Business > Flexible Working

Making mobile working a reality

Gill Hitchcock Published 12 December 2012

Kent and Medway NHS trust's ICT director talks to Gill Hitchcock about the county's patchy Wi-Fi, the need for e-record integration and supporting social care networks


Mobile working for Kent and Medway NHS and Social Care Partnership Trust's crisis teams isn't always straight forward, particularly if they get a call in the middle of the night about a mental health crisis and need broadband to access patient records in the field.

They are relying on Kent's notoriously patchy broadband coverage and the trust's ICT director Les Manley admits this is an issue he is trying to resolve through talks with suppliers. "It might mean using multiple networks and roaming between them, or using wireless hotspots. BT, for example, has quite an extensive network of hotspots across the county, so we are trialling some of those things now to get the best overall coverage," he says.

The interim solution is for staff to know where they can get a signal. According to Manley: "Kent is not as patchy as in Cornwall, where they have what they call 'golden lay-bys', places where they know they have good coverage, and our teams are starting to develop that type of knowledge."

Kent and Medway's mobile teams are able to access a growing number of networks set up by partner organisations, however. As one of the country's larger mental health trusts, providing mental health, learning disability, substance misuse and other specialist services for 1.6m people, its staff use the Wi-Fi links of Kent county council and acute trusts, including Maidstone, Dartford, East Kent and Medway.

All the trust's new facilities are wireless-enabled, including the £10m St Martin's hospital in Canterbury which opened this autumn. It also operates two audio and videoconferencing suites in Canterbury and Maidstone, intended to facilitate meetings between staff across 100 sites and connect home workers. Presence instant messaging allows the trust's staff to check whether colleagues are online, and WebEx is used for briefing and remote training.

One of the early lessons that Manley and his IM&T team learned about audio and videoconferencing was the need for engagement, after his team installed the technology, provided training, but found people were not using it.

"The reason was that they were not comfortable with the technology. Despite training, they found that they might have a technical problem, and weren't quite sure how to resolve it, couldn't contact anyone immediately and so they gave up," he says.

"And because the whole meeting was then a disaster, they were disincentivised. What we have introduced is service management, so when they go into the meeting the session is maintained and monitored remotely and the people in the meeting don't have to actually do anything."

A key trust objective is to slash expenditure by £13m in this financial year. Manley says that IT is expected to contribute to savings and the shift to a private cloud has started to realise savings in network costs estimated to reach £145,000 a year. The private cloud currently provides about 1,800 staff with virtualised desktops and access to the RiO e-patient record system, Microsoft Office, finance, payment and ordering systems via a web browser.

He says that staff can access their desktop from any almost any location and the system is secure "because the only thing that you have is an image in the browser, no actual data moves up and down the wire". Significantly, the trust reported three data breaches last year, all involving the incorrect disposal of paper documents.

"We are saving on end-point support. I am talking about the technicians going out and fixing software problems and that is worth about £60,000. Technology refresh using the virtual desktop also allows us to replace out computers less frequently and has a value of about £40,000 a year," Manley maintains.

The private cloud is provided by the in-house team, supported by the Health Informatics Service, and neighbouring Medway Community Healthcare is piloting the service for its own use. But Kent and Medway also uses a public cloud hosted by BrightCloud for services such as its Maps Health Suite rostering system.

Manley admits, however, that most of the savings from IT are expected "down the line", in particular from a thorough review of paper driven processes over the next couple years.

He says that the shift to RiO a year ago brought a raft of benefits, including efficiency and better patient care and safety by having medical records in one place, but the lack of an e-record interface with other NHS and social care agencies is a major limitation.

"We see the mental health record on our system. What we can't see is all the physical health care from the acute hospitals; we can't see the primary care record from the GP, and some of the elements of those records are relevant to us," he explains.

Kent and Medway's IM&T team is currently working with Medway and other councils to integrate their systems, as well as with GPs so that when a patient is discharged by the trust it can produce an electronic discharge summary which will be securely posted into primary care patient record systems.

The trust is also looking to improve patient feedback. The primary method is to use a tablet device to enable patients to complete a nationally agreed questionnaire. But as part of its IT strategy, in 2013 it will begin developing an interactive patient portal with the aim of making the patient's records, appointments and contact information available online at a single point. Manley predicts the project is likely to take 18 months to develop.

"We might even look to use the portal to deliver services, so maybe using that combination of conferencing tools and WebEx services we will engage with some patients without them having to travel to our clinics," he says.

An increasing number of mental health services are introducing online therapies and Kent and Medway is working with 50 patients to pilot Buddy, an online tool for recording mood changes which also facilitates text message prompts for activities, such as exercise. It is also talking to the designers of Grouple, an award winning private online social network intended to help people share the responsibilities of caring for someone with dementia.

The concept is that Grouple enables members of a care network to post their schedules, ideas and experiences of caring, and divide responsibilities and efforts to provide regular care without one person being overburdened.

So what is Manley's biggest challenge in delivering IT services to nearly 3,500 staff with a revenue budget of £5m? "It's an awful lot of trying to juggle and so it's that constant checking and rechecking and making adjustments when we have technical problems, external dependencies that let us down. It's just keeping the whole thing on track really."



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