Memorandum by Research In Motion (PEX
04)
EXECUTIVE SUMMARY
(a) On the basis of our experience working with
NHS organisations and local authorities throughout the UK, Research
In Motion, the designer and manufacturer of BlackBerry smartphones,
believes that significant savings can be achieved by giving health
professionals secure tools to work more effectively when mobile.
(b) Our work with NHS Trusts and local authorities
in Portsmouth, Birmingham, Cambridge and Glasgow, amongst others,
demonstrates the potential for BlackBerry-enabled solutions such
as digital pen and paper, digital dictation and remote, secure,
real-time access to patient records. As well as realising efficiency
savings, these solutions have been shown to improve care quality
and patient experience.
(c) These savings can be achieved across the
NHS so long as Trusts are able to overcome their reluctance to
invest to save during a period of considerable uncertainty as
the NHS embarks on both a major reorganisation and a reduction
in back-office costs. A focus on rapid return on investment to
free front-line resources from administration would help facilitate
these gains.
(d) By harmonising protocols across Government
departments and avoiding duplication of standards, through adhering
to central government security guidance issued by CESG, the DH
could directly reduce its central back-office costs and simplify
local processes while simultaneously improving security. This
would also enable front-line professionals to integrate more easily
across social and healthcare functions, thereby generating further
very significant savings.
(e) Funding flows need to be aligned throughout
the system to incentivise cost-effective care. This will often
mean moving care out of hospital and into the community.
INTRODUCTION
1. Research In Motion (RIM), is the designer
and manufacturer of the award-winning BlackBerry smartphone, used
by over 50 million people around the world. Many NHS organisations
use BlackBerry solutions to improve their efficiency and the quality
of care they deliver through a growing range of clinically-focused
applications specifically designed for UK health settings.
2. Our experience working with NHS organisations
suggests that there are numerous scalable opportunities to improve
the quality of care experienced by NHS patients while simultaneously
reducing unproductive time spent on administrative tasks. If incentives
are aligned across the healthcare providers we believe the current
focus on public sector efficiency represents a significant opportunity
to realise these improvements in care.
3. The Informatics Planning guidance that
accompanied the 2010-11 NHS Operating Framework rightly identified
that all local health communities should make significant progress
"investing in, and beneficial exploitation of, mobile technology
to improve quality and productivity". This was a direct response
to earlier observations made in November 2009 in Transforming
Community Services: Improving Information for Stakeholders that
"the lack of secure mobile technology has meant that clinicians
have to return to a central base or GP surgery to enter data;
this detracts from time that could be spent with patients and
is counter productive."
4. As a result of our work with NHS Trusts,
we are confident that significant savings can be achieved through
BlackBerry use. For example, community midwives at Portsmouth
Hospitals NHS Trust have halved the amount of time they spend
on administration using BlackBerry-enabled digital pen and paper.
This solution alone would generate savings of around £32
million per year if rolled-out across all community midwives in
England. There is the potential to make similar savings in acute
settings. For example, digital dictation solutions already in
place in Sheffield Teaching Hospitals NHS Foundation Trust are
significantly improving the turnaround time to produce accurate
medical records, increasing their accuracy and allowing clinicians
to spend more time with patients. It is becoming increasingly
straightforward for BlackBerry-based solutions to interface directly
with IM&T systems already in place in NHS hospitals and community
settings, providing seamless secure access to information and
reducing unnecessary time spent on administration.
5. As well as enabling front line clinicians
to deliver care more efficiently, we also believe that there is
potential to reduce unnecessary admissions into hospital by using
smartphones to help patients manage their conditions more effectively.
For some this will be through ongoing monitoring of vital signs
and key health indicators such as blood glucose, while for others
this will be more about using mobile connectivity to encourage
healthier behaviour. We are actively working with NHS Choices
and other organisations to develop solutions along these lines.
STRATEGIC ASSESSMENT
What are the implications of the "£15-20
billion efficiency challenge" described in the Revised Operating
Framework for the NHS as "absolutely critical for the future"?
6. To some extent these efficiency savings
have focused NHS organisations' attention on working more efficiently
but several Trusts have responded through blanket responses to
close down or delay future investment despite the potential to
yield greater efficiencies. For example, Trusts that are in "turnaround"
find it difficult if not impossible to make investments that would
deliver mid-term savings. If such practice becomes widespread
across the NHS then there is a significant risk that mid- to long-term-term
efficiency could be seriously compromised by too strong a focus
on short-term budgets. It is not clear to us that the time savings
correctly indentified in the Informatics Planning guidance referenced
above will be achieved this year. We would therefore recommend
that the NHS should be encouraged to pursue a more proportionate
approach so that investments with a shorter horizon for returns
to be realised are encouraged.
What commitment is the government making on capital
expenditure as opposed to revenue expenditure?
7. At present there seems to be a lack of
understanding within NHS organisations about the likely future
impact of capital expenditure restrictions which has had the effect
of slowing investment decisions. This is further complicated for
technology-based solutions given the ongoing uncertainty about
the future of NPfIT. We remain hopeful that these sources of delay
will be resolved following the October spending review and the
anticipated new information strategy for the NHS.
What level of commitment is national and local
government making to Social Care, and how does it compare with
long term trends of demand, cost and efficiency?
8. RIM does not have a view on the level
of commitment made to social care per se, but it is clear that
demographic and public health pressures are going to lead to greater
pressure on resources which can only be met if NHS and Social
Care provision operates in a more integrated way. If implemented
effectively, this would both improve users' experiences and reduce
duplication and therefore costs.
9. It is worth noting that the work of professionals
from health and social care often overlaps in community- and home-based
settings. If the NHS and social care providers are to realise
effective cost savings then it is essential that these workers,
who are by definition mobile, are appropriately equipped so they
can share timely and relevant information throughout their working
day.
What are the implications of the government's
plans for the interface between the NHS and Social Care?
10. We welcome closer working between NHS
and Social Care and would draw attention to some of the practical
challenges that need to be overcome to ensure that the system
is able to benefit from operational synergies, for example:
(a) staff working in the community across NHS
and social care should have secure auditable access to relevant
information from systems held both by the NHS and local authorities;
(b) at present all central and local government
departments except for health follow the same security guidance
for mobile access set down by CESG;[5]
and
(c) by adopting CESG mobile security standards,
costs could be cut by reducing duplication between departments,
avoiding confusion throughout NHS Trusts and enabling staff to
work across health and social care more securely and more effectively.
11. Our work with the Direct and Care Services
(DACS) department of Glasgow City Council which provides a range
of welfare services to the residents of Glasgow has generated
approximately 20% savings on back office costs by enabling those
staff to move to front line functions. We believe that even greater
savings could be achieved if NHS and social care front-line community
staff were able to use secure, auditable mobile access to records
to work in a more coordinated way across both services.
CENTRALLY FUNDED
HEALTH SERVICES
What services are procured from this "top-sliced"[6]
budget, and how do the government's plans for those services compare
with long term trends of demand, cost and efficiency?
12. There are many services procured from
top-sliced budgets. RIM does not have a view on the proposed structural
changes to the NHS, but we would draw attention to valuable work
hitherto carried out by SHAs in encouraging Trusts to adopt innovative
practice. For example, our work improving the efficiency of community-based
midwives using BlackBerry-based pen and paper in Portsmouth was
funded by South Central SHA as part of a drive to develop a scalable-solution
from which the whole region could potentially benefit.
13. We recognise that the Government has
indicated its intention to abolish SHAs, and while RIM does not
have a view on the merits of that development, we would draw attention
to the importance of giving Trusts support so that they can learn
from the experience of their peers and continue to innovate while
under financial pressure. This will be particularly important
during the next two years as the NHS goes through a major transition
to the new arrangements outlined in the White Paper, Equity and
excellence: Liberating the NHS.
LOCALLY COMMISSIONED
HEALTH SERVICES
What scope exists for locally commissioned health
services to manage demand, cost and efficiency to increase the
resources available, in particular, for elective and non-urgent
services?
14. The next few years will see a dramatic
increase in the power of mobile technology to help patients manage
their conditions more effectively. For example, continuous real-time
monitoring of patients with long-term conditions such as diabetes,
COPD and CHD could lead to very significant reductions in hospital
admissions and in turn significantly reduce costs. However, there
are two blocks in the system that risk jeopardising such savings:
(a) technology uptake in the NHS is significantly
lower than in other countries; and
(b) current funding flows do not readily support
significant investment solutions such as telehealth which can
reduce admissions to hospital.
15. Innovative solutions by definition require
commissioners to exercise vision and to break with the past. While
many GP consortia are likely to excel in rising to these challenges,
we are concerned that significant numbers may take a noticeably
more cautious approach that in turn could delay the uptake of
new solutions that hold out the potential to improve patient care
and reduce cost. We would recommend that the DH considers ways
to encourage GP consortia to share learning so that they make
the most of modern mobile communications capabilities and other
innovations.
SOCIAL CARE
SERVICES
What scope exists for social care services to
manage demand, cost and efficiency within constrained budgets?
16. Currently many patients in receipt of
home-based healthcare and social care receive multiple visits
each day from staff from each care sector. By coordinating visits
more effectively we believe that staff time from health and social
care professionals could be used far more effectively. Specific
savings could be achieved by:
(a) utilising mobile technology-based solutions
to access medical and social care notes on the move;
(b) inputting data securely and remotely rather
than wasting time returning to base;
(c) scheduling visits more effectively to minimise
journey time, including utilising GPS navigation which can be
accessed through the same mobile platforms used for accessing
patient records; and
(d) coordinating visits across health and social
care so that resources can be fully utilised for individuals who
require two members of staff to be present at any given visit.
CONCLUSION
17. We believe existing deployments of mobile
technology show that considerable efficiency savings can be realised
across health and social care, so long as:
(a) organisations are encouraged to make relatively
small-scale investments that will deliver rapid efficiency returns;
(b) funding flows are aligned across the system
to incentivise cost-effective care which can mean investments
in community-based rather than acute-based care; and
(c) mechanisms are in place to encourage the
uptake of new technology that can help patients to manage their
conditions more effectively and avoid unnecessary admissions to
hospital.
September 2010
5 CESG (Communications-Electronics Security Group)
is the Information Assurance arm of GCHQ. Back
6
i.e. reserved for central disbursement by the Department of Health
or NHS-and not allocated to PCTs. Back
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