research and industry.  

 For example, we have: 

• Awarded 14 NHS sites with £2 million from the Unified Tech Fund to pilot XR projects and generate evidence and learnings over the next 1-2 years 
• Set up a community of practice to encourage collaboration and knowledge sharing between the NHS, research institutes and industry 
• Established a clear route to market for XR in education and training to be taken forward by Health Education England  
• Developed a living product directory to support NHS providers looking for specific XR solutions to meet their needs 
• Shared a list of evidenced high-level benefits identified through our evidence based library 
• Developed and shared a growing number of case studies, alongside their learnings and recommendations

Dr Neil Ralph, Head of Technology Enhanced Learning, at HEE, said: “We are excited to be working on ways in which we can support NHS providers and training organisations to more easily access and benefit from the latest XR and immersive technologies.

There is growing evidence of the benefits and huge future potential that these technologies can bring to education and training. This work will support their expanded and accelerated adoption, so educators and learners more rapidly experience these benefits, alongside aiming to reduce risk and increased value for money. We are working on a dynamic approach to procurement to support a clearer route to market, to capture the best solutions and services across the XR and immersive technology sector.”  

Delivery of some longer term recommendations will be dependent on the evidence generated from XR projects in healthcare, the relevance of this data against NHS priorities, and the direction of travel for XR as it evolves further. We have therefore developed a cost-benefit analysis framework along with some guidance to support the ongoing evaluation of impact for XR projects. We encourage NHS colleagues and XR suppliers to healthcare to use this framework and contribute to building a robust evidence base for XR, and improving the understanding of the impact it can make in healthcare.  

If you would like to join our community of practice and read the discovery report, access resources or share your experiences, please get in touch at england.digital.productivity@nhs.net. The community is open to everyone interested in supporting safe and effective use of XR in the NHS and social care including academia, NHS providers, industry and many others.

Registered users of the FutureNHS platform can scan this QR code to directly request to join the ‘XR in Healthcare’ community of practice  

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