In our latest interview we asked the NHS Test Bed Partnership at Chelsea and Westminster Foundation Trust some questions on how they are managing unscheduled care.
The NHS Test Bed Programme brings NHS organisations and industry partners together to test combinations of digital technologies with pathway redesign in real-world settings. The goal is to use the potential of digital technologies to positively transform the way in which healthcare is delivered for patients and carers.
As part of Wave 2 of the programme, NHS England announced that Chelsea and Westminster Foundation Trust had been successful in their bid for a Department of Health and Social Care (DHSC) funded programme.
Tina Benson, Hospital Director and Deputy COO, Chelsea and Westminster Foundation Trust said: “The Trust is excited to be working with partners to develop digital solutions to support patient care. Working with clinicians and patients themselves we will develop a way to change the traditional ways of delivering care in the NHS.”
HTN asked the team a few questions about the project:
The aim of the programme is to keep patients out of hospital by giving them the right tools to manage out of hospital. This is possible because North West London has a true patient portal organising care around the patient.
The partnership between Chelsea and Westminster Hospital NHS Foundation Trust (CWFT) (which runs West Middlesex University Hospital and Chelsea and Westminster Hospital), Patients Know Best (PKB), Waitless, Dr Doctor and Medopad is bringing together market-ready innovations to address the demand for urgent care services in North West London.
Patients will be given access to their health record, such as the scheduling of their appointments, the visibility of their waiting times and the remote reporting of their health status. This will help to reduce missed appointments and the duplication of clinical activity, whilst directing patients to the most appropriate urgent care services.
What does the project mean to patients and healthcare providers?
The NHS is a complex system and it can be confusing for patients to know where best to go. Like many parts of the NHS, the conventional offering to patients is old fashioned with two work streams; unscheduled and scheduled care. However in reality life isn’t quite like that, so sometimes we need something in between.
The project will offer patients a way of digitally interacting with their care pathway. It will give them instant access to and management of their information, scheduling and communication. It will also support them to become more aware of and to adopt non-A&E urgent care services whilst creating operational efficiencies as systems become more joined up.
How accessible is the solution?
The Care Information Exchange (CIE) is the largest patient portal program in the UK. Powered by Patients Know Best, CIE is fully operational in the region enabling easy integration between partners to share data with native applications. Patients will use CIE to receive their pathology results, clinic/ appointment letters and reports, to complete surveys and to communicate with their clinical teams. The test bed programme acts as an extension of this existing service.
How are you reducing the demand on unscheduled care?
Based on historical trends, the trust will by 2020/21 see an increase of 75,000 A&E attendances, with additional non-elective admissions of 5,200 between the two hospitals. This would require an additional 41 beds across the trust in 2019/20 – that’s more than two wards! This is expensive and unsustainable and does not provide a future-proofed way of dealing with emergency activity.
The programme aims to tackle the root cause of the issue by reducing A&E demand and non-elective admissions to expand Ambulatory Emergency Care (AEC) and digitally enable patients to self-manage their care, whilst directing them to the most appropriate urgent care service.
What return on investment / estimated costs are you aiming for?
CWFT had the 4th highest number of A&E attendances in 2017/18 as a trust, with over 305,000 attendances recorded. Out of this, there were over 51,000 non-elective admissions. The trust also has the highest levels of heart failure in this part of London with approximately 250-300 admissions for maternity cardiac failure patients per week, with an average length of stay between 8-10 days. The programme will be evaluated against these figures to measure impact.
Where are you with the project and what is next?
Although CIE is fully operational across North West London, work is underway to integrate the other solution providers into CIE.
The initial focus will be on specific urgent care pathways in cardiology and maternity, with a view to spreading effective interventions to new clinical pathways, integrations (including 111) and areas across the country.
The partnership is in the early stages of developing a proof of concept with the cohorts that have been identified. The aim is to refine the approach and scale up across the trust.
What’s the biggest challenge for your project?
We recognise the importance of effectively engaging healthcare professionals and patient cohorts to fully integrate the approach into the healthcare infrastructure. We do not underestimate the challenges this presents.
