The health secretary, Jeremy Hunt, wants to extend the provision of seven-day services in the English NHS, arguing that patients admitted to hospital are 16% more likely to die if they arrive on a Sunday than a Wednesday. This results in 6,000 more deaths each year. “I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend or would not prefer to get test results back more quickly for their own patients,” he said in a speech in July.
Hunt plans to remove an opt-out from weekend working for newly qualified consultants, but faces opposition from the British Medical Association. “The biggest inhibiting factor to more seven-day working is staff,” it says, arguing that there are not enough qualified NHS professionals to provide routine and elective services seven days a week.
Can IT help by making more efficient use of staff? The Northumbria specialist emergency care hospital opened in June with consultants available around the clock seven days a week. Dr Phil Stamp, Northumbria healthcare NHS foundation trust’s chief clinical information officer, describes IT as “integral to its smooth running”. As the first purpose-built, dedicated emergency care hospital in England, it handles the most urgent cases from across Northumberland and North Tyneside, with the trust’s existing hospitals providing urgent care in less serious cases.
But its specialists can help treat patients at those general hospitals. “Our clinicians are able to access information regarding patients, while maintaining the highest levels of governance, from multiple sources on a fixed desktop or mobile laptop devices and share this with colleagues on our other sites to help deliver high quality patient care,” says Stamp. “For example, through the use of mobile video conferencing, a specialist in critical care is able to review a patient on a general hospital site.”
Running a specialist emergency hospital means the trust needs to have joined-up records on its patients. “Although there remains a master paper record for each patient that is stored (until patient attendance) 15 minutes away from the Northumbria hospital within a 24/7 service, we use electronic access to information wherever possible,” says Stamp.
“Outpatient letters and electronic discharge summaries, also requests for diagnostic tests are requested electronically and results viewed electronically. With patient consent, we have access to the summary care record for local and national GP data and we can share information electronically with community services which is part of our trust.”
Such links also extend to the local ambulance service, which brings in many of the new hospital’s patients. “We use a display screen to see the number of patients and brief description of each one either en-route or planned to be brought in to the emergency care department,” says Stamp, and can also talk to ambulance staff bringing in patients.
The trust plans to go further in joining up with other organisations, as Northumberland is an NHS England “vanguard” site trialling new models of care. “Plans include care delivered by an aligned, integrated workforce, operating as one team, in one system with joined-up IT systems and processes across health and social care and one unified patient record, reducing the need for patients to repeat their story to different health professionals and different parts of the system,” says Stamp.
Across the UK, round-the-clock healthcare advice is offered by telephone services, available via 111 in England and Scotland. In England, 87% of the 987,107 calls made to 111 in June were “triaged”, a process where call handlers use NHS pathways clinical assessment software to direct callers to the right service. A fifth were sent an ambulance or told to go to A&E, while three-fifths were referred to primary care – which is likely to be more convenient for the individual as well as cheaper for the NHS.
However, a recommendation to use primary care is of limited use outside the working day, according to Janette Turner, a senior research fellow at the University of Sheffield and director of the medical care research unit at the Sheffield School of Health and Related Research. “If it’s urgent at 10pm or a weekend, you’ll end up defaulting to the emergency department,” she says, adding that even when weekend callers are told that they can safely wait until Monday to see a GP, some will choose A&E.
If some primary care services in England were open seven days a week and for longer hours, 111’s recommendations would be more useful, Turner adds. The service would be able to direct callers to the nearest extended-hours service.
However, Turner says she sees less potential for patients assessing themselves through online symptom checkers. “People call things like 111 and take themselves to A&E with what turn out to be minor complaints,” she says. “A lot of that is around anxiety. They need reassurance from someone.”
As well as linking up hospitals, video can be used in providing primary care for longer hours. Andy Ostler, head of Brother’s Omnijoin business unit, says a few clients are already using video conferencing for patient consultations, including a London clinical commissioning group trialling this in care homes. “If a resident has an accident in the night, there is a decision on whether or not to call out a doctor or an ambulance,” he says. Staff are using tablet device cameras to let an on-call GP assess injuries remotely, and decide whether immediate attention is required.
Bromley healthcare, another Omnijoin customer, started using its video conferencing to offer virtual consultations to its Smokefree Bromley service in August. Clients use a web browser on a phone, tablet or computer to see an adviser. “The service is particularly beneficial to those who are housebound or struggle to find the time to access the service in our clinic locations or during traditional working hours,” says Sareena Gill, its stop smoking lead.
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