Connectivity for peripatetic health care workers

This guidance provides an overview of the health applications and potential benefits of some of the most commonly used wireless connectivity technologies options available to NHS staff. It is designed to be an entry point for any healthcare professional wanting to know more about wireless technologies and their potential applications and benefits for peripatetic workers. 

The guidance supports CIOs, IT and network managers, operational and estate managers seeking a broad technical understanding of wireless technologies and supporting capabilities, and potential applications within their organisation and other health environments.

In this context, connectivity means enabling a health care worker, travelling between fixed sites and visiting patients at home or in out of hospital care settings to access, through their mobile devices (whether mobile phones, laptop or tablet), systems and data via methods including mobile coverage, Wi-Fi and satellite.

Who this guidance is for

This guidance is written for those that support delivery of healthcare, through NHS commissioned organisations, specifically those involved in:

• connectivity technology selection decision making
• business case definition for connectivity investment
• budget allocation
• service commissioning
• delivering the health care service itself – the peripatetic workers

What this guidance enables you to do

This guidance details the factors that can influence selection of connectivity technology and support more informed decisions on what technology to invest in and maintain, to enable those using the technology to work in the most efficient way when accessing necessary systems and data.

The 2018 and 2022 Queens Nursing Institute for Nursing surveys both found the vast majority of community nurses have insufficient connectivity to perform digital tasks in people’s homes. Yet in a digital NHS, the productivity and safety of peripatetic health care workers and their patients, means they must have access to up-to-date information.

The Nursing and Midwifery Council code (section 10.1) states that nurses should “complete records at the time or as soon as possible after an event, recording if the notes are written sometime after the event".

Peripatetic workers providing health care therefore need to access, maintain and update data and systems before, during and after performing their work with patients in out of hospital locations.

A digital NHS requires connectivity to function properly and effectively. Community staff should not be excluded the right of digital connectivity.

There are a wide assortment of different devices and solutions used for digital connectivity available to healthcare staff, and the purpose of this guidance is as reference material to allow users and decision makers to choose the right solutions for their local needs.

Before we detail some of the digital connectivity options, it is important to understand the role of 'Offline Mode' applications. Applications used by peripatetic health care workers may have an offline mode, allowing them to access an application to enter and record data when they do not have connectivity and then sync and upload the record when connectivity is available.

As connectivity can never be guaranteed 100% of the time, offline mode design is important to allow access to and recording of information without connectivity, providing resilience and reducing the risk of lost data.

However offline mode designs can never meet all of a remote workers requirements and as such are always a compromise in some form. This guidance is focused on the importance of connectivity, and as such will not cover offline modes in detail and advises readers to endeavour to have real-time access to clinical and safeguarding information whenever possible.

Whilst other connectivity methods will be discussed in this guidance, mobile phone coverage and connectivity is predominantly used and can be considered the default connectivity by peripatetic workers who need access to digital applications and voice and text communication on the move.

You may already know which mobile networks are the best in your area, although mobile network operators (MNOs) are constantly rolling out new infrastructure and services under their spectrum license agreements. 

Checking MNO coverage maps (or a simplified cross-network mobile and broadband checker from Ofcom) regularly and prior to making any change or investment, is highly recommended to understand developments and changes.

Understanding coverage availability should be a first step in researching connectivity options and can be used to inform decision making or trials of other connectivity solutions.

You can use a combination of the above, or other coverage checkers, to get a clear view of coverage availability by network and identify which MNO provides the best coverage in areas staff operate in.

This guidance assumes that staff have access to 5G mobile data for connectivity.

To utilise 5G connectivity a remote worker will need a 5G enabled device, data plan and SIM card. Whilst these are becoming the norm for modern smartphone devices and data plans this may not be the case for staff with older devices. If staff are reporting issues with mobile connectivity in areas where 5G coverage should be available (according to a coverage checker) we recommend auditing their devices, SIMS and data plans to ensure they are 5G capable. Some smartphones also need 5G connectivity to be enabled separately from mobile data in the device settings.

Learn more about different mobile connectivity generations.

Factors to take into account when assessing network defined mobile coverage for peripatetic workers:

1. Any quoted indoor coverage is an algorithmic approximation based on network supplied data with a standard decrement in signal strength to account for walls blocking signals. In practice, indoor performance will be variable and may differ from the network stated coverage based on building materials, fabrication, the age of building construction, number and type of internal walls, and so on – so this is rarely a reliable indicator. Learn more in our wireless infrastructure building guidance.
2. Due to the environmental effects on radio signals, no service guarantees can be provided by mobile network providers (unlike digital services delivered end-to-end through fixed lines) and even the best solution will have no connectivity in certain situations.

For the purpose of this guidance, it is assumed that a single SIM solution is the baseline for mobile connectivity. Solutions that seek to enhance the connectivity of a standard single SIM will add additional cost to purchase and maintain, although these costs can deliver significant benefits.

 Costs to consider in any procurement of a new solution include:

• upfront equipment and device costs
• run and maintain costs such as more data, SIM rental, device maintenance and support
• costs of change, including training for more complex solutions and roll-out
• consider appropriate and cost efficient data tariffing, look into data usage to decide if this should be individual data allowances or a pooled group data allowance

User needs are vital when making a decision on connectivity and devices, and understanding these needs through gathering staff feedback and using this to inform decisions is recommended.

 Some examples of user research include:

Certain solutions listed in this guidance may require user intervention, whilst others should be seamless for the user, so digital maturity and training requirements may be a factor in considering certain solutions over others.

Some solutions require additional devices, and as such, additional device weight and access to charging facilities during a working day, as well as any training is a consideration.

Once you have gathered your requirements and understand staff needs, we recommend contacting suppliers to request samples of their equipment and solutions, allowing staff hands on experience with the devices to understand if they are suitable. Smaller scale trials, such as deploying a new connectivity solution and an application on the device to survey and record connectivity, can inform whether solutions are suitable, identify any unforeseen requirements or challenges and help inform business cases to justify investment in new solutions.

The Future Connectivity programme have produced a report in partnership with Mid Cheshire Hospitals Partnership Trust illustrating how they worked with their staff to understand their requirements and test a range of devices and solutions to solve connectivity challenges for remote workers.

Read the Mid Cheshire Hospitals Foundation Trust: community connectivity challenges report.