Using technology to help reach less connected communities in Lancashire and South Cumbria
What was the aim?
Lancashire and South Cumbria NHS Foundation Trust (LSCFT) is a mental health and community trust covering the population of Lancashire and South Cumbria and employing nearly 7,000 staff. LSCFT also offers community-based services delivering over 4,500 outpatient clinic appointments a week and in excess of 5,500 community clinic appointments a week. The trust’s footprint covers a large geographical area which includes centres of urban deprivation and remote, rural locations.
Delivering efficient care over such a wide area and multiple sites to a heterogeneous population is a huge challenge. In common with other large trusts, LSCFT felt that using technology could help to reach communities which were less connected in terms of public transport infrastructure, and to assist services which had to cover wide geographical footprints.
LSCFT was nominated to join the Global Digital Exemplar (GDE) programme as a Fast Follower in 2018, partnered with GDE Berkshire Healthcare NHS Foundation Trust. Fast Followers are supported by programme funding, working with their partner GDE to accelerate their digital journey.
What was the approach?
In recognition of the challenges described above, LSCFT planned to undertake an ambitious programme of digital transformation. The aim was to enable the organisation to maintain high quality and effective care for patients, fit for the 21st century, as well as equipping staff to feel confident and competent in using updated technology. This programme was underpinned by the introduction of Rio as the new Electronic Patient Record (EPR) for mental health services in the trust, delivered in a staggered roll-out between 2018 and 2021. In July 2018 all LSCFT services moved their administrative records to Rio. The deployment of Rio as a full clinical system was completed in early 2021.
What was the impact?
The GDE programme has had a profound impact on the trust’s approach to digital transformation. It has further emphasised to the trust board the importance of technology as an enabler of excellent care, rather than just being seen as a “nice-to-have”. This has been evidenced in terms of the nature of the conversations that take place at the highest level of the organisation, and the level of support and constructive challenge to the digital directorate.
This has also been accompanied by a significant investment in digital staff resource, particularly in the Clinical Informatics team. At the start of the GDE programme, the Clinical Informatics team consisted of a band 7 nurse and a CCIO working less than full time. Now, the team consists of eight staff, with funding for four more Associate CCIOs to further bolster the resource. This is a reflection of the importance that the organisation places on digital transformation, a direct consequence of the achievements of the GDE programme.
Some examples of how digital has impacted trust staff and patients include:
- Enhanced communications between primary and secondary care mental health services
- Digitising seclusion recording in secure care settings
- Improved digital training for staff
- Online consultations
Enhancing communications between primary care and secondary care Mental Health Services (Advice and Guidance)
Local acute trust University Hospitals of Morecambe Bay NHS Foundation Trust developed its own version of the Advice and Guidance (A&G) functionality available in the national e-Referrals Service platform, providing enhanced functionality. This was adopted by LSCFT and embedded in EMIS, the system used by GP practices. It allows GPs to raise a query digitally through a patient’s EPR to LCFT’s consultant psychiatrist team. A consultant psychiatrist can then directly provide the GP with clinical advice.
The A&G functionality reduces the number of traditional referrals to mental health (MH) services which can often include an initial appointment with a mental health nurse followed by further appointments before the patient receives the treatment they need. Using this new channel, for some patients all they need to do is see their GP who will message the psychiatrist who will then message back within a few days recommending appropriate treatment. This means quicker care and fewer repeat appointments.
In the first 12 months of the service:
- 51% of GPs felt confident in treating patients themselves as compared with 9% prior to the introduction of the system
- only 24% of the patients discussed required an onward referral to MH services, compared to 60% prior to the introduction of the system
- 92% of GPs said the advice given was really useful or useful
In addition, referrals to the MH service were reduced from 2,984 (12 months pre-deployment) to 2,554 (12 months post-deployment).
Digitising seclusion recording within a secure care setting
In some situations in a mental health in-patient unit, some patients require a brief period of seclusion in order to reduce agitation, and for protection of themselves and others. In this period, regular physical health checks must be undertaken to ensure the safety of those patients. A full digital seclusion recording solution was implemented within LSCFT’s in-patient Secure Mental Health Services. The aim was to improve visibility of seclusion records for both front line staff and operational management to ensure the liberties of our most vulnerable patients were protected.
The seclusion solution has improved the accessibility and visibility to seclusion data by allowing the seclusion record to be accessed anywhere across the site, and by multiple people to complete reviews. This in turn supports staff with decision making to ensure patients are able to return to ward environments at the earliest and safest opportunity.
- Nursing reviews improved from 37% to 93%
- Medical reviews improved from 24% to 73%
- Multi-disciplinary Team reviews improved from 40% to 84%
- Care plan meeting COP guidance improved from 23% to 86%
More importantly, the average length of time patients are spending in seclusion has reduced from approximately three and a half days to a little over one day. The reduction is linked to improved review compliance, increasing opportunities for clinicians to end seclusion, and improved care planning focussed on ending seclusion.
Improved digital training for staff
In 2016 LSCFT implemented a full Learning Management System (LMS) for around 7,000 staff ranging from consultants, nurses and healthcare assistants to administrative and corporate staff. The LMS has been used to host e-learning packages for clinical systems training over the last three years, providing improved access to learning.
A trust blueprint has been developed which outlines the procurement of the LMS, and how the offering of e-learning has been extended and improved in 2019/20 to include digital skills training to enhance the skills of trust staff as new technologies are adopted to support patient care.
A pilot of e-learning for a clinical systems deployment supported 1,500 staff to complete training over a three-week period. This evidence was the driver for pursuing an LMS that would continue to offer benefits to staff.
In 2020, LSCFT implemented a web based online consultation platform. Due to the COVID-19 pandemic, original plans for a limited pilot deployment were rapidly accelerated to make the tool available to every clinical service in the Trust.
In the last year, more than 70,000 video consultations have been held, across more than 130 clinical teams, by around 2,000 clinical staff members. This tool has enabled patients to continue to receive high quality care with the staff who are caring for them, which still includes some degree of face to face contact.
A blueprint has been written to detail the project, its impact and associated learning. This is due to be published via the GDE blueprint library in the near future.
Insights and learning
By being part of the GDE programme, LSCFT immediately gained access to a network of like-minded organisations who were equally ready to turbo-charge the transformation of care, and who were willing to share their successes – and importantly their challenges – around this work. This took place through regular in-person learning events (pre-COVID) where colleagues could meet in a less formal setting to discuss their digital journeys. Trust staff found it reassuring to know that no single organisation had solved these challenges, but all had something to contribute, and staff were able to take this learning back to their own organisations.
Those learning networks also sparked personal connections between individual colleagues who have maintained contact throughout and beyond the programme, and who have been available at the other end of a Teams call to act as a sounding board.
The trust has also benefited from the expertise of colleagues within NHS Digital who put on specific training around problem statementing and benefits realisation. These sessions have changed the way the organisation approaches the initiation of digital programmes of work, such that this way of working is now embedded in the trust’s “business as usual” approach for all projects it undertakes. These techniques have been shared with the trust’s ICS partner organisations, so the ripple effect of learning has spread further than the participants of the GDE programme itself.
Over the last few years, the trust has embraced digital transformation as part of its “business as usual” rather than being an exceptional event. In terms of future projects, LSCFT is linking with the Healthier Lancashire and South Cumbria ICS to develop a joint patient portal. This will allow patients to see their care plans, view their upcoming appointments, and track their symptoms.
There are also plans to develop a suite of clinician-friendly dashboards, so that frontline staff and managers can monitor their own individual and team performance, but also keep track of key clinical tasks to ensure optimal patient care.
Ayesha Rahim, Chief Clinical Information Officer at Lancashire and South Cumbria NHS Foundation Trust, said: “Being on the GDE programme has sped our digital transformation ambitions as an organisation. The profile of technology as an enabler of care has been raised from board to ward, and that is played out in the amount of resource we are putting towards digital. This has also been demonstrated in the approaches we now get from frontline clinical and manager colleagues, actively seeking to work with the digital directorate in exploiting technology to improve care.”
View a short video of nursery nurse Julie Chapman and service user Natalie Taylor describing how online consultations are giving service users an alternative to face to face appointments.