1. Pathway redesign - The Acute Hospital AIREDALE NHS FOUNDATION TRUST 28 th June 2011

2. No longer fit for purpose….. AIREDALE NHS FOUNDATION TRUST 28 th June 2011

3. How to change? - challenge everything Notes: Shared electronic patient records – John Parry TPP SystmOne Opinion: e-consultation – John Stoves / John Connolley Who is in charge?: Care Planning – Shahid Ali / R Pope ExemplarsDiabetes Renal Medicine Palliative Care Today’s focus: Telemedicine….

4. Prison Healthcare - the start line Patient Care UK Prison population - guaranteed the same access to healthcare as the general population Prison population 82,000 - challenging health requirements Security and Costs Inmates escape from hospitals, not from prisons Escort and bed watch costs >£25M/year (This does not includes consultation, hospitalisation and treatment) Public prisons - healthcare costs with PCTs

5. Could telemedicine help?

6. Prisons supported (5yr programme): Wide geographical area 20 prisons, including: Acklington (Northumberland) down to The Verne, YOI Portland (Dorset) 21 outpatient specialties offering elective services via telemedicine link, e.g. orthopaedics, dermatology, neurology, dietetics and physiotherapy A&E urgent care service available Effective

7. Where it is safe and effective to do so Patients are treated in the Prison, not Hospital Cost savings: Reduce acute and elective transfers out by ~50% Average cost per escort episode: £425 Average cost per bed watch episode: £3,731 Savings at least £400/transfer avoided Revised Pathway Other Benefits: Patient and Staff satisfaction Empowering Prison clinical staff Less disruption to NHS Acute Trusts Improved patient privacy and dignity Improved response times Reduced prison lockdowns

9. Implementation Challenges faced: Technology Existing technology – highly reliable Installing / maintaining in prisons… Culture RED TAPE…… Clinical acceptance – initially sceptical but now well supported Clinical capacity - job plans Critical mass crucial to success Governance Strong clinical governance Contemporaneous record Consultant delivered service Implementation Clear processes agreed Go live planned carefully Funding arrangements Security arrangements

10. Care close to Home

12. Care in the Home

14. Question 1: Overall level of satisfaction with completed Telemedicine Consultations 95% patients and 90% of clinicians described themselves as being “very satisfied” or “satisfied”.

15. Question 2: Level of satisfaction – ability to communicate issues and concerns during the Telemedicine consultation 90% of users described themselves as “satisfied” or “very satisfied”. Several patients have mentioned the positive benefit of including family members in the consultation:- “It was good how we can all have input; Dr. Pope, Jackie [DSN], myself and my wife all round the TV”

16. Patient quote “…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…”

17. When to use? Numerous potential use cases: Long Term Conditions Outpatients Nursing Homes Employee Health & Well being Early supported discharge admission avoidance Dementia – carer support Social Care Purely Social calling Specialist Networks

18. NHS Yorkshire and the Humber

19. Hospital:Hospital telemedicine “Distributed Specialist Networks” Telestroke tender won Infrastructure located at Airedale Mobile telemedicine carts in every Yorks+Humber ED VC-enabled laptops with on call consultant Intention that this would act as a common platform …….??

20. Conclusion Very strong future for digital healthcare (telemedicine) Transforming the Acute Hospital’s role and reach Hub approach key to get to scale Much to learn, but No more pilots – time to commit richard.pope@anhst.nhs.uk