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Innovation in rural health and social care

New models of care, including the work of the vanguards, will be key to the delivery of sustainability and transformation plans, which are being developed across the country.

As commissioners gathered at the National Children and Adult Services Conference last week, Keith Bentham highlighted the work Better Care Together (Morecambe Bay Health Community) vanguard (@BCT MorecambeBay) is doing to improve health and social care for residents living in remote communities.

We like to think that our area is unique. We have the beautiful Lake District, the historic city of Lancaster, the industrial locality of Barrow-in-Furness and geographically isolated communities such as Millom.

Millom is a 45 minute drive from the nearest A&E department. There’s just one road and if that is blocked there are real issues that affect whether the 8,500 people who live in and around the area can get access to healthcare.

It is not alone in being geographically isolated in our area, but it’s probably the most extreme example. As a result, we have trialled a number of new ideas in this community in a number of different settings – making sure that they achieve what the community want, before we then provide them in a wider area.

The unique thing here is that the community works as equal partners with the health service in the Millom Alliance. We have a ready-made group of people able to tell us when we get things right – and when we are wrong!

As an integrated primary and acute system (PACS) vanguard, one of the first links we have made is a high definition telemedicine link between the GP surgery in Millom and the A&E department in Barrow-in-Furness.

This means that when a GP isn’t sure whether a patient needs intensive treatment or can be treated in the community – they can call through and have an A&E specialist examine the patient. The High Definition (HD) camera is so good that the clinician on the other end can see detailed close-ups of the patient in order to help them diagnose. This link – and a similar one to the GP out of hours service can save patients a long journey and also help prevent the town’s ambulance being unavailable for long periods of time – potentially life-saving.

The link to the GP out of hours means that patients over the 1,000 square miles that Morecambe Bay covers, can have access to expert opinions without having to travel further than their nearest healthcare building.

One patient who has used the system said it was as good as a face to face meeting – and that’s the standard we’re aiming for.

The most recent development was to link Haverigg prison to the A&E department. Each time a prisoner needs treatment – two guards have to travel with them and wait with them until they return. Getting access to expert advice over the telehealth link saves time, money, and reduces the risk of offenders being out of prison.

Patient and public engagement and clinical buy-in were crucial in getting these ideas off the ground, and we have now taken it one step further by holding a full virtual outpatient clinic. The clinician was on a completely different site to the patients but they all said it was a positive experience. Thanks to early positive results, more are now planned.

The focus groups we held were important too. They allowed us to tailor the project to meet what residents wanted to see – and two are now working with our team on a new, virtual waiting room project which will ultimately allow video consultations with health care professions to take place from the patient’s home.

Friday was a great opportunity to tell people about what we’re doing, and I’ll be following up with Paul Mckay, from Nottinghamshire County Council who was particularly interested in these future plans as they will negate the need for patients to travel at all to see a health professional in some cases.

So we’re already seeing the benefits of utilising new technology – the reduction in travel is happening. The key to this was ensuring that we engaged with the public and clinicians and took the time to find the ways to overcome barriers to acceptance. I really feel we really are witnessing the future of healthcare.

Keith Bentham

Keith Bentham is a Senior Programme and Project Manager with over 25 years’ experience of working for and with the NHS.

His health career began as an Information Systems Manager at a hospital in Manchester, and has since progressed through various pre-sales, project and programme management roles.

In 2008, he was a medallist at the prestigious British Computer Society Project Manager of the Year Awards for his work in the Lorenzo Release 1 Project.

Within the last five years has worked in a very senior capacity within the Health Informatics team in University Hospitals of Morecambe Bay NHS Foundation Trust.

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6 comments

  1. Dr John Mercer says:

    Could you advice of safe remote access system/software for GP EMIS System; e.g. for a GP to access EMIS from home to surgery

    • NHS England says:

      Thank you for you comment,

      There are a number of ways you can remotely access EMIS, for example, using an N3 enabled laptop or through the mobile version of EMIS, but it would depend on which would best suit your specific situation. Our suggestion would be to contact your own local IT support in the first instance or try the GP system of choice team. However, they would not be able to advise one product over another, only guide to the products that are listed on the website.

      Kind Regards
      NHS England

  2. Adrian Smith says:

    Fabulous project Keith – congratulations. Can we connect please on the related projects we are undertaking in Scotland and Cornwall where we are using Satellite Communications and supporting software solutions to ensure that the HD solutions are ‘always connected’ in remote rural environment. Would love to share experiences and future opportunities.

  3. KASSANDER says:

    Congratulations all round for this ground breaking use of technology – it is the future staring us in the face, and Our=NHS isn’t blinking.

    It would be interesting to know some more about the
    “Patient and public engagement”
    aspects of the programme.
    In so many cases this is much trumpeted, but on inspection consists of self-appointed Patient Leaders and paid reps of the Gov’t subsidised Vol’y and Charitable sector who have become dislocated from us, the P&P.
    Do please reassure us that the P&P involved in YOUR engagement trials were true grass-roots P&P.
    Looking forward to more news of the roll-out of your MOST welcome innovations.
    Best wishes.

    • NHS England says:

      Dear Kassander,
      We would like to reassure you that we connected with real patients who had experienced the system – via both local membership schemes but also by attending out patient clinics to gather patient intelligence – and also investigated those who weren’t happy with new technology further to help us build systems which would be accepted by patients and the public.
      Kind regards,
      NHS England