Forget S.P.E.C.T.R.E, Mr Bond S.L.O.T.H is the enemy! Professor James Ferguson, Professor of Remote Medicine, Robert Gordon University Clinical Lead, Scottish Centre for Telehealth and Telecare Consultant Surgeon in Emergency Medicine, NHS Grampian

The Enemy - SLOTH Secret League Opposed to Tele Health and Care

ED Door to medical team time 30-day adjusted mortality P < 0.0001

The Healthcare Quality Strategy for Scotland: Effective The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated

Aim Provision of rapid access to senior paediatric clinical support for unscheduled care cases by video conferencing, initially for clinicians in rural general hospitals (and selected “no pass” healthcare facilities).

Background Instigated by The Scottish Centre for Telehealth and Telecare Supported and funded by the North of Scotland Planning Group One of the highest priorities from the North of Scotland Paediatric Sustainability Review by Dr Zoё Dunhill was to participate in the pilot Project management provided by NHS24

Set Up - Users

Set Up – NHS 24

Set Up – Hospital response Recruitment of On Call Consultants

Set Up - Evaluation

Key Findings Activity 230 calls from August 2013 until July 2014 approx 4 per week Confidence: Staff and parents Consistency Transfer support Local knowledge: Capacity and competence. Medico-legal Work arounds

Key Findings (cont) Peer Review 5 Clinicians Rural GP Paediatric ED Consultant PICU Consultant General Paeds Consultant (DGH) General Paeds Consultant (Tertiary Centre)

Peer Review Improved care: 33% (Range 20% to 60%) Avoided transfer : 25% (Range 15% to 50%)

“Veterinary” Paediatrics Paediatric clinical examination made easy; 5th Edition, Denis Gill, Niall O’Brian. Churchill Livingstone 2007

KERR REPORT

Technology Enabled Care (TEC) Integration of Health and Social Care

MACHIAVELLI Let it be noted that there is no more delicate matter to take in hand, nor more dangerous to conduct, nor more doubtful in its success, than to set up as a leader in the introduction of changes.   For he who innovates will have as his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.   This lukewarm temper arises partly from the fear of adversaries who have the laws on their side and partly from the incredulity of mankind, who will never admit the merit of anything new, until they have seen it proved by events.   The result, however, is that whenever the enemies of change make an attack, they do with all the zeal of partisans, while the others defend themselves as feebly as to endanger both themselves and their cause. "The Prince"  Niccolò di Bernardo dei Machiavelli published in 1513  Born 3 May 1469 Florence, died 21 June 1527  Italian diplomat and political theorist

“Better an imperfect tool than no tool at all” WAYNE BOBBITT