The term ‘integrated care' is much-used in health policy and management circles. It is transforming the patient experience, but could it help save our overstretched NHS too?
This winter has seen scores of hospitals unable to maintain a full range of routine services, and NHS figures show that the waiting list for treatment has risen 47 per cent faster than the population since 2012, while the number of 'trolley waits' for admission has quadrupled. Most worrying, this is despite the £335m bailout fund announced in the Government's 2017 budget in November, and the fact that the predicted major flu outbreak is only now hitting. Last January, there was national outcry when it was revealed that two patients died on trolleys in the same A&E in the same week. Hospital trust chief executives have disclosed they are running at close to 100 per cent bed occupancy, and Maidstone and Tunbridge Wells Trust fear so many patients will die this winter that they are planning to increase mortuary capacity by 100 “to cope with potential increase in demand”.
Winter pressures aside, other shocking facts show that 54 per cent of patients who die in hospital don’t want to. According to Macmillan, when asked, most people approaching the end of life say they would prefer to be cared for and die at home. However, currently nearly half of all people end their days in hospital, which is more expensive than community care. What’s worse is they have stated in their care plans that they don’t want to. So why the disconnect? It’s not because meeting end of life preferences is unfeasible or unaffordable, but all those health and care professionals who look after the patient and their carers in the last months of their lives are currently disconnected and using paper, fax and telephone to communicate with each other. The final care points (emergency services, NHS 111, Out of Hours, ambulance crews and A&E teams) are also disconnected at the point of urgent care from the latest patient care plans. Working in pressured conditions without mobile access to this information – essentially operating in urgent care siloes – they are ignorant of, and therefore unable to respect, each patient’s wishes.
In the digital era in which we live, it’s unfeasible to think relevant patient data isn’t integrated and available at every critical point across the care continuum. Especially when doing so would not only ensure that care decisions are based upon the most pertinent, complete and timely patient data, but would potentially save the NHS millions every year – in unnecessary ambulance trips, avoidable hospital admissions and enabling patients to die in their preferred place, all this in a time when NHS resources are stretched beyond belief.
Affordable solutions exist too, making the situation even more shocking. There are examples of systems that are operating – such as Black Pear’s healthcare technology for shared patient care. Its system is currently being used to power an Electronic Palliative Care Co-ordination System (EPaCCS) which records patients' preferences as they near the end of their life and then automatically shares this information with all relevant parties such as the ambulance service, urgent care, - i.e. NHS 111 and Out of Hours services. Hospices, hospitals, community palliative care teams and community nurses can update the EPaCCS record as new information is revealed. The system also instantly notifies the GP or other carers of any patient updates, as well as reveals the patient’s carers and their contact details, creating a seamless, up-to-date, integrated, summary view of the patient journey.
But the system has far broader uses too. We know GPs are the starting point for many care plans and many currently use Adastra, our clinical patient management solution, which covers 80-85 per cent of urgent care providers and promotes data flow between clinicians. The solution ensures that, when a patient arrives at a service, their medical record can be viewed instantly. Early figures reveal that, of the electronic care plans that are live, over 50 per cent of information access requirements are out of hours. By integrating technology between our Adastra system and Black Pear’s EPaCCS system, care plans can be shared in real time between all those responsible for a patient, no matter what the time of day. This means all healthcare professionals can quickly manage care plans built around the patient’s individual needs and requests, and even create a new plan pre-populated live with information from the patient’s GP record before saving it back to the GP patient record to maintain its completeness.
Over 2,000 EPaCCS records have been created, with Black Pear successfully being used in Worcestershire, NHS South Warwickshire CCG, NHS Warwickshire North CCG and NHS Coventry and Rugby CCG. The Worcestershire EPaCCS project is part of the ‘Worcestershire Well Connected’ health and social care transformation programme and is led by NHS South Worcestershire CCG.
When a patient or their carer calls NHS 111 or the Out of Hours service, data from the EPaCCS record populates the Palliative Care Special Patient Note. Feedback from GPs and other users from a recent survey on EPaCCS in Worcestershire has been very positive, including that it is clear and user-friendly, and more efficient when it comes to sharing information.
In addition, the system has increased communication between providers, decreased the amount of GP administration time and ensured patients plans and wishes were available in a crisis to all relevant providers.
These projects allow for much better integrated care, are potentially far safer and more convenient for patients, and take the pressure off stretched GP, OOH and A&E services as the information provided supports clinicians in their decision making. Such improved recognition of palliative care needs, as well as optimised provision of services outside the hospital setting, could translate to a potential reduction in hospital costs and reinvestment of £180 million per annum, as well as improve patient choice and increase their confidence that their wishes will be respected.
Changing the culture
By integrating primary, secondary, tertiary, urgent and emergency care in a single system, it’s possible to provide real time access to accurate patient information – easily, securely and from any location. When combined with the expertise of medical professionals, this ensures timely and safe access to the appropriate and effective treatment most appropriate to the patient’s care needs, and enables the best decisions for seamless transfer of care to other services. Imagine, for example, a patient rings 999. The rapid response team retrieves the patient’s care plans automatically on their mobile device, highlighting the patient’s medical history and flagging their relevant wishes. The most appropriate care route can then be chosen, with authenticated users able to update actions in real time so that it synchronises with the various care points throughout the care process going forward.
However, as with any successful digital transformation project, investment must be made in changing the culture – in this instance within the NHS – to support new ways of working with technology. Cross-border agreements to ensure integrated access to appropriate critical patient data security is high up there as a priority. That said, as EPaCCS shows, there has been some acceleration in the implementation of integrated digital transformation across the NHS, with organisations coming together to link their systems.
Although we can’t yet know whether these digital advancements are enough to curb potential risks this winter and eradicate the shaming situations where patients’ last end of life wishes aren’t fulfilled, they are certainly part of the solution. It’s far too simplistic to see technology as the lone saviour of the NHS but a connected, integrated approach to patient information can certainly help transform the organisation and deliver better outcomes and services for patients.
Nick Wilson is Managing Director, Public Sector, Health & Care, Advanced
Image Credit: Advanced