Will Smart, director of IM&T for Royal Free Hampstead, on how he and colleagues are trying to connect London’s hospitals.
The NHS needs to improve co-operation on a local basis, Will Smart, Royal Free Hampstead trust’s director of IM&T, has told an event in London.
In December, Royal Free and partner University College London Hospitals (UCLH) trust launched a joint procurement for an Oracle finance system worth up to £20m.
However, Royal Free has no connection to records used by UCLH, despite the finance plans and the trusts being closely linked through both the UCL Partners academic health science partnership and the University College London medical school, Smart said.
“We need to connect up the health economy,” he told an event run by supplier OpenText in London. “That’s our challenge.”
Establishing joint working and connectivity presents significant difficulties, according to Smart: when Royal Free compared its ICT infrastructure to that used by other London acute trusts, it found that 95% of systems were different. Another challenge comes from trusts competing for business: “The NHS is a small world, so we do tend to know our peers,” he said. “But it does tend to be opportunistic.”
The health service has historically had a tranche of management that could facilitate local co-operation between trusts. That level of management was partially removed when the last government combined 28 strategic health authorities into 10, and has been cut further under this government with strategic health authorities (SHAs) being combined into four clusters, covering the north, Midlands, south of England and London. The SHA clusters will be abolished in April 2013, although the NHS Commissioning Board plans to retain the four zones.
Smart criticised the National Programme for IT, which had aimed to establish common systems for the health service allowing connections between trusts. Royal Free uses Cerner’s Millennium patient record suite, provided through the National Programme: “It works for us. It saves people’s lives,” he said. “It’s just delivered under a framework that is barking mad.”
Royal Free experienced “a significant number of problems” introducing Millennium in 2008, with the software’s introduction needed far more resourcing than expected.
The trust plans to improve its own patient records through a pilot a document scanning system in its infectious diseases department.
The trial will start in March, with the hope of using the system to phase out the 30m paper records in the hospital’s basements. The trust is using agile methods to run a quick pilot of an OpenText system, with which it signed a memorandum of understanding in November. According to Smart, the trial will focus on creating an easy to use interface – something he said had been a problem with other systems used by trust.
Saving money also remains a focus at the trust: it is cutting £120m from its £556m annual budget over five years, with £30m going from the budget in this financial year alone, Smart said. “That clearly can’t be done by managing agency costs or being harder on suppliers,” he added. “It’s got to be done fundamentally changing acute care.”
As part of this, Royal Free is reducing the number of elderly patients it admits, and discharging them more quickly. This depends on ensuring there is appropriate care in the community, Smart said, which the trust is doing through working with partners including the London boroughs of Barnet and Camden and their equivalent primary care trusts, rather than by taking over provision of such care itself.
“We’re beginning to look at the world as a supply chain,” said Smart, adding that through this process the trust has prevented 640 elderly patients being admitted through this work, and cut the readmittance rate from 24% to 7%, which has allowed the trust to close a ward in its main hospital.
Smart told the audience that suppliers wanting to work with his trust, and with the NHS in general, do not need direct healthcare experience, but must be able to show how they can create savings rapidly, rather than two years after deployment.
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