INPATIENT ADMISSIONS AND BED MANAGEMENT:
THE CLINICAL APPLICATIONS FOR LOGISTICS MANAGEMENT (CALM) SYSTEM
Part of a letter to the Chairman of the
Committee from the Chief Executive, NHS Executive
I am writing to follow up my appearance before the
Committee on 29 March.
During questions by Mr Nigel Griffiths it was
evident that a consultant at the Royal Shrewsbury Hospital had
written twice to the Committee in detail about the hospital's
CALM information system. I did not receive copies of these letters
until the hearing was over and was therefore left on the back
foot when Mr Griffiths questioned me about them. I thought this
was a lost opportunity for the Committee to hear a full account
of the system.
You will recall that Mr Griffiths' questions
focused on whether or not the NHS Executive had taken active steps
to roll out CALM to other NHS Trusts, and whether PAS-linked or
stand-alone systems in other Trusts were delivering similar benefits.
CALM is a piece of decision-support software
designed to be linked to hospital Patient Administration Systems
(PAS). Its design and development are described in Mr Hay's letters.
As I understand it, intellectual property rights are now in the
hands of a private company (ISL) with close commercial links with
the SEMA Group, who are PAS suppliers. CALM is DOS-based and therefore
not the most up-to-date technology. I understand that SEMA are
working to upgrade and integrate CALM into their own PAS system,
but do not intend to make CALM available separately for integration
into other PAS systems.
A key feature of the success of CALM in Shrewsbury
is that it operates in a setting which also has the other vital
ingredients needed for effective bed management; viz:
in-depth understanding of the dynamics
of the local scheduling/booking/patient management and discharge
key players, especially the clinicians,
buying into the system and giving up personal control over admissions
committed staff, trained to use the
facilities and their and others' experience;
reliable and up-to-date in-put information;
I made the point at the committee that a successful
bed management system depends as much on people, knowledge, commitment
and local circumstances as on particular technology. The necessary
ingredients do not exist in equal measure everywhere in the NHS,
nor with sufficient regularity to make it sensible to specify
a single technical solution. It is the job of the NHS Executive
to promote good practice and we believe the most appropriate way
to do this is to inform both product and outcome specifications.
Our experience suggests that it is unlikely that the answer to
effective bed management lies in a single technological solution.
I am sure that the Committee would also accept
that I have to be very cautious about actively promoting a product
that commercially benefits one firm when there are other equally
good alternatives on the market. I therefore stand by the line
we have taken on Shrewsburyholding it up as an example
of what can be achieved by targeting the right resources, including
technology, but stopping short of requiring other NHS Trusts to
apply the same technological fix.
All main acute NHS Trusts now have a core PAS
and the ability to develop a bed management system as admissions,
discharges and transfers are devolved to ward level. Many NHS
Trusts will be market-testing or procuring PAS systems as part
of the move towards implementing the Electronic Patient Record.
The IM&T Procurement Review will address how to make best
use of the experience and market position of the NHS and to ensure
lessons are shared through the service. Inpatient planning and
bed management systems will certainly be a part of that process.
Specifications will be informed by CALM and other similar projects
but it will be up to suppliers to demonstrate value for money
and tailored solutions.
Sir Alan Langlands
9 May 2000