Reg Company No 4394761 VAT No 858 516 979
UNITED KINGDOM • UNITED STATES • AUSTRALIA CAS Services Ltd trading as Clinical Solutions
Clinical Solutions Midpoint Alencon Link Basingstoke RG21 7PP United Kingdom
Main +44 (0) 1256 337300 Fax +44 (0) 1256 337399 Email [email protected] View www.csdss.com
12 November 2007
`
Better Health, Better Care: A Discussion Document`
A contribution from Clinical Solutions
RESPONDENT DETAILS
Title Mr
Full Name David Baker
Organisation Clinical Solutions
Role Chief Executive Officer
Address Clinical Solutions, Midpoint, Alencon Link, Basingstoke, Hampshire, RG21 7PP
Email address [email protected]
Telephone 01256 337300
INTRODUCTION
Clinical Solutions is the world’s leading provider of software to support clinicians. We have designed and provided the clinical algorithms underpinning NHS 24 and NHS Direct, as well as
in healthcare settings around the world – in Australia, New Zealand, Norway, Scotland and the United States. Last year in Scotland over 1.5 million people called NHS 24.1 All of our products have been delivered to the NHS on time, and on budget. Moreover, with all its products Clinical Solutions provides project management, IT consultancy, training and 24/7 support.
The Scottish Executive rightly recognises that in the future health care in Scotland will need to be orientated towards preventative care, long term conditions, treatment in the community, self- care and greater patient involvement. Our research and experience has shown us that new technologies, such as clinical decision support software, TeleHealth and TeleCare systems, can transform the quality and accessibility of health services and help the NHS to cope with the increased demand that will be placed on it by an ageing population.
We therefore welcome the publication of `Better Health, Better Care: A Discussion Document`
and hope to be involved in future discussions with NHS Scotland over the development of its new eHealth strategy.
Our response focuses on those areas in which Clinical Solutions has the greatest expertise, including:
• The use of telephone triage in out-of-hours services;
• The use of communications technology to improve patient information;
• How telephone and face-to-face triage software can improve efficiency in the NHS;
• How telephone triage and bio-surveillance software can help the NHS to cope with the outbreak of an infectious disease pandemic;
• And how TeleHealth systems can improve the management of long term conditions.
We hope that the knowledge we have gained through our extensive work in eHealth will prove of use to you. If you would like to know more about our work and products do not hesitate to contact us.
IMPROVING YOUR EXPERIENCE OF CARE Out-of-hours care
We welcome the commitment in the consultation document to “improve access to health
services”, particularly out-of-hours and walk-in care. The sixty years since the establishment of the NHS have witnessed a transformation in lifestyles in Britain. People today lead 24/7
lifestyles, and expect the same of their health service. The Government has recently indicated that the health service must become more flexible, allowing patients to access out-of-hours care when convenient for them. This is of vital importance to the Scottish economy, as the CBI estimates that inflexible surgery opening times cost industry £1 billion a year in lost work hours.2
1 NHS 24 Annual Report2006-2007: Towards the Future, pg. 4
2
http://www.cbi.org.uk/ndbs/press.nsf/0363c1f07c6ca12a8025671c00381cc7/f60cebe0663c98d68025734600573f81?
OpenDocument
The software provided to NHS 24 by Clinical Solutions can help to improve the accessibility of out-of-hours care, by providing a 24-hour gateway which triages patients and directs them to the most appropriate level of care. Through the integrated mapping system, the software can determine the position of the best situated GP or ambulance service and dispatch them to the patient’s location. The service we have developed and used by the Australian government in Tasmania, gives 500,000 people access to nurse triage between the hours of 6PM and 8AM as well as a walk in clinic during those hours. This service is supported by a team of doctors who are available to consult on more complex cases, and in a small proportion of cases, visit the patients. By using this service, fewer than 10% of patients require the visit of a doctor during out of hours, and it has greatly improved the retention of GPs in the rural communities.
Clinical Solutions note that access to health services is often impeded by public confusion over the various options available for primary care. We therefore recommend that a single telephone number for urgent care services be established, in order to provide a universal and consistent access point for patients. Telephone triage software could then be used to assess the level of care needed by the patient and direct them accordingly.
In England the use of walk-in clinics has proved successful in improving access to health
services and relieving pressure on Accident and Emergency centres. Walk-in centres have also proved more cost effective, as the average attendance at A&E costs over three times that at a walk-in clinic.3 Clinical Solutions are currently assisting over 40 walk-in-centres throughout England to expand their responsibility for primary care, by providing them with face-to-face triage software. This allows them to prioritise patients according to need and speed up treatment. We believe that the introduction of a similar system of walk-in centres in Scotland could help to improve patient care, and would be happy to share our experience and expertise in this field with you.
Case study: Tooting Walk-in Centre
Opened in 2000, the Tooting Walk-in Centre – which uses the paperless software developed by Clinical Solutions – sits alongside the fully equipped A&E department at St George’s Hospital in South London. Its location ensures that it eases pressure on the A&E unit: people visiting A&E with minor conditions are instead directed to the Walk-in Centre, and almost three in five visitors to the Walk-in Centre said that – if it did not exist – they would have gone to A&E or other local health services instead.
Information
We also welcome the Scottish Executive’s intention to “improve the quality, consistency and accessibility of the information we provide to patients and carers”. Through our work with NHS 24 and NHS Direct we have found that improving patient access to health information can
3 Hansard, 1 November 2006, Col. 484WA
reduce the number of unnecessary visits to GPs and Accident and Emergency centres, and help patients to look after their own health. New communications technology has greatly expanded the ability of the NHS to engage with its patients. Meanwhile, patients are
increasingly becoming experts in their own conditions and using web sources to seek diagnoses and treatment options. There is therefore the need for quality online health information. NHS 24 has taken full advantage of new technology to inform patients, and Clinical Solutions is expanding the channels available to patients and the public at large for accessing health information and services. Our triage system is now available via the telephone and the web, and will soon be accessible in every home through a digital interactive TV service.
As the discussion document recognises, high quality information is particularly important for patients living with long term conditions, and those that care for them. Working with patients and clinicians, Clinical Solutions have used new TeleHealth technologies to develop a long term conditions management system. This system helps to engage and empower patients and their carers, by providing them with the information, resources and support needed to manage their own conditions. Tailored software helps educate patients about their specific condition, whilst support is provided through regular telephone contact with a healthcare professional. By integrating this service with in-home monitors, the health care professional can then receive feedback and information about the patient’s condition, in order to monitor their health and make an intervention where necessary. This software has been developed and is being trialled in conjunction with NHS Direct in Newham, London.
BEST VALUE
As the Scottish Executive is aware, an ageing population and an increase in long-term
conditions, combined with higher costs for new medical technologies, will continue to increase the financial burdens placed on the NHS. Therefore, it is important that the NHS prioritises its services and seeks efficiency savings wherever possible. Although in some ways new
technologies bring extra costs, they can also become part of the solution to the NHS’s financial challenges. We believe that telephone and face-to-face triage software has an important role to play in helping NHS Scotland make efficiency savings, by prioritising patients and ensuring they are treated by the most appropriate health care professional.
A 2006 Department of Health report entitled `Our Health, Our Care, Our Say` found that in England over 50% of people who report to A&E “could be dealt with, just as well or better, elsewhere”.4 The same is likely to be true in Scotland. Considering that the average
consultation at A&E costs £87, whilst the average consultation at a minor injuries unit costs £37, a walk-in-centre £27, and a GP consultation only £185, this means there is huge potential for savings from a service like NHS 24, that assesses the level of care needed by a patient and directs them to the most appropriate service.
Clinical Solutions can offer the NHS in Scotland confidence that their money is being used efficiently and effectively, as all our products have been delivered to the NHS on time and on budget.
4Department of Health, Our Health, Our Care, Our Say, 30 January 2006
5Hansard, 1 November 2006, Col. 484WA
TAKING RESPONSIBILITY Pandemic influenza
Section 3 of the consultation document states the Scottish Executive’s intention to “ensure that we are well placed to combat new threats such as E Coli and pandemic flu”. We welcome this recognition of the need to prepare for an influenza pandemic. The last outbreak was in 1968-9, and the Chief Medical Officer in England has suggested that we are overdue for the next.6 Clinical Solutions have therefore developed bio-surveillance software to help detect and manage an infectious disease pandemic or other large scale health emergency.
We believe that it is important to put in place systems to cope with the extra demand on NHS services that will occur in the event of a flu pandemic. The Department of Health has already recognised that the provision of telephone contact and support to patients will be a key element in the NHS response to an infectious disease pandemic. Our clinical algorithms will allow patients to be quickly and easily assessed and prioritised at a time when there will be a
shortage of nurses and expert call-handlers. Since our bio-surveillance software is web based it can be accessed by many users it different locations, which will be important in the event of an outbreak of an infectious disease. Our flexible software will allow the Government and
healthcare professionals to monitor the progress of the disease, co-ordinate services across government departments, and adjust their systems rapidly, depending on the severity of the threat. Clinical Solutions bio-surveillance system was successfully trialled by the Australian Government in October 2006 during `Exercise Cumpston`, which simulated the outbreak of a pandemic disease.
Case study: Exercise Cumpston
Exercise Cumpston was undertaken by the Australian Government in October 2006, during which Bio Surveillance was successfully trialled in its role during the initial containment of a pandemic and thereafter its maintenance. The Exercise comprehensively tested governance arrangements and decision-making at all levels.
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ohp-cumpston.htm
http://www.aodgp.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2006-ta- abb143.htm
6 `GPs told: prepare for 14 million flu victims`, The Guardian, 16 October 2005
ANTICIPATORY CARE AND LONG TERM CONDITIONS
We welcome the consultation document’s recognition that in the future health services will need to be more orientated towards long term conditions. The Long Term Conditions Alliance
estimates that there are currently two million people living with a long term condition in Scotland7, and this is likely to increase as new technology and medical advances improves survival rates. We applaud the Scottish Executive for seeking to increase the independence of patients with long term conditions by providing them with the information and resources needed to manage their own conditions. We believe it is important to encourage the management of long-term conditions in the community in order to make the most effective use of emergency beds and resources.
You may be interested in our Long Term Conditions Management System which has been developed with NHS Direct in Newham, London. Our system encourages patients to be independent and to maintain a normal lifestyle, through regular support and guidance from a qualified health professional. It also takes advantage of TeleHealth technology to help manage long-term conditions within the home, whilst providing the support of a healthcare professional.
We believe that information is vital to encourage self care, and therefore provide patients with tailored software to help educate them about their specific condition. Meanwhile, patients are given constant support through telephone contact with a health care professional, who receives constant feedback on the patient’s health from in-home monitors, allowing them to admit the patient to hospital if their condition deteriorates.
CONTINUOUS IMPROVEMENT IN HEALTHCARE eHealth
We were particularly interested in Scotland’s development of a new strategy for eHealth, as mentioned in the discussion document. We support the view that information and
communication technologies can make dramatic improvements to patient care.
• Telephone triage services using clinical decision support software can help to quickly and effectively assess patient needs and refer them to the most appropriate level of care, thus helping to reduce the burden on hospitals and A&E units and improve efficiency. Clinical Solutions have made use of the full range of communications
technology and the triage system we provide to NHS Direct and NHS 24 is now available via the telephone, on the web and soon through a digital interactive TV service.
• The use of similar triage software in minor injury units and walk-in centres helps to prioritise patients, thereby speeding the treatment of those most in need.
• TeleHealth systems can be used to help manage long-term conditions in the home or wherever the patient needs to be, avoiding unnecessary consultations and stays in
7 http://www.ltcas.org.uk/index.php?id=8
hospital. TeleHealth can also help to address the health challenges posed by rural communities.
• Computerised clinical algorithms and telephone triage systems will prove vital in allowing the NHS to cope in the event of a serious infectious disease pandemic.
Clinical Solutions have vast experience in a range of eHealth services. We feel that the knowledge we have gained may be useful in the development of Scotland’s eHealth strategy, and welcome the opportunity to be involved in consultations on this strategy.
