Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by SchlumbergerSema (DD 31)


David Tait is MD of the Public Sector Business Unit of SchlumbergerSema, responsible for the company's business in the Health Sector in the UK.

  With over 22 years' public sector experience, SchlumbergerSema is a major provider of IT, business and medical services to the public sector worldwide. Drawing on sector knowledge and capabilities in consulting, systems integration, managed services and products, SchlumbergerSema enables government organisations across the globe to run their operations more securely, cost-effectively and efficiently.

  Specifically, in the UK, SchlumbergerSema currently supplies systems and services to the National Health Service Information Authority, to the National Health Service in Scotland, to Health Authorities and to Trusts. In conjunction with the Charles Wolfson Foundation, SchlumbergerSema has developed and implemented the "CALM" system in the Royal Shrewsbury Hospital which was mentioned in the 2000 National Audit Office study as a beacon of good practice in avoiding delayed discharges and cancelled admissions.


  This evidence addresses the issues set out in bullets 1, 4 and 6 of the Press Notice of 13 December 2001. That is, the necessity to improve management of the patient flow, clinically prioritised, through hospitals and to improve co-ordination with other agencies "downstream".

  Many current difficulties of the NHS, such as delayed discharges and cancelled admissions, can be addressed better by improved information systems of the kind demonstrated at Shrewsbury to make better use of resources rather than throwing more money at them.

  IT systems in the NHS are largely antiquated and certain features of the procurement process militate against innovation and effective implementation of good practice on a national scale

  We believe that the future solution, at a local level, must lie in the effective implementation of Electronic Patient Records and workflow management techniques that will encourage the essential changes in culture without which efficiency improvements cannot be made.

  Techniques of the kind implemented in Shrewsbury have real potential to substantially improve matters in a measurable way inside two years (with hard evidence of real progress within one year) and we believe that a centrally sponsored initiative should be set up to test the techniques thoroughly.


  1.  We welcome the opportunity to input to the discussion on Delayed Discharges.

  2.  It is our belief that the NHS must modernise the way it works to join up the various agencies that provide elements of care to citizens. A catalyst for this change would be the introduction of new, patient centred IT systems. Modern cost-effective technology will facilitate access to information by all agencies either directly or via national brokering systems. Existing IT systems too often act as a barrier to change and a drain on resources.

  3.  Discharges from hospitals are often delayed because arrangements, eg for aftercare or even transport, are made at the last minute. With constrained resources this inevitably makes arrangements difficult and enormous human effort is employed to minimise delays. The National Audit Office, in their 2000 report on Bed Management, pointed out that in the last decade the number of beds in acute care had remained stable. But the corresponding huge decline in community beds over the same period has caused a logjam moving back up the patient process as far as acute hospitals. This leads to blocked beds, delayed discharges and many other avoidable problems.

  4.  Any delay in discharge is firstly a human problem. The patient involved is recovering, they are anxious to move onto the next stage, perhaps to get closer to their family. But it also wastes valuable and scarce resources that should be applied to subsequent patients. This delay, in turn, results in cancellations of admissions. For the subsequent patient this translates to inconvenience, disappointment and, in many cases, in deterioration of their condition. This is a bad experience for the patient but it also represents spiralling healthcare costs for the NHS to re-arrange things, to continue care whilst the patient waits and finally the further treatment of a patient who has deteriorated.

  5.  Implementing new technology systems based on a patient centred care process will, we believe, pay immediate dividends in terms of increased efficiency (measurable and demonstrable) and will enable the NHS to provide the consumer oriented service demanded by the public today and to meet the challenges set by HM Government.

  6.  The NHS must gain management control of the patient process. Modern IT systems can help achieve this by providing tools that capture information as "incidentally" (ie as the patient progresses through the process of treatment) as possible throughout the care of a patient starting at the ambulance, the General Practitioner or the Accident & Emergency department. This ensures that the information is timely and accurate and can be used to re-inform existing plans. Furthermore IT systems should then use this information to present operational tools to improve efficiency across the entire system not just in one agency such as a hospital. Sharing of accurate information about the patient throughout the treatment process (or "care pathway") enables all agencies to perform more efficiently, and indeed more safely through minimising the risk that lack of information will lead to the wrong treatment.

  7.  The NAO Report into Bed Management commented that the application of IT to bring about improvements in operational efficiency had only been demonstrated at one hospital—the Royal Shrewsbury. These improvements were attributed to the implementation of CALM (Clinical Applications for Logistics Management) as part of the SemaHelix Hospital Information Management system. Here, modern techniques of clinical resource scheduling in the form of CALM, embedded within the patient process have been demonstrated to reduce cancellations of operations by 40 per cent and to increase routine bed occupancy by 10 per cent from a national average of 82 per cent within a year of implementation. The impact on the NHS overall, if these results could be repeated nationally, would be dramatic in terms of resource saving, in care outcome improvement but most crucially in the patient experience.

  8.  Using the CALM approach, a health community can manage the use of beds and theatre time to ensure that clinical priorities are applied to the use of these resources. They can plan bed allocations, staffing levels and negotiate discharge arrangements in advance. Finally they can spot and easily react to any changes in circumstances. The NHS annually cancels 50,000 appointments on the day of admission whereas Royal Shrewsbury contributes almost nothing to this figure because they have management control of their "factory". The factory metaphor is not intended to connote any dehumanisation of the process—rather it points to a key issue which is that IT-based planning and resource management techniques which are commonplace and essential in manufacturing industry can be successfully applied, mutatis mutandis, to the NHS. Indeed, getting the right clinician to spend the right amount of time with the patient the first time is not just more efficient but a major improvement to the patient experience and their welfare prospects.

  9.  This is best illustrated by the winter '97 'flu epidemic in Shropshire. Using the CALM tools the Royal Shrewsbury was quickly able to identify the unexpectedly high number of medical emergency admissions. They therefore adjusted the resources available to elective surgery but were able to preserve the clinical priorities so that minimum cancer waiting times were maintained. This is just what society wants from a National Health Service. This is an improvement in care but it also represents an enormous reduction in costs.

  10.  We feel that too often, the NHS procurement process for IT systems does not facilitate this process of adopting and adapting modern IT systems insights. NHS procurements of IT systems are frequently protracted, expensive and result in poor decisions. The consequence is that change is avoided and innovation stifled. In fact, over 90 per cent of hospital IT systems are based upon administrative systems that stem from 1980's designs and before.

  11.  The CALM component which has performed so effectively at Royal Shrewsbury is contained within SemaHelix, a system developed by SchlumbergerSema with vital support from the Charles Wolfson Foundation. The approach is not simply based on new technology and the concomitant lower running costs, but crucially, embodies the important principle which puts the patient at the centre of a "joined-up" care process. It helps to break down the strong cultural and procedural differences between administrative and clinical functions in a health service. This is essential because many functions hitherto regarded as administrative have clinical facets. So, for instance, Bed Management is no longer a fire-fighting exercise but must be seen as a clinical management role.

  12.  We propose that the experience at Royal Shrewsbury should be replicated in a dozen "incubator" health communities (possibly some of those with particularly high incidence of cancelled appointments) to demonstrate the general applicability of CALM approach and to demonstrate the benefits of efficiencies, improved healthcare and patient experience already demonstrated at Royal Shrewsbury. The results of this programme would be measurable within a year of implementation.


  This evidence can only scratch the surface of the issues and we would welcome the opportunity to give oral evidence to amplify our views and our proposal.

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Prepared 29 July 2002