Deep dive into digital advance care planning

CMC

What are the benefits of advance care planning using digital tools and how challenging is it to implement an effective system?  In this Q&A discussion, NHS South West London CCGs Digital Urgent Care Planning Project Officer Lucy Colleer and NHS England Assistant Director for Enhanced Health and Care Homes and Care Sector Support Fay Sibley answer key questions in the aftermath of Covid-19 and its impact in care homes. The conversation centres on the advanced digital care record, Coordinate My Care (CMC).

Photo of Fay Sibley

Photo above: Fay Sibley

Why is advance care planning and having a digital urgent care record important for care home residents?

Fay:

I think it's incredibly important that care home residents have a digital urgent care record. We know that care home residents are often in the end phases of life. Even those that aren’t, are living with often extremely complex health and social care needs. So to have a single place where information is recorded about their wishes and preferences as well as their medical needs, including their medication, diagnosis and CPR status means that we are able to look after care home residents in a more holistic way.

"I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves."Fay Sibley

It means that all of the health care professionals who are involved in that person’s care, and look after that person have access to information about that person. I think that's particularly important when we start to think about people who, for various reasons, aren’t able to necessarily advocate for themselves. Or may not be well enough at the point in which they're accessing care to be able to advocate for themselves, or to put forward their needs and preferences.

Putting in place a system 

To have that in a systematic way that's consistent and that everybody is familiar with, really does help them with transfer of care. This means we can make sure that we do meet those wishes and preferences and just means we can deliver the right care. Whether that's keeping somebody comfortable at home, or whether that's escalating and transferring them to hospital. If you can access that information, it allows you to consider that on a very individual basis.

Photo of Lucy Colleer

Bitesize info

A series of short case study videos have been produced to demonstrate the value of individual patients having advance/urgent care plans brings to the wider health and care system.

Photo above: Lucy Colleer

Lucy:

We conducted a case study recently with a care home in Kingston, to look at how they were using CMC. How they got on with setting up CMC in the care home as well as getting their staff trained and using it. I think the biggest benefit, is that [CMC] puts the resident’s wishes first.

From a technical point of view, having a digital urgent care plan allows everyone to have access to the same information. It’s updated automatically, which means that you don't have to worry about bits of paper going out of date or going missing.

Saving time in an urgent situation

One of the things that the care manager we interviewed spoke about, was that it saved them so much time in an urgent care situation. In one instance, they had a resident who had a fall, and they called the ambulance service. Normally they would get phone calls from A&E saying, ‘What are the patient’s medical details?’, ‘What medication are they taking?’ But having it in that digital care record just meant that they didn't have to spend time printing documents, or taking those phone calls. And also for the staff in A&E as well, it was really helpful to have that information. Having an End of Life care plan really saves time and can strengthen decision-making.

It's just about putting the resident and the patient first. It also helps make life easier for clinicians who don't have an awful lot of time on their hands, and the care home staff as well.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

In July 2020, the HIN was commissioned to deliver a programme to increase use and quality of shared electronic advance and urgent care plans using Co-ordinate my Care (CMC). The programme concentrated on clinical engagement. Read about the Advance and Urgent Care Plans – London Accelerator

Fay:

I used to work for the ambulance service and one of the most difficult things was going to a care home in the early hours of the morning after being called to a resident. In one instance where this happened to me, the resident was acutely unwell, had a complex medical history and wasn't able to communicate. I was faced with trying to make an informed clinical decision with no access to information. Often at night in a care home they're operating with skeleton staff and, quite often, agency staff or bank staff because there are challenges in the care sector workforce. So they might not even be able to access patients records because they would be locked in the manager's office.

The problem with limited information

What we would know about that resident would be so limited that often as a paramedic, you end up taking people to A&E despite having concerns about whether the distress that course of action entails would justify the benefits. At that point it comes down to questions around what is “right” or “fair”, which are very difficult to answer as a clinician.

You are so limited to be able to make any other choice, because you didn't know their medical history. You didn't know what their wishes were. Nor which family member to call or who might have some more information about that person.

Seeing the info on an iPad

When paramedics first started to be able to access urgent care records we used to have to do that by phoning up the control centre. Amazingly, now paramedics can actually see it in real time on an iPad. But even when I left the service, you could call up the control centre and ask for that information. It just meant that you could make a different decision and you could justify that decision.

It was an informed clinical decision that was backed up and supported by the input of that person's GP. The input of that person's family, the input, hopefully, of that person themselves, as it allows you to make different decisions. And as Lucy said, a decision that really puts the person at the centre.

"There was real recognition that care needed to change quite quickly [because of Covid], and that those effects would probably be lasting."Fay Sibley

Bitesize info

The HIN, in partnership with the End of Life Care Strategic Clinical Network, secured funding from the NHS England (NHSE) personalisation team to work with Marie Curie nurses to create CMC records for care home residents in three nursing homes in south east London over a five week period. Read Increasing the number of care home residents in Lambeth supported by a Co-ordinate My Care plan

How is the HIN doing in terms of speeding up the spread and adoption of digital urgent care records in south London?

Fay:

The HIN has been working in this space for a long time, probably since the HIN started (in 2016) and more formally with CMC for the last two and a half years. Through a small pot of funding, through The Health Foundation, we were able to do a pilot project with about 10 care homes looking at different methods of getting care homes access to CMC. We also looked at the things that care homes would need to do in order to be able to access CMC. Either to view it or to put information into the record.

The challenges for care homes

From that project we learnt an awful lot about some of the process aspects of this that are challenging for care homes. Things like Information Governance (IG) requirements, the hardware requirements, having a laptop or a device to use and the Wi-Fi requirements.  I think that learning has then helped us to try to move this conversation on.

Obviously in terms of the [Covid-19] pandemic, it changed lots of things. Particularly the work that care homes are doing and the focus being put on care homes by the Government.  So at the beginning of the pandemic the HIN was really instrumental in trying to pull together various stakeholders who were looking at the key questions ‘How do we create records for care home residents?’ There was real recognition that care needed to change quite quickly, and that those effects would probably be lasting.

Collaborative working

The other thing we did was we worked with the End of Life Care Strategic Clinical Network to secure some funding and ran a small-scale pilot with Marie Curie. That was really interesting because Marie Curie had a number of frontline clinical staff who were shielding themselves because of the pandemic. Those staff were at risk of being furloughed and not able to work because they weren't able to do their frontline job. So what Marie Curie did was give them some additional training and upskilling. This meant they could support care homes to create CMC records for residents.

Working with care homes

We worked with three care homes in Lambeth, one GP practice and Marie Curie to deliver a small kind of, ‘proof of concept’ project around the use of CMC in a care home.  We learnt lots. We realised that to create quality records remotely with another organisation that doesn't perhaps know that person or have access to all of their clinical information has its challenges. They were able to do a fantastic job in starting the record off, but they still required a fair amount of input from the GP. It was not a perfect model, but we learnt a lot from the project. It was really interesting to use voluntary sector organisations to support this work.  In particular, organisations like Marie Curie that really have a lot of knowledge around end of life and advance care planning. And to use a staff group that otherwise, perhaps, wouldn't have been working during the pandemic and certainly couldn't do their main role.

Bitesize info

The HIN Healthy Ageing and Informatics Teams were commissioned to create a user friendly and useful digital maturity dashboard for care homes across London. This project was led by the Health Innovation Network and funded by the Digital First London region team.

Since then we've been doing a lot of work with Lucy and trying to support the coordinated pan-London effort around care homes and CMC. So it's absolutely brilliant to see this is on the commissioners’ radar and the work that Lucy’s doing. Lucy's pulled together a steering group that now meets monthly, and the HIN is also trying to help with some of the analysis of the data.

A dashboard for care home digital maturity

We've developed a Care Homes Digital Maturity Dashboard. This is a tool to be able to  monitor each care homes maturity status, in terms of their digital abilities. A key part of that for London care homes is CMC. 'Do they have access to CMC?' 'Do they have the right IG requirements that allow access to CMC?  'How many residents in their home have CMC?' We’re pulling all of those data sources together and presenting that information in a way that's useful to Lucy and other colleagues across London working in this space.

I think the HIN’s moved more into a supportive role, trying to share the lessons that we've learned from some of the early work. And then really letting the commissioner drive it forward in a way that we don’t have the reach to do.

"(A CMC care plan) really means that we are able to look after care home residents in a more holistic way."Lucy Colleer

Bitesize info

View the collection of resources. Coordinate My Care has provided a wealth of info to support the patient-led portal to create an end of life care plan. MyCMC: your plan, in your own time, in your own home

How many digital urgent care records have been created through CMC?

Lucy:

It’s in the region of thousands (see chart below). There are lots and lots of residents who do have care records, so the focus of our pan London work at the moment is actually getting care home staff themselves to look at those records. At the moment the majority of those records are created by the GPs and sometimes in the acute trust. So we're trying to encourage care home staff to start looking at those resident plans and keep them up to date.

The power of data

We have been working really closely with Fay and the HIN and I would say that the HIN has been more than just support. We're trying to lead the way from where you paved the way and the Care Homes Digital Maturity Dashboard is really, really helpful especially from a commissioning perspective because we can look at how it's affecting the ambulance call-outs and the conveyance rates and use the information to make commissioning and transformation decisions. From a commissioning point of view, obviously patient-centred care is the most important thing, but financial return on investment is important too. It’s been really great to be working with it with the HIN and supporting work that Fay and the team have been doing.

Fay:

I think the other thing that's really helpful is about data, and CMC actually produce a fair bit of data.  Again we could debate the data set of course we could, but they do produce a commissioners’ workbook, again on a monthly basis. One of the useful things about data is it allows you to look at different areas and make those comparisons.

Incentivising GPs and the role of the ICS's

For example in south London, south west London do particularly well in terms of the number of CMC records they’ve created. So you can look at some of the models that they've put in place over the last, let's say five years, that have really led to that. For example they incentivised GPs to do some of this work, so you saw a really big increase in that they've got a really established enhanced health and care homes programme and End of Life care programme within their Integrated Care System (ICS).

Again, they're really driving that work forward from a ICS strategic point of view, so having data allows you to look at factors such as where’s doing well? And ask questions like 'What are they doing?' 'Who’s lagging behind and 'what might be the reasons for that?'

The quality of the record

And then one of the other things that the HIN has really been focusing on is thinking about the quality of the record. Creating a record is one thing that's really important, but the record is only really as good as the information that's in it. 'How do I make sure that the information that I include in that record is of quality and is useful?' 'Does it make sense as a kind of complete picture?'

The HIN developed a checklist of the non-mandatory information that would be most useful to clinicians. And then from that we've done some work with south west London to try to refine that. Again, we pulled together a steering group with various clinicians from south west London to look at how can we use something like a checklist to drive up and standardise the quality of CMC records. This is so they are a useful, high quality, advanced care planning record.

"Creating a record is one thing that's really important, but the record is only really as good as the information that's in it."Fay Sibley
Table showing number of care home residents in London with a CMC plan

What would you say has been the biggest challenge in setting up more CMC records?

Fay:

I think capacity of the workforce to really do this, is the biggest challenge. As Lucy said, at the moment the vast majority of CMC records for care home residents are created by GPs. But GPs are an incredibly over-stretched workforce and it's not a quick five-minute job. It can take up to an hour to really have a meaningful conversation and then translate that into a record and publish that record. When you start talking about thousands of records across London, that's thousands of hours of GP time.

Who else can support the programme?

But I think the thing that may help us around that is understanding who else within the primary care and community services workforce can support this work.  Care homes themselves absolutely play a vital role and can feed into the record and do some of the data entry and have the conversations, but also, say, palliative care teams often do this kind of work; hospices, they've got brilliant teams that can support with this. Voluntary sector organisations; Macmillan, Marie Curie and GP practices are now starting to grow their workforce. Through the Primary Care Networks, we've now got paramedics working in GP practices. We've got highly skilled nurses that are really, really knowledgeable. There is a growing pool of professionals who could support the creation of urgent care records.

Getting patients and their families involved

We’ve also got an opportunity through MyCMC potentially as well which is something that was set up to be a patient-led record. Somebody would initiate that record for themselves, and there are roles within a GP practice where that could be a supported process, so social prescribers for example have the potential to be able to support somebody, even living in a care home, to initiate that record. People have a bit more agency. This includes setting up a record in mental health care homes and learning difficulty care homes. It may be appropriate sometimes to use MyCMC.

Lucy:

I take your point on capacity in terms of creating and maintaining those care plans. Once the plan is there,  it’s fairly easy to update and maintain it and we've seen that with some of the care homes that have been using it. They include it as part of the weekly rounds when the GP comes along, they include it at the Multi-Disciplinary Team (MDT) meetings that take place. And actually it's not too much work once the initial plan is filled out. In some of the more successful care homes using CMC the biggest thing, is just being engaging with them, and that's quite difficult to do from a commissioning perspective.

Resource challenges

I work in a very small commissioning team of just two. We’re covering the whole of London, including all health and care organisations across London.  So between us, it's very difficult to do that engagement. CMC does have a very strong engagement team, and they are successful, but they're still quite a small team for the whole of London. Some of the more successful care homes have been the ones that the CCG has provided resource, such as project support officers that have literally been hand holding those care homes to support them with all sorts of digital maturity aspects, like the Data Security and Protection Toolkit (DSPT) compliance and also, they've been really helpful with getting the care homes access to CMC.

I think engagement is one of the biggest success factors, but also a huge challenge. I think there's such a variety of resources across London. I know some STP's simply just don't have the resource to hand hold care homes with it.

Care homes 'left behind'

I think care homes have been left behind a little bit in terms of digital maturity. That's one of the key things - being able to have access to a computer, good internet, the IG (Information Governance) - all in place.  I think that they've been a bit left behind. I don't know what the historical reasons behind that are, but I think the digital maturity side of things is a big challenge for some care homes, especially the smaller ones.

Fay:

I would agree wholeheartedly with that around the kind of digital maturity aspects.

And I think there's lots of reasons. Obviously, many of them are private providers. Historically, social care hasn't received the same level of funding as the NHS. It perhaps hasn't been seen as a priority or our job.

Equality of access to care

But I think when we talk about and think about equality of access to care and the world that we now live in, and the fact that many health services have been forced to, at least in some ways, move to a more virtual remote delivery then actually it's no longer the responsibility of social care alone because we're denying people access to the care that they have a right to.

I think that's probably why there is such an increased focus throughout the pandemic on getting care homes up to that basic level of digital maturity; that same digital standard that we would expect of our NHS.  It's not easy, and I think one of the reasons we started the dashboard was because at the beginning of the pandemic, what we didn't know is what we didn't know (i.e we didn't know whether this home in Southwark had Wi-Fi even, or if they even had a laptop and that information wasn't anywhere). There were no agreed datasets around the care homes. There was no kind of central repository to go to and just put in the care home name and it will bring that up, so we didn't even know how to support them, because we didn't know what they had to start with. So that's part of the reason we initiated that dashboard work because we were like how we can support the central government functions - health and social care, public health and other involved organisations?

This was joint interview that took place remotely in April 2021.

NB: Fay Sibley was speaking in her previous role as the HIN's Head of Healthy Ageing.

Explore our website for more

See more info on our work with CMC here.

Click here for the CMC project webpage

Get in touch with our Healthy Ageing team

E-mail the team for more info.

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St George’s Hospital unveils dual electronic queue management and self check-in

Clinicians in ED

St George’s University Hospital Emergency Department unveils one of UK’s first dual queuing and self check-in system where patients see real time updates of their queue position on TV screens and smartphones.

HIN Innovation Grants supported project

St George’s installed the system after winning a HIN Innovation Grants award in 2019

St George’s University Hospital is one of the first Emergency Departments in the UK to introduce a dual queuing and self check-in.

Patients in the ED can map their queue position through real time updates on TV screens and smartphones.

In a move that reassures patients that they have not been missed or bypassed, the new system called “Patientcheck.in” helps free up emergency reception staff who handle a high volume of questions from patients about their wait and queue position. This has a knock-on delay in booking in new patients. Patientcheck.in – previously called “EDck.in” – also allows patients to complete a brief assessment questionnaire while they wait, using their own smartphone, which saves time during the assessment.

The technology aims to reduce patient anxiety around waiting times and improve efficiency.

Funded by the NHS’s Health Innovation Network, a joint Emergency Department and Transformation project team at St George’s was awarded £9,928 to design and build the software system and install TV monitors in the waiting areas.

Previously, a whiteboard behind the reception desk was used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This can lead to repeated queries to reception staff about the waiting time and occasionally result in aggressive and abusive behaviours which puts additional pressure on staff.

The second function – the assessment questionnaire – has three major benefits. It empowers patients to tell clinicians why they are in the ED, in their own words using a non-verbal communication channel; reduces clinical administration workload and creates better quality, standardised medical documentation.

Through its integration with Cerner, the hospitals’ electronic health record system, Patientcheck.in sends the questionnaire responses directly into the electronic clinical notes. This reduces note-typing time by around eight minutes per patient. Therefore, if just half of St George’s 400 ED daily attenders complete Patientcheck.in, this equates to a potential saving of more than 26 hours of clinical time every day.

The Health Innovation Network grant was used to develop and implement the system. Now live, the team hope that Patientcheck.in will be adopted by other NHS Emergency Departments. There is also an opportunity to use it in outpatient departments and development projects are underway.

Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust, said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.
“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.”Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust

Health Innovation Network Programme Director for Innovation Lesley Soden said:
“Hospital emergency departments can often be highly volatile as by their nature they have anxious patients waiting to be seen. Those patients often worry that they have been missed or passed over by other patients and this can lead to repeated questions to hard pressed reception staff, who are then preventing from getting on with their work to triage.
“This is a simple system using existing technology that can improve the patient experience, free up reception staff to focus on registering arriving patients and ultimately lead to faster care in hospital emergency departments.”

HIN Innovation Grants

See more info on the HIN Innovation Grants

Click here to see webpage.

St George's Patientcheck.in

Get more info on St George’s Patientcheck.in

Click here to contact Verity Croll

Helping break unwelcome news

Helping break unwelcome news COVID-19 outbreak

Health Education England has published a set of materials and films which aim to support staff through difficult conversations arising from the Covid-19 outbreak.

The AHSN Network was part of a small group of people that helped pull this resource together in less than two weeks.

The framework includes posters and films based on the evidence base from Real Talk and then filmed with willing volunteers.

You can also follow #UnwelcomeNews on Twitter.

Start here for an introduction to the framework: Discussion of Unwelcome News during the Covid-19 pandemic: a framework for health and social care professionals

You can watch the films here:

  1. The framework
  2. Community
  3. Breaking bad news
  4. Ceilings of treatment

Then access the resources here:

Follow this link for more information on patient safety during Covid-19.

Covid-19: Patient Assessment the role of physiology and oximetry

COVID-19: Patient Assessment the role of physiology and oximetry

The assessment of patients who are unwell with Covid-19 or other causes presents a significant challenge for GPs and clinicians working in Primary Care. The Royal College of General Practitioners (RCGP) and the AHSN Network are holding a joint webinar looking at the role of oximetry and other physiology in that assessment.

The webinar will be led by:

  • Dr Jonathan Leach, RCGP Honorary Secretary and Covid Lead
  • Dr Alison Tavaré, Primary Care Clinical Lead at West of England AHSN
  • Dr Simon Stockley, RCGP Lead for Acute Deterioration and Sepsis

Overview of content to be explored:

  • Clinical features of Covid-19
  • Importance of oximetry in Covid
  • Clinical judgement and physiology in Patient assessment
  • Role of NEWS2 in General Practice and Care Homes
  • Remote oximetry in the assessment and management of Covid disease in the community
  • This will be followed by a Q and A session.

The webinar will be held on Wednesday 29 April, 13.30 – 14.30pm and you can register here. The webinar will be recorded and shared afterwards.

World Mental Health Day: A story of a burning platform for change

A burning platform for change

By Breid O’Brien, HIN Director of Digital Transformation

Today is World Mental Health Day; a day observed by over 150 countries globally to raise awareness and reduce stigma around mental health. In the 17 years since the day was first conceived, society has come a long way in its understanding of mental health. However, even today, people with serious mental illness are still likely to die approximately 15-20 years earlier than other people.

So this World Mental Health Day we would like to highlight some of the incredible progress being made by mental health teams around the world, to bring about parity of esteem in this area by reflecting on a recent roundtable event we held to share learning internationally, where Martin Davis, a Clinical Nurse from New South Wales’ Mental Health Emergency Care division (MHEC), presented on the successful implementation of a virtual consultation system in a rural and remote mental health setting in Australia.

This is a story of a small team that led the way. MHEC was kick started by a government cash injection at a time when the team needed to deliver a better, more cost-effective system of care to its rural and remote population in rural Australia. Before the MHEC service was introduced remote and rural ambulances (and often other emergency services) were transporting patients hundreds of miles just for an acute mental health assessment; taking them from the comfort of their home, family and friends when they were in a vulnerable state, and often leaving their hometown without any emergency provision. Imagine living somewhere where if there was a fire, there would be no one to put it out, simply because they are effectively acting as a patient taxi? Their situation provided a clear rationale for change – a burning platform, if you will. By using virtual consultations, they could save time, save money and deliver faster patient care.

Starting with an 1-800 number 12 years ago and progressing to an online video system just under a decade ago, MHEC now prides itself on answering calls within three rings, and being able to assess patients on a video call within an hour during daytime hours. The stats continue. Every year since its inception, they have saved the combined services over $1,000,000 AUD a year; and 80% of the patients they see are discharged back into their community within a day, a direct reversal of the 20% of patients who were able to go home under the previous system.

“All just geography”

Despite the obvious differences between MHEC’s setting (their ‘patch’ is the size of Germany but has only 320,000 residents), and our urban south London area where almost three million people reside in an area a fraction of the size, when Martin shared his story the similarities were immediately apparent. In London we have a diverse population who speak an estimated 250 languages, requiring a need for numerous cultural sensitivities; the MHEC team have a large aboriginal population – almost 40% of their mental health in-patients identify as aboriginal.

Patients in New South Wales were having to travel miles away from their families to receive acute mental health care; we too have examples of this happening in acute mental health care in the UK, and while the distances in Australia may be greater, the impact on the patient and their family will be the same. The Australian health system also faces an increasing demand for acute mental services against a backdrop of challenges with staff recruitment; turns out, Julia Roberts had it right in Pretty Woman; it is “all just geography”.

The question our roundtable guests discussed cut to the heart of the complexities of digital transformation: if we have so much in common, why, over a decade later, are we still not embracing virtual consultations in the same way that they are? Distance and cost were MHEC’s burning platform, pushing them to make changes ten years ago that other services are only just catching up with. We seemingly are yet to find our burning platform, despite the pressures on our services and the progress being made in many areas.

As our roundtable participants moved the discussion on to the inevitable complexities of implementation, many of the usual barriers made an appearance; procurement, interoperability, money, time. But a few more situation-specific ones also livened the debate; what are the implications for information governance? How do you prevent reprisals of misdiagnosis? How do you train people to deliver virtual care? How do you ensure that changing a pathway won’t affect patient safety? How do you empower your teams to step outside their role? How do you get buy-in from all the organisations needed to deliver the change?

The need for systems to talk

For Martin – and MHEC – all the barriers to change raised were not only a stark reminder of how far they have come, but also how much work is still to be done. We delved into the extensive stakeholder engagement the MHEC team undertook (they visited all the GP practises in person because face-to-face meetings achieved better buy in from clinicians – an irony that wasn’t wasted on them), and listened to how the accountability process was redefined, before unveiling a key area of distinction between our two situations; how joined up their IT systems had become. A steely silence answered Martin’s assumption that we’d managed to fix the interoperability of medical records in the 20 years since he’d served at Homerton, Enfield and the Royal Free. Sadly, Martin, we have not but it is high on the agenda of NHSX and others so perhaps this time we will.

And therein lies part of the problem. The collaborative nature required to implement the MHEC system between mental health, emergency departments, General Practitioners, community mental health teams and even the police (they have supplied local police with digital tablets to ensure they can get the virtual consultations to people in their own homes, not just the local emergency department) is a testament to the power of joined-up care systems, but working together was undoubtedly made simpler by the support of a joined up technology system, something the various LHRCEs are still working hard to crack.

From the discussion, it became clear however that no one issue of technology, procurement, change management, organisational boundaries or geography on its own poses enough of a barrier, but the cumulative effect of them all risks putting off too many commissioners, clinicians and managers from implementing digital transformation. The risk made all the more terrifying by the fear that it might go wrong and that safety could be compromised.

Martin was incredibly open and forthcoming about the fact that MHEC is not yet perfect. When they started the technology didn’t work; not everyone was bought in to the system; it was not – and still isn’t – an overnight success, but none of that mattered. They were trying something new that, at its heart, was trying to improve patient care and support emergency services to deliver better support to people in a mental health crisis, whilst also saving the overall system money. It is clear that really innovative organisations are willing to tolerate failure and see it as an opportunity for learning and doing things even better. Whilst we can’t tolerate failure in terms of compromising patient safety, it does feel that perhaps sometimes this fear also stops us from implementing proven innovations. So why does the fact that something won’t work perfectly first-time round make us in the NHS feel so uncomfortable? Perhaps this is our inherent fear of failure?

We heard from some present about the fabulous work they are doing to implement similar technology and different ways of working, however, to really impact care we need to do this at scale. And to achieve anything at scale, risks will have to be taken. Perhaps our burning platform is just not hot enough. Yet.

About the author
Breid O’Brien leads HIN’s digital consultancy function. She has extensive improvement and digital transformation experience supported by a clinical and operational management background in acute care within the UK and Australia. She has supported major system level change and has a strong track record of delivering complex programmes of work whilst supporting collaboration across varied teams and organisations. With a Masters in Nursing, an MSc in Healthcare Informatics and as an IHI improvement Advisor, Breid is especially interested in the people, process and technology interface.