Comment: Improving services in the field – the NHS’s biggest opportunity?
Bob Stewart of Kirona Solutions explores how mobile technologies, together with workforce management solutions, will save the NHS money and improve patient care
In this article, BOB STEWART, health sector manager at Kirona Solutions, focuses on how mobile solutions, combined with better rostering, can help to deliver a more caring and personalised service to patients in their homes
The NHS is under pressure, no secret there, but it is the scale of the challenge that sets it apart from other organisations.
A funding policy that fails to keep pace with the demographic shift of an ageing population that has complex care needs is perhaps the biggest challenge. In 2010, 10 million people in the UK were over 65 years old. The latest projections are for an additional five-and-a-half million elderly people in 20 years’ time.
Already there is financial strain and the board reports of the 145 hospital trusts in England disclose that 44% expect to end the year in deficit to the tune of £330m.
The challenges don’t stop there, however. The government also seeks £20billion in efficiency savings by 2015.
Managing information in the field is also largely paper based. Aside from being difficult to access this is also prone to error and insecure
NHS England’s vision is 'Everyone has greater control of their health and their wellbeing, supported to live longer, healthier lives by high-quality health and care services that are compassionate, inclusive and constantly improving'.
This is a fantastic aim, but the problem of balancing the books and providing high-quality care, to a growing number of patients, is seemingly paradoxical. However, I do not think it is impossible.
The inefficient use of highly-skilled people and equipment is one of the NHS’s greatest weaknesses, but the optimal deployment of these enviable assets is perhaps its greatest opportunity.
There are many fronts to attack. There has, for instance, been a 60% rise in the total bill for locum doctors in the past three years, with doctors being paid up to £3,000 a shift. That represents a £2.4billion annual bill for temporary staff.
Backed by medical staff, the Future Hospital Commission (FHC) has made a recommendation that 'much specialised care will be delivered in or close to the patients’ home. Physicians and specialist medical teams will expect to spend part of their time working in the community...' (Point 11 of a New Model of Care). This is a recommendation that I back wholeheartedly.
To emphasise the opportunity, it is important to outline the issues. If there is to be this shift towards caring for individuals in their homes, and even if there isn’t, current systems in the NHS struggle to manage the complexities of health services in the field.
There are two staples of successfully managing field services, firstly managing appointments: providing the right people at the right place with the right skills at the right time; and, secondly, managing information.
Currently most of the NHS manages appointments using paper or manual systems. This is slow, risky, prone to error and heavy on costly administration. This is because there are so many variables that impact the scheduling of staff and appointments, such as employee availability, location and skills. These must be balanced against patient availability, location, and required treatment. Add to these a series of potential unknowns, like traffic on the road, patients missing appointments, or employee sickness, and it is easy to see the difficulty. I have witnessed first-hand the fallout; skilled medical staff on extended breaks because patients have cancelled; staff turning up without the necessary skills to deal with a patient; even four different people visiting the same patient on the same day to complete four tasks that actually only required one visit from one employee – this equals huge waste.
The inefficient use of highly-skilled people and equipment is one of the NHS’s greatest weaknesses, but the optimal deployment of these enviable assets is perhaps its greatest opportunity
Managing information in the field is also largely paper based. Aside from being difficult to access this is also prone to error and insecure. Additionally, the last thing a district nurse wants to do at the end of a busy shift is copy the same information from their notes into multiple systems for multiple agencies. This is mundane, robs them of time on the frontline with patients, and often encroaches on a healthy work/life balance.
The hard truth is that this situation is not acceptable - patients and carers deserve more. Workforce management combined with mobile technology has huge potential to address the situation.
Workforce management technology is available that will crunch industrial-scale algorithms to consistently deploy the medical workforce so that they spend more time with patients and less time driving and filling out forms. It optimises the workforce, juggling the schedule against variables like missed appointments, skill sets and patient needs. By optimally planning staff deployment, trusts would also be able to reduce their reliance on temporary staff, as the City of Edinburgh Council did, reducing outsourcing by 25% for its field-based repairs team. The Government, recognising its significance, has recently announced a new £1billion framework for workforce management services which will initially be offered to the NHS.
Mobile devices and the applications that run on them will take care of managing information in the field. Clinicians and nurses can enter information only once while visiting the patient, reducing inaccuracies, providing others with information they need, and freeing up time to provide more care. They can also be walked through a set process to make sure patients get a consistent and thorough service./
However, the real power is linking mobile applications to workforce management, as has been demonstrated by other similar sectors like social housing. Services can become more convenient and focused on the patient - smaller appointment windows can be offered to patients at a time convenient to them via their mobiles, online, or email; you could make sure the same care worker visits the same patient; accurate patient notes are automatically delivered to mobile devices before each visit; and appointment reminders can be sent by SMS. These differences all add up, taking the hassle out of what is already a stressful situation for them and making sure that the same person treats them, makes a huge difference. Additionally it leads to a better operating model. Newport City Homes almost immediately reduced no access to properties by 40% and Salix Homes made efficiency savings of £5,000 per worker using this type of technology.
I would urge anyone looking to create a better NHS to investigate the possibilities of workforce management and mobile because together they can be centred on 'high-quality health and care services that are compassionate, inclusive and constantly-improving'
All this data can then be captured electronically, which allows easy reporting and auditing, but also the clear visibility of performance that is needed to make better-informed decisions on service improvements.
These technologies working in harmony can make a huge difference to balancing the books, but more importantly they can make sure that there is a more human face to the NHS.
I would urge anyone looking to create a better NHS to investigate the possibilities of workforce management and mobile because together they can be centred on 'high-quality health and care services that are compassionate, inclusive and constantly-improving'. Workers will spend more time on the frontline and have the exact tools they need to understand often vulnerable patients as individuals. Patients truly are put at the centre.
