James A Thomas
Chief Operating Officer
As the number of patients with COVID-19 decline we have begun work around recovery and restoration of services, as described in Suzanne's recent messages.
We have also changed the bronze / silver / gold command structure we implemented at the start of the COVID-19 situation and as such, all COVID-19 news and the weekly update with numbers of COVID-19 patients, discharges etc. will go out through Ryalto and the bulletin and we have reinstated our usual Chief Executive's weekly message. Over the coming weeks we will share much more detail about the new operating model which sets a new objective for the Trust to end health and care acquired infections for the team, patients and the community we serve in order that we can deliver our mission to ensure the provision of high quality sustainable healthcare services. Fundamentally this is about creating a safe environment for you and for patients so we can reinstate services confidently and build on all the good work we've done. Staff testing will be an important element of this approach and as the policy becomes clearer we will share more detail about this (including the antibody test), social distancing measures across the hospital sites and a robust infection and prevention control policy to prevent hospital-acquired infection.
The start of the pandemic triggered a significant change to the way we work. Although there has been more media coverage about the impact of COVID-19 on emergency services, critical care and wards; outpatients has also changed beyond recognition throughout the emerging COVID-19 situation.
We have seen an overall reduction in outpatient activity, for a variety of reasons including redeployment of staff to cover more inpatient areas. There has been a dramatic reduction in outpatient face to face activity since lockdown commenced to follow social distancing guidelines, with a corresponding increase in virtual activity. All services are now undertaking recovery planning to look at how they can increase activity to pre-COVID levels, whilst maintaining and hopefully increasing the benefits of the changes that we have seen to date by moving the majority of activity to virtual. I suspect many of you, like me have been turning to video based platforms such as Zoom and Microsoft Teams to have meetings and keep in touch with family and friends and would never go back to the telephone – Attend Anywhere is the video answer to virtual patient consultations. The virtual model brings many benefits to patients and the team and importantly aides the reduction of footfall within the organisation which is essential if we are to operate in a way that ends infection transmission. Other positives include:
- A better experience for those who find it physically difficult to leave home and travel to site
- More convenient options for those with work or caring responsibilities
- Reduced site congestion with increased availability of car parking spaces for those who need them
- Positive impact on the environment with fewer unnecessary car journeys
- More efficient model for teams delivering outpatients services, enabling them to cope with increasing demand
To give you an idea of the numbers – in 2019, England was seeing a 6% annual increase in outpatient (OPD) consultations resulting in >100M outpatient appointments per year. Studies have shown that 20% of patients report feeling worse after attending an outpatient clinic because of the stress involved in the journey. 5% of road traffic in England is NHS-related, contributing to pollution and traffic congestion. HMRC have calculated that every hour of the average adult's time costs £17 to society, so 3 hours of a patient's time (travel, parking and appointment) costs society £51 per outpatient appointment, with a further £51 for any partner/carer who accompanies the patient to their appointment. The case for change was clear and that was before COVID-19! We'd made some good progress already but responding to the COVID-19 situation has galvanised a response at pace and our mission now is to continue building upon that great work. The graph below gives you a flavour of the progress we've made in moving from face-to-face to virtual appointments. This includes both telephone and video appointments and the use of a system called "Attend Anywhere" as part of a national pilot with NHS Improvement.
All services are requested to increase usage of Attend Anywhere - a video based appointment platform. For clinicians, it very easy to use and has additional functionality compared to telephone clinics (e.g. screen sharing, ability to visually assess the patient in their own environment). It also enables people to work flexibly and remotely. For other colleagues, there are changes to the admin processes for booking and outcoming clinics but the process is straight forward and guidance is available to help with this. Attend Anywhere has many of the attributes of a face-to-face consultation and as such is far more versatile than a telephone conversation.
For patients, they are able to see and interact with the clinician so it is a more personable service than telephone consultations, and feedback has been really positive. One patient commented:
"I have to say that I was a little anxious about the video call as I have never done this before, but I will definitely be happy to do it again when needed, it was so easy and so much less hassle, and the physiotherapist was absolutely brilliant! Definitely a 10/10 from me for this service! Thank you".
The therapies team were early adopters of the Attend Anywhere system and as such are currently providing over 200 video appointments per week. The team helpfully put together a series of helpful training videos;
- For Patients
- For Clinical staff
- For Non-Clinical staff
Another service that have innovatively adopted Attend Anywhere is the Respiratory-Emergency Department (REED) clinic. This was implemented to enable safe and supported discharge home for patients attending the Emergency Department with COVID-19 symptoms who were felt to be at high risk (for example due to age or co-morbidities), but who at the time of attendance were not experiencing significant symptoms. Patients are discharged with a device to measure oxygen and followed up at regular intervals for around seven days for monitoring. This meant there was a lot less pressure on our inpatient beds than we otherwise may have seen during this time.
So in summary, we need to continue our adoption of Attend Anywhere for outpatient services where possible. Having been through such a rapid and significant change, and received such positive feedback from both patients and colleagues, this is a game changer for outpatient services and we must embrace this new way of working. Of course, there will always be a requirement for some face-to-face consultations but the new model means this is the exception and not the rule.
Divisional teams will be working with colleagues to increase virtual activity in their area as part of the national COVID-19 recovery programme which is now underway, so please do discuss with your service manager. Jamie Parkinson is the clinical lead for the roll out of Attend Anywhere after extensive experience in using the system for therapies. He is working with several of our services across the Trust and although outpatient clinics are likely to be the main beneficiaries, there is also potential that this could help in other areas of the Trust (e.g. ward staff wishing to help patients stay in contact with family).
I hope you all have a pleasant weekend and the opportunity for some well-deserved rest.
With best wishes
Chief Operating Officer