Videoconferencing in the Welsh Health Service Experience of the South West Wales Cancer Network and Hywel Dda Health Board Delyth Lewis Telemedicine Service Manager South West Wales Cancer Network and Hywel Dda Health Board

Introduction Requirement to achieve compliance with National Cancer Standards in Wales Meet challenges of delivering healthcare in rural Wales Response to clinical needs

National Cancer Standards  Calman Hine Report 1995  Cameron Report 1996 (recommendations) ­Cancer Centres ­Cancer Units ­Multidisciplinary Teams ­Cancer Networks ­Minimum Standards  Keeping Care Local (KCL) Feasibility Study, 1998 ­Reducing unnecessary travelling for patients and staff ­Forming electronic links with specialist centres and centres of excellence ­Creating educational links with others to overcome clinical isolation

Cancer Unit and Cancer Centre 75 miles apart Road infrastructure is poor - 4 hours travelling time by car Long distances for patients/ staff to travel Poor public transport – Limited bus service No rail links South West Wales Cancer Network covers a large geographical area – combination of inner city, urban and small dispersed rural populations. Challenges

Aims Telemedicine in routine use in Ceredigion and South West Wales over last ten years. Main aims: keep care local as much as possible reduce travelling for patients and health professionals improve the quality of care.

Examples of uses of videoconferencing Clinical use - ‘virtual’ meetings between cancer multidisciplinary teams in local hospitals and specialist teams in specialist centre. Patient videoconsultations – ‘virtual’ clinics Transmission of live images for specialist advice, radiology/ histopathology images and echocardiography ultrasound. Educational seminars, lectures and professional sessions. Management and staff meetings. Interviews (national/international). Cross video-network links eg Universities, County Council, English Health Authorities and International sites. Multi-site and point to point sessions. (No dedicated videoconferencing suites at NHS sites)

Virtual Cancer Multidisciplinary Team Meetings Improved access to specialist opinion Improved communication Improved patient care Achievement of national cancer standards Efficient Multidisciplinary Teams Strengthening of clinical networks

Environmental impact of using videoconferencing ( one month - one site ) October 2006 October 2007 October 2008* People using vc Meetings held Hours travelling saved Miles travelling saved 11,17612,99308,737 Travelling expenses saved £4,470£5,172£3,249 Total kg CO2 saved 1696kg2590kg2039kg Number of trees required to absorb total kg CO *14 excluded from survey – details of car engine/fuel and/or mileage omitted from questionnaire

Palliative Care Telemedicine Palliative Care Resource Centre Dedicated videoconference suite Marie Curie Hospice, South Wales Improved community staff support – access to ad hoc advice – weekly videoconference meetings Reduced the need for staff to travel for advice/support Extended to palliative care units at: Ty Bryngwyn - Llanelli, Ty Olwen -Morriston and Y Bwthyn - Bridgend Marie Curie Hospice link enabled: Joint educational meetings and best practice seminars to Consultant Palliative Care Physician and team in South Wales 40 miles 110 miles

Paediatric Cardiac Telemedicine Transmission of echocardiography images Singleton Hospital, Swansea 42 miles 1 day Welsh Health Video Network (minutes) Quicker diagnosis and implementation of treatment plan agreed by a group of experts. More efficient use of specialist staff. Reduced the need for Consultant Cardiologist’s travel to Singleton Hospital (especially on call). Lower cost of service delivery due to reduced travel expenses. Guidance/supervision of newly qualified staff in echocardiography ultrasound. University Hospital Wales, Cardiff

Neurology Telemedicine Clinic Improved patient access to neurology services - frequency of clinics increased from once every three months to six weekly. Waiting list eliminated. Neurologist travel eliminated Better use of scare resources, eg clinical time. Improved educational opportunities for staff at remote site. Opportunity for local physician to discuss neurological diagnosis/management of patients requiring local assistance from time to time (eg epilepsy). Instigated regional neuroscience videoconference meetings with remote site for consultant and trainee education.

Head and Neck Cancer Speech and Language Therapy Patient videoconsultations to Speech and Language Therapist in tertiary centre for pre and post laryngectomy management (Aberystwyth – Singleton and Withybush – Singleton) Patient benefits include: immediate positive verbal feedback not having to travel for consultations specialist services closer to home more relaxed, no anxieties about travelling, weather, parking etc Welsh Health Video Network

Clinical Pathology Conferences Clinicians use videoconferencing to link into educational, professional and multidisciplinary meetings, eg Interstitial Lung Disease Network, Regional Stroke Meetings, Welsh Paediatric Network, Nutritional multidisciplinary meetings) Benefits: Enables clinicians’ participation in clinical discussion on complex or interesting cases Opportunity to present own patients, share radiology and discuss management with colleagues across Wales (eg Regional Stroke Meetings, Interstitial Lung Disease Network) Reduced travelling expenses and clinicians’ time travelling Need for sites hosting conferences/educational sessions to make videoconferencing available

Management/Educational Use Multi-site management meetings between health board managers and locality staff, clinical team leaders and staff working across different sites. Cancer Network board meetings. Consultants and trainees linking into Paediatric Academic Programme – weekly sessions. Tele-lecture between Physician at Bronglais and Swansea medical students. Tele-lectures to students on BSc Medical Sciences and Humanities,- Module PM102 Delivering Healthcare at Swansea University and MSc Health Informatics Module at Swansea. Nursing staff linking into PGCE lectures at Newport University. Nursing students linking into lectures with Carmarthen Trinity College and Swansea University.

Lessons for Universities Training for users (including etiquette) to be confident and competent in use. Promote potential of videoconferencing. Introduce videoconferencing techniques into curriculum of future workforce. Reliability - network and equipment. Robust helpdesk support. Establish easier inter-organisational/network connectivity Encourage use of videoconferencing for lectures.

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