I thought this week we could do a bit of role play. Yesterday we spent the day with a community interest company who deliver a ‘hospital at home’ service, which aims to keep people out of hospital and at home.
It tends to focus on acute care (such as frailty) with a short turnaround (as in, people don’t stay in the service long — they’re either better or referred to other care settings).
My head is full, today we will be doing the analysis. But we’re going to imagine you, dear reader, are a senior stakeholder interested in the project. We’ve just bumped into each other, and you’ve asked what the big things coming out of the research are.
We all know interoperability is one of the biggest problems in the NHS. Systems don’t talk to each other, and it means a lot of manual work to get everything working properly. What we saw yesterday was that there is some integration, but it’s not very good, and doesn’t go far enough. Some things are not integrated at all. For example, there is a rostering system, but that is not integrated, meaning that it needs to be duplicated somewhat in their main system. Meanwhile, they’re using a system to do remote monitoring of vitals, and while some of this shows up in their main system, it doesn’t go far enough, thus requiring more duplication.
Despite the above, I was surprised (pleasantly) at the lack of paper. I thought there’d be more. There are discharge letters printed, and because they haven’t got a particular version of their main system, they have to print the whole schedule off every night as a back-up — and then shred it the next day. Incredible! But, pretty much all day-to-day systems are digital. There’s just too many of them operated semi-independently.
Community isn’t designed for. The main system used in GP surgeries are used in community, despite those environments being fundamentally different. GPs have people come to them, so can be strict about time slots for appointments; in the community, they need to travel, sometimes quite long distances. Furthermore, they need to not only get the right practitioners with the right skillset to the right patient, but that person needs to have the right equipment. GPs have it in one building; if an ECG machine is needed for a community visit, you best have it with you otherwise it’s all wasted time (and it will hopefully have all cables included!). Also, if someone does need an ambulance when at a GP, it’s easy to manage; in the community someone will stay with the patient: if there is no family around they will stay and all subsequent appointments will missed. Oh and things like bloods need to be dropped off at hospital. AAARGGGHHH!
Systems aren’t great for pharmacists. This might be specific to who we saw, but with no drug chart, it’s hugely manual to keep track of who was on what drug and what’s been changed. There’s a lot of manual work, but the stakes are high here.
Like elsewhere in the NHS, the people are stellar. Lovely, upbeat, doing their best. But they’re spending far too much time acting as the glue holding the service together, and the potential for human error is too great.
I have probably missed some massive things off there, but I think it’s interesting to see what’s top of mind after research.
Next week we will be having a similar day, but with a provider who provide other services, a bit more local, not as acute, so may do a similar thing with the weeknotes.
So. If you were that stakeholder, would you find the above interesting?