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Remote working in patient care, with staff 'hot-desking' using mobile broadband-enabled laptops, is a proven cost-saver for the NHS. But the idea has been met with caution by some trusts owing to the limitations of 3G mobile reception.
However, one primary care trust, NHS Kirklees, has embraced the technology by deploying around 600 Panasonic Toughbooks, supplied and serviced by BT Health. The staff are, in the words of Robert Flack, managing director of Kirklees Community Healthcare Services (CHS), "loving it".
Flack's NHS organisation is the provider arm of NHS Kirklees, which employs more than 1,200 staff to meet the healthcare needs of more than 400,000 people across Dewsbury, Batley, Spenborough, and central and southern Huddersfield.
The area's topology is quite diverse, ranging from the university town of Huddersfield to open areas of countryside – and owing to the proximity of major towns and cities, almost all of the Kirklees trust area gets good 3G cellular reception.
But, says Flack, the technical aspects of laptop-toting members of clinical, nursing and administrative support staff is only part of the equation. Improvements in patient care in the field are what is driving the project forward.
The last 12 months have seen Kirklees CHS steadily introducing 600 laptops to staff in a variety of healthcare environments, including health visitor services, to patients in their own homes.
"The fact that it involves the patient working with NHS professionals to determine how their healthcare will progress is the really great thing. We've had 25 (in-depth) interviews with patients about the new system and they all love it," says Flack.
The use of laptops at the clinical coalface - in the patient's home - has been especially successful, says Flack, particularly on family partnership work. "This is where the NHS works with teenage mothers to ensure that mother and baby get the best start in life, and the system allows staff to fill in the health record with the mother," he says.
As well as tangible cost savings - NHS Kirklees is saving around £600,000 year in travel costs, as staff no longer need to return to base or the GP surgery to pick up notes - the use of remote working laptops has changed the way people work. Staff spend less time at base and increase their productivity when out and about.
Photo: Kirkless Community Health Services
Vision for faster healthcare
And, Flack says, it also increases the speed at which patients can receive their treatment. "We had one patient, a mother whose a baby had crossed vision. The treatment usually involves a visit to the GP who then registers an appointment with the local hospital, a process than can take a few months.
"With the laptop in the patient's home, the health visitor looked online and saw that the GP was also online - and was able to interact directly with him from the patient's home. The GP realised that it was in the patient's best interest to refer, and immediately made an appointment with the local hospital," he adds.
As a result of this immediacy of response, Flack says that the baby was given a hospital appointment to start treatment within three weeks, which is a much faster response than would have been possible under the old manual regime.
"The message here is simple - the technology is simple to deploy and use. It saves money and just works," he says.
BT Health provides the laptops to Kirklees CHS, as well as supporting staff in the field with remote access technical support or, where required, providing replacements on a next-day basis. Jon Moggridge, a BT spokesperson, says that the scheme has been well received, with the Toughbooks being kitted with integrated high-speed mobile broadband facilities and an integral NHS smart card reader.
The laptops are pre-configured and supplied by BT against an agreed standard build that includes the SystmOne clinical records application, as well as mobile Internet and email, using a secure mobile virtual private network connection to guard patient confidentiality.
Back at Kirklees CHS, Flack says that the plan is to deploy a further 50 Toughbooks to those staff that need them, with more in due course. With this further deployment, he says that his team are looking at a leasing arrangement to allow the trust to pay for the laptops out of operating expenses, rather than minor capital fund allocations.
Kirklees CHS has been working with BT Health to calculate the true cost benefits of the Toughbooks and has developed a 'benefit output tool' that can quantify how much money the mobile health worker solution can save in both direct and indirect terms. BT Health says the likely cost savings for Kirklees CHS is likely to be around £10m a year.
NHS Kirklees says that the next stage in the project is to carry out a study into whether the trust can reduce its property estate, as there are fewer staff to house in their offices.
The Toughbooks are provided under a centralised agreement for mobile health workers administered by the Yorkshire and The Humber strategic health authority. According to Trevor Wright, its deputy chief information officer, it is recognised that mobile health working gives clinicians the ability to make more informed diagnoses, more able to recommend the most appropriate courses of action and therefore deliver higher quality of care.
"However, as you would expect in the current financial climate, the key driver for mobilising our clinicians is centred on increasing productivity and reducing costs," he says. "The business case for mobile health working has been proven with a number of deployments across the region that have demonstrated an increase in clinician productivity and significant cost savings, including reduced travel costs and a reduction in unnecessary hospital admissions."
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