Aiming for best results wherever you live

Shocking statistics revealed unacceptable regional differences in healthcare, but as Joshi Herrmann reports, NHS initiatives are aiming for high universal standards


Two recent news stories have laid down a significant challenge to healthcare professionals across the country, although some may not immediately have seen the link.

First, at the end of May, the NHS announced that it had empowered 15 regional Academic Health Science Networks (AHSNs), challenging the new bodies to put “innovation at the heart of the NHS”. Sir David Nicholson, chief executive of NHS England, says they have the potential to “deliver transformational improvements in the quality and value of care”.

Two-and-a-half weeks later, the worrying discrepancies between mortality rates in different regions of the country revealed by a new Public Health England mapping project prompted Health Secretary Jeremy Hunt to express his horror at the “shocking variation in early and unnecessary deaths”. He called for the data to be used “to identify local public health challenges like smoking, drinking and obesity”.

The challenge to every outpost of the NHS is clear: to solve the local problems evermore detailed data about healthcare outcomes is increasingly bringing to light by taking innovation seriously – and do it better than the health service has done historically.

Chief medical officer Professor Dame Sally Davies hints at the scale of that challenge when she says the AHSNs can be “an important mechanism for achieving a step-change in the way the NHS translates research, innovation and best practice into effective and cost-effective treatments and services for patients”.

The health service’s problems with innovation, and technological innovation in particular, are well-documented, as anyone who has followed the saga over attempts to populate a central NHS database will know.

Increasingly people should recognise that innovation is the way to get better care and greater efficiencies

Sally Chisholm, who is charged with promoting innovation at the National Institute for Health and Care Excellence (NICE), admits as much, noting that “there isn’t a strong history of implementing [new ideas and technologies] at pace and at scale”.

Yet she and other point to stories that might give the health secretary, Sir David (and his 2014 replacement) and those starting soon at the new AHSNs genuine hope that the health service can solve some of its most pressing local problems by clever use of technology, and strong collaboration.

One such story is the Telestroke initiative in Cumbria and Lancashire, where ambitious technology has successfully tackled a problem as old as the hills. The hospitals in these largely rural counties faced a problem administering stroke patients with drugs within the required four-and-a-half hours after the onset of symptoms, especially after 5pm when no stroke physicians were on call.

They responded by creating a network of six acute trusts across eight hospitals and seven primary care trusts, and jointly using a video conferencing system that allowed a patient to speak to a physician from whichever A&E they had arrived at.

The high-quality camera in each hospital transmits live to the doctor’s home computer, allowing the specialist to carry out a high-level neurological examination, including a zoom function to examine the patient’s eyes, to confirm the diagnosis and the severity of the stroke. The physician can also remotely view CT head scan images to see whether the cause of the stroke was a blood clot or a bleed.

An assessment by the hospitals estimated that in the 18 months after the scheme’s launch in 2011, 523 patients had benefited from a video consultation, and the Telestroke initiative had saved Lancashire and Cumbria ÂŁ1.8 million in that period.

If, as the Department of Health’s National Stroke Strategy Impact Assessment claims, the ten-year cost of dependent stroke is ÂŁ56,381 per patient, then the 60 per cent reduction in dependent patients achieved by Telestroke in those counties means the additional saving could be ÂŁ2.03 million over a decade. The hospitals’ modelling suggests 24 patients a year will be saved by it, with 40 emerging without symptoms after receiving quick thrombolysis because of it.

“It was a local, technological solution to a local problem,” says Ms Chisholm, who is the programme director for the NICE Health Technologies Adoption Programme which works with NHS staff to help them use and procure approved technologies, producing documents to accompany each one, and advising on training and cost.

“People will say to us, we’ve got a particular problem, and we can suggest technologies that can help,” she says, acknowledging that “there are examples of NICE guidance on medical technologies not being taken up within the NHS as widely or comprehensively as would be ideal”.

Ms Chisholm is optimistic that “increasingly people recognise that innovation is the way to get better care and greater efficiencies”, and says AHSNs should be able to deliver those improvements where they are needed locally by bringing universities and the private sector more into the discussion about innovation.

Based at Papworth Hospital, Cambridge, Health Enterprise East (HEE), which started as one of the NHS’s innovation hubs, works between the health service and the private sector, turning the inventions of frontline healthcare staff into commercial products and advising companies on how to negotiate the tricky landscape that is NHS procurement.

Anne Blackwood, HEE chief executive, says there has been “a problem of industry not being able to find the door” and “of being told by the NHS that they aren’t making what they [the NHS] want”, to which she says companies tend to respond “you weren’t telling us what you want”. She thinks AHSNs should be able to help, making sure innovations being brought to market are ones that clinicians want and need to solve the local problems highlighted by figures like those earlier this month from Public Health England.

Her company has had success bringing its products, such as the TracheSeal Dressing which helps improve wound healing following temporary tracheostomies, into frontline NHS usage soon after development, and are hoping to replicate that with their latest piece of tech, a piece of web software made by uMotif that helps Parkinson’s patients to manage their medication.

It aims to reduce unnecessary hospital visits and medicine waste – a problem thought to affect areas of poverty in particular, where patients may not understand their medication as well – by providing patients with reminders of when and how to take their medication, and connecting them to other patients through a social network.

A trial earlier this year saw 70 per cent daily use rates by patients and increases in medication adherence, with a second phase of trials in the planning for NHS centres in London, Liverpool and Scotland.

Can regional initiatives in the NHS use technology to integrate better, improve care and address the variations in outcomes that technology itself is helping to expose? A few years ago health service commentators might not have been too optimistic but, even as the NHS undergoes major structural transition, increasingly there are reasons to be hopeful.

CASE STUDY

Blazing a trail in Airedale

Anyone searching for inspiration in technological innovation need look no further than Airedale NHS in Yorkshire, where investment in digital healthcare is benefiting patients.

On a recent visit to Airedale, Health Secretary Jeremy Hunt tweeted that he had “seen some of [the] best tech anywhere in [the] NHS”.

Patients with a digital unit in their home or care home are given 24/7 support from a telehealth hub.

In 2010, Airedale NHS Foundation Trust won funding from the European Commission in a three-year programme over four countries, called the RICHARD project, which aims to create an action plan for widening the use of ICT in healthcare.

Ex-Royal Marine Albert Joyner recently became the 1,000th patient to be linked up to the telehealth hub.

Using video technology provided by Red Embedded Systems, Airedale have put TV set-top boxes in patients’ homes which they can use to make video calls to carers, doctors and others.

Secondary consultants can give patients consultations, so unnecessary hospital visits are avoided, and prescriptions can be made and altered – a process Airedale calls telemedicine. Less specific conversations about wellbeing, self-care and positive behaviour are known as telecoaching.

Some patients also have measuring equipment in their homes, which the doctor on their screen can instruct them to take readings from to inform the hospital’s analysis of a complaint or emergency.

In its first 11 months, the hub averted 124 admissions to hospital, saving more than ÂŁ330,000 and avoided the need for 94 face-to-face clinic appointments. Records from calls made to the hub last Christmas show that three out of four hospital and A&E visits were avoided.

The aims of the digital healthcare scheme are to improve quality of care, reduce the time patients spend in hospital and promote self-care, where patients know more about their disease and act in a way that keeps them well.

Rebecca Malin, Airedale’s head of business development and investment, says that if the scheme avoids one unnecessary admission in a year, it has paid for itself because a hospital admission costs about £2,500 and looking after a patient through telemedicine costs around £200 a month.