Directors of communications from 15 Swedish county councils visited London to learn more about the health and care system in England.This presentation is from this visit. NHS Improving Quality planned and hosted the study tour as a result of close links with Jönköping, one of the councils represented in the delegation. Our guests learned about the important role of communications specialists in transforming healthcare in England, and the leading role NHS Improving Quality has taken in engaging and mobilising staff at scale and pace. During the study tour it became obvious that many of the challenges and opportunities we face in our health and care system mirror those in Sweden, in particular issues such as emergency care, obesity and smoking, patient safety and working with the media. This was a fantastic opportunity for NHS Improving Quality to strengthen alliances at an international level and share ideas and approaches, and we hope to build on this in the future

1. care anywhere
Ann Wagner
Director of Strategy & Business Development

2. 2
SCENARIO FOR A FRAIL ELDERLY PATIENT TODAY
EDNA IS 79 YEARS OLD, HAS
CHRONIC CHEST DISEASE
AND LIVES ALONE AT HOME
1
2
EDNA IS ALONE AND DOES
NOT KNOW WHO TO
CONTACT, SHE CALLS 111
AN AMBULANCE IS
DESPATCHED AND
TAKES EDNA TO THE
EMERGENCY
DEPARTMENT
THE EMERGENCY
DEPARTMENT DOES
NOT HAVE ACCESS TO
EDNA’S PRIMARY CARE
RECORD. EDNA IS
STABILISED AND
TRANSFERRED FOR
INPATIENT CARE
DURING EDNA’S INPATIENT
STAY HER SOCIAL CARE
PACKAGE IS PLACED ON
HOLD. THIS
SUBSEQUENTLY RESULTS
IN HER DELAYED
DISCHARGE
3
5
4
6
EDNA’S
CONDITION
DETERIORATES
EDNA
AIREDALE PARTNERS
FOLLOWING HER DISCHARGE
EDNA IS CONFUSED ABOUT HER
MEDICATION AND HER FOLLOW
UP CARE PLAN
ANNUAL PATIENT JOURNEY COST: £40,500ANNUAL PATIENT JOURNEY COST: £40,500

3. 3
SCENARIO FOR A FRAIL ELDERLY PATIENT TOMORROW
EDNA IS 79 YEARS OLD, HAS
CHRONIC CHEST DISEASE
AND LIVES ALONE AT HOME
1
2
EDNA IS ENROLLED
ONTO THE NEW MODEL
BY HER GP
EDNA IS SUPPORTED
BY AN INTEGRATED,
MULTI-
PROFESSIONAL
TEAM
EDNA RECEIVES SUPPORT
IN SELF MANAGEMENT,
INCLUDING PULMONARY
PHYSIOTHERAPY
EDNA MONITORS HER OWN
CONDITION USING GUIDANCE BUILT
INTO HER ELECTRONIC WORK
SPACE WHICH SHE ACCESSES
FROM HOME
EDNA USES HER WORK
SPACE TO
COMMUNICATE WITH
OTHERS IN A SIMILAR
POSITION AS WELL AS
HEALTH AND CARE
PROFESSIONALS
IN THE EVENT OF A DISEASE FLARE,
EDNA USES TELECONSULTATION TO
SEE AND SPEAK WITH HEALTHCARE
PROFESSIONALS AND SAFELY DEAL
WITH THE ISSUE IN THE COMFORT
OF HER OWN HOME
3
5
4
6
7
RULES DRIVEN ANALYTICS
IDENTIFY EDNA AS SOMEONE
WHO SHOULD BE SERVED BY
THE NEW MODEL
EDNA
SUPPORTED SELF CARE
PATIENTS IN CONTROL
REDUCTION IN UNPLANNED HOSPITAL ADMISSIONS
PRIMARY CARE CONTACTS MINIMISED
BETTER REOURCE UTILISATION & VALUE FOR
MONEY
AIREDALE PARTNERS
ANNUAL PATIENT JOURNEY COST: £26,100

4. introducing Airedale

5. our focus
right care

6. telehealth, e health,
digital health…..
 Telecare
 Telecoaching
 Telemonitoring
Teleconsultation

7. teleconsultation journey
 Prison health care
8 year programme
Live in 15 prisons
Up to 50% change in patient flow
>1600 consultations past 2 yrs
 Stroke patients
 Care at home
 Nursing and Residential care homes
 Supporting end of life patients
 24/7 Telehealth Hub

8. Telehealth Hub
 24/7 seven day working
 Experienced acute nurses
 2nd tier - physician
 Shared electronic record
 Resilient infrastructure
 Technical partnership
 Opened September 2011 – now
supports >3238 people (April 2014)
 EU 3 star status

9. 0
100
200
300
400
500
600
700
Acute Admissions 1
Year Prior to
Deployment of
Telemedicine
Acute Admissions 1
Year Post
Deployment of
Telemedicine
care homes results
-35%

10. care homes (continued)
0
200
400
600
800
1000
A&E Attendances 1
Year Prior to
Deployment of
Telemedicine
A&E Attendances 1
Year Post
Deployment of
Telemedicine
0
2000
4000
6000
8000
10000
Acute Beds Days 1
Year Prior to
Deployment of
Telemedicine
Acute Beds Days 1
Year Post to
Deployment of
Telemedicine
-53%
-59%

11. call outcomes

12. results: 24 hr teleconsults to 26 patients with
COPD (at home) – 1 year pre/post
 Video system displays via home TV
 Patients measure their Oxygen / Peak
Flow
 Typically have “rescue” meds at home
-45%

13. nurse led triage is the norm

14. results: primary care

15. applications

16. case studies
 Trapped wind
 Sleep walker
 Falls
 CPR
 Allergic reaction
 Medication
 Good death

17. feedback
Patients/Carers
“The Telehealth Hub came into its own last
winter when snow and ice brought traffic to
a halt. My Husband’s condition
deteriorated suddenly, and having visual,
instant contact with the team was very
reassuring. A wonderful service.”
“I only have one word to describe [the]
Telehealth [Hub] – excellent.”
“Telemedicine became our lifeline – what
a wonderful piece of equipment!
At the press of a button we could have
face-to-face contact with a medical team,
which is so important for both a patient
and carer, and that helped to keep Geoff’s
spirits high…”
Care homes
“A very good service. It made me feel
confident within my job so I could do the
best I can for our residents. This service
takes the pressure off us as we have
access quickly to a health professional…”
“The Doctor was fantastic when one of our
dementia patients fell and hurt herself. I
would have called an ambulance and she
would have endured an A&E visit which
would have terrified her. Your consultant
saved her from this and reassured me that
the cut was superficial and she was fine...”
“Definitely has reduced admission rates.
Telemedicine is an asset to the home with
benefits Out Of Hours and weekends”

18. what are the challenges?
 technical (care homes)
 tariff
 scheduling
 collaborative working
(community teams, GPs)
 culture change…STILL
(evidence?)
 the importance of scale
 noise – right noise

19. our future vision

20. our next steps
 Scale up our teleconsultation work
 Transform workforce
 Adopt new models of care
 Close gap between primary &
secondary care
 Greater cross org working
 Integrated, supported self care
becomes the norm
 Maximise benefits from technology
 Understand resulting financial flows

21. so what are we waiting for?
“Just been to Airedale
hosp & seen some of
best tech anywhere in
NHS including digital
patient records shared
with GPs – and gr8
patient care”

22. any questions?