How Good is Hospital Management at the Point of Care?

John Whelan, Group Editor

big_jwThe editor’s laptop at Hospital Management Magazine is bombarded daily with leading NHS Foundation Trusts and their PR agencies either boasting about their great new technology or from the private sector vendors showcasing their IT solutions. Yet believing all that is a fool’s paradise which may sound harsh but it is born out of my three months of totally chaotic care as an “NHS consumer”—I believe that is the right jargon.

The reality is rather different when it comes to the patient experience far removed from the press hand-outs—the leading NHS Trusts (mine is in central London) have paper-based systems, fax machines, lack of joined up care, and the consequence is wasted hours in hospital outpatient clinics and appointment letters that arrive the day after the appointment or simply not at all.  And each missed appointment costs the NHS over £150.

Even my home Trust with two hospitals sends you to the wrong hospital which is why I am late filing this copy. I took a taxi so no cost to the taxpayer there. And as for a seven day NHS then if you are admitted at A&E on a Friday—as I have been three times since November—doctors and nurses are actually on hand but rarely the technicians to carry out the necessary CT scans until Monday morning. So what does that cost the taxpayer in bed blocking terms when a stay of maybe two days in hospital lasts five?

So what needs fixing? Let’s use the language of the NHS—“multiple health records” are clearly defeating the system because clinicians and administrators (the people who phone you about appointments) have to reactively chase data, orders and other information across locations. This clearly makes it harder to provide support at “the point of care” to use NHS jargon but it also compromises the future of healthcare in this country.  Because information exists in NHS silos patients almost inevitably are asked for the same data multiple times when admitted to hospital wasting time and taxpayers’ money. This leads to the health and care professional having to re-key data that may already exist and log into multiple sources of information. In reality there is no one “single version of the truth” which leads to poor standards of care, delays in arriving at clinical decisions and a lack of continuity between different and often warring professionals—for example medical and surgical teams at my Trust rarely agree on “outcomes” especially when as a patient I have been admitted to hospital at weekends.

Technology experts no doubt can explain this away by such platitudes as “variation of the evidence base begins at the source” but the real priority is to exploit access to information at the point of care. This would enable doctors to engage more fully with patients even while out of the office and in real time. Chance would be a fine thing.