News
The tablets that help cure cancellations
O
n a hot summer’s
afternoon, Roger Burns,
a cancer survivor, is
outside the café in the
sweltering lobby of
University Hospital
Southampton. He’s had one of his
regular check-ups and is thrilled to
still be clear of the prostate cancer he
received successful chemotherapy
treatment for two and a half years ago.
The retired civil engineer, 73, is one
of 20,000 patients who are signed up
to an online system which allows them
to check vital test results quickly and
easily from their own home. It means
Mr Burns can find out the results of
his regular checks for levels of PSA – a
protein linked to prostate cancer – by
checking his tablet or computer at
home within two or three hours of
having a blood test.
Before he signed up to the system,
called MyMedicalRecord, he faced a
three or four-day anxious wait before
he could call his GP surgery and, as he
puts it, “argue with whoever picked up
the phone to get told the full result”.
Seven years ago, when he was first
diagnosed with cancer, there were also
delays to the start of his treatment.
And when he finally did get an
appointment to start radiotherapy, it
was cancelled with no explanation. MrBurns submitted formal complaints
about both incidents and was told they
were due to failings with “internal
procedures”.
It is procedural failings like these,
plaguing hospitals up and down the
country, which University Hospital
Southampton NHS Foundation Trust is
now using technology to try to avoid.
In the past decade, the number of
cancelled appointments has almost
tripled, with close to 8.93 million
cancellations by hospitals in England
in 2017-18 – a rise from 3.25 million in
2007-08.
Across more than 150 NHS hospital
trusts, the Southampton trust was
10th worst – with almost one in five
appointments ending up cancelled.
Now it is one of just 16 acute hospital
trusts awarded a £10 million grant by
NHS England under the Global Digital
Exemplars programme. The project
aims to encourage hospitals to develop
and test technology which can be used
more widely in the health service to
tackle common woes.
In early 2016, a few months after
Mr Burns started using the graph on
MyMedicalRecord to check his results,
he noticed a gradual increase in his
PSA levels.
He messaged the cancer team
directly through the system and
within 24 hours was booked in to see
a consultant. This time, he received
treatment swiftly.
“Obviously the consultant would
have looked at my results and bookedme in at some point anyway but they
can only check results at set times so
it could have taken a few days,” he
explains.
“As I was able to check the results
within a few hours, I could contact
them and get booked in straight
away. It meant everything happened
more quickly, which gives you peace
of mind.” Mr Burns can also use the
system to read any letters which are
sent to his GP. Twice he has spotted
errors – one which got his name wrong
and one which included inaccurate
information about his condition –and messaged the hospital to correct
them. The services available through
MyMedicalRecord are helping to cut
the number of appointments taken up
by healthy patients simply being given
all-clear test results.
Around 650,000 outpatient
appointments are made in
Southampton each year but the trust
estimates 20 per cent of these – around
130,000 – are unnecessary.
However, the piecemeal nature of
progress across the NHS, the world’s
fifth largest employer, means that
even when Southampton makes a stepforward, it can be held back by the
glacial pace of change elsewhere in the
country. Improvements in technology
at Southampton mean Dr Ashwin
Pinto, a neurology consultant, can now
see his patients’ MRI scans as soon as
they are performed – but only if they
live in the Hampshire region.
As a specialist who treats patients
from anywhere between Devon and
West Sussex, he must battle archaic
systems to get hold of results from
further afield.
Many patients’ notes are still
physically posted to him, while scanresults must be uploaded by someone
at a patient’s local hospital, sent
overnight – when there’s less demand
on the bandwidth for electronic
transfers – and then downloaded
and assigned to the right patient at
Southampton. The whole process can
take two or three days.
“There’s still too much delay in
transfer of notes, some of which
remarkably are still sent by post –
although at least we now have turned
off our fax machine,” he says.
“There’s nothing more frustrating
for a patient than going to their doctor
and finding they don’t have the right
information because the technology
has let them down.”
In the hospital’s intensive care
unit, consultant Matt Cordingly is
reaping the benefits of 18 months of
painstaking changes. Over the period,
an iPad-based patient notes system
has been brought in to replace the old
computer-based systems and their
paper-based predecessors.
When notes first began to be moved
from paper to digital around 20 years
ago, they were stored on computers
which either had to be wheeled around
the ward on huge trolleys, or were
fixed at a desk so a junior doctor had to
keep running back and forth from beds
to find the relevant information.
With the iPad-based system, called
digiRounds, medics can use tablets at
the bedside to view all the information
for each patient on the ward, including
test results, medications and vital
observations on their condition.
Since the system was rolled out
across the hospital, it has saved around
a minute and a half per patient which
was previously wasted on simply
trying to find information, meaning
doctors doing a ward round with 20
patients now have an extra 30 minutes
to treat them.
Sandra Souto Hermida, a ward sister
who works on one of the hospital’s
16 medical wards, has also seen the
benefit of technological advances. She
used to spend at least an extra hour
of her day trying to get hold of all the
information necessary to discharge
patients, including checking results
and ordering prescriptions.
For each patient, it involved logging
in and out of up to seven different
computer systems, and she was often
held up by the slow computer or other
people needing to access it.
Now the ward boasts a large screen
called an eWhiteboard, which at one
glance shows the nurses all the vital
information they need to know about
each patient, including whether tests
results and medications have arrived
or are still outstanding.
When it comes to discharging
patients, what would have taken 20
minutes to find under the old system
now takes just two.
It has also reduced the amount
of time patients are left waiting. “It
used to be I would find out at 11am
they could be discharged, but they
wouldn’t go home until 8pm,” she says.
“It has reduced the time they have
to wait as it’s easier for me to chase
things like discharge letters – and the
patients are more informed about
what’s going on while they’re waiting.”A hospital in Southampton is pioneering the use of technology to ensure patients get seen by doctors on time, reports Rosie Taylor
Patients left suffering by the ‘failures
and bungles’ of NHS administration
GPs prescribe plants to get
to the root of depression
Continued from Page 1
experience is not the care they receive,
but the failures and bungles of NHS ad-
ministration. Cancelled appointments
... can add massively to the distress of
being unwell.
“Patients are not customers – they
cannot take their ‘custom’ elsewhere.
But at times the NHS offers a level of
service that would prompt customers
of banks, internet service providers or
many other businesses to switch their
provider.”
Lillie Wenzel, a fellow at The King’s
Fund, said too many patients were
forced to battle with the NHS system
over cancelled appointments and other
failings in administrative processes.
The think tank is about to launch a
research project, to examine the im-
pact of “bad admin” on patient care.
She said: “The NHS is under signifi-
cant pressure and there are numerous
reasons why an appointment might be
cancelled. Despite the efforts of many
NHS staff, patients’ experience is often
hampered by poor administration.
“We hope to establish whether the
negative experience some people have,
and the anecdotal evidence many of us
hear from friends and family, is just the
tip of the iceberg,” she said.
An NHS spokesman said: “Patient
satisfaction with outpatient services is
the highest ever recorded, but while
the proportion of appointments which
are cancelled by hospitals remains low,
we recognise it can be inconvenient if
it happens to you or a loved one.
“That’s why the NHS Long Term
Plan sets out how – through a combina-
tion of more services being provided
closer to home and better use of tech-
nology – we will deliver an increasing
amount of routine care in a way that’s
more convenient for patients, and re-
duces pressure on hospital teams.”
Trusts said they provided care as
quickly as possible and apologised for
the inconvenience when patients suf-
fered repeated cancellations.
They said they were coping with
growing demand and attempted to pri-
oritise the most clinically urgent cases.By Sarah Knapton SCIENCE EDITORFOR thousands of years plants have
been used to alleviate anxiety and de-
pression, with Pliny the Elder recom-
mending borage, and the Roman
military doctor Proscurides extolling
the benefits of St John’s wort, as early
as the 1st century AD.
Now the NHS is catching up, pre-
scribing plants instead of pills in a pilot
scheme in Greater Manchester.
Instead of sedatives and antidepres-
sants, patients are being given a tub of
herbs, pot plants or trays of vegetables
to tend in the hope that caring for a liv-
ing thing will help lift their spirits.
Doctors have also selected specific
herbs for their mood-boosting ben-
efits, including lemon balm
which is used in aromatherapy
to relieve anxiety, stress and
shock, and catmint which
helps release tension and aids
insomnia.
After tending to the plant for
a while, patients are encouraged
to bring it back to the surgery’s
communal garden, and get involved
in looking after the space. It is
believed to be the first scheme of
its kind in the country.
Augusta Ward, 31, a medical sec-
retary at Cornbrook Medical Prac-
tice in inner-city Hulme, said: “The
plants we will be giving people are
mainly herbs – things like lemon balm
and catmint, which all have mindful
qualities.
“Having something to care for
brings so many benefits to people –
especially for those who may not have
a garden or be able to have pets.
“The plant is then a reason
to come back to the surgery
and get involved in all the other ac-
tivities in our garden and make new
friends.”
Matt Hancock, the Health Secretary,
has called for an increase in “social pre-
scribing” in a bid to “shift the balance”
away from automatically prescribing
drugs for many illnesses. At last year’s
NHS conference in Manchester heRepeatedly cancelled
appointments are on the increase
Instances where hospitals have cancelled
the same appointment repeatedly,
by year of cancellationSOURCES: 41 NHS HOSPITAL TRUSTS IN ENGLAND AND
WALES WHO RESPONDED TO A FOI REQUEST2016 2017 2016806040200(thousands)Instances where an appointment was
cancelled 3+ times2016 2017 2016151050(thousands)Instances where an appointment was
cancelled 5+ times2016 2017 2016200150100500Instances where an appointment was
cancelled 10+ timesAndrew
Marsden, 50, a
stroke survivor,
was due to see
his hospital
consultant last
October – but
the appointment
was cancelled
four times.
In one case, he
received his
cancellation
letter at 7.30pm
the night before,
after it was sent
by taxi.
Even when he
went to see his
GP, after
suffering a
suspected
repeat attack,
the hospital
continued to
postpone his
consultations- resulting in a
delay of four
months before
he saw a
specialist.
Mr Marsden,
from Oldham,
said: “I didn’t
know what to do
or where to
turn. I was really
frustrated.”
Despite Mr
Marsden’s pleas,
administrators
at Pennine Acute
Hospitals Trust
said there was
nothing they
could do.
It wasn’t until
February that he
saw a junior
doctor, who was
running late and
apologised for
eating a
McDonald’s
during theconsultation, Mr
Marsden said.
And it took until
April – a full six
months later- until he saw a
consultant.
He said: “She
was half an hour
late, didn’t have
my notes, and
didn’t know
anything about
my recent
incident.”
He said that in
many of his
encounters with
the NHS, he was
struck by how
“disorganised”
and “unpro-
fessional” it was.
Pennine Acute
Hospitals Trust
did not respond
to a request for
comment.
Stroke survivor I waited six months
Dr Ashwin Pinto
and Dr Matthew
Cordingly check
patient notes on an
iPad at University
Hospital
Southampton in
Hampshire‘There’s still
too much
delay in
transfer ofnotes, some
of which
remarkablyare still sent
by post’Lavender
Its distinctive
scent is
thought to
encourage
relaxationCatmint
The herb is
believed to help
release tension
and aid
insomniad
ry’s
lvedveded
isis
ofofecc--
Pracc-
“Thehe
e are re
n balalm m
mindful ulre ffor or
eople ––
t t havhave
...erac-
ke newthought to
encourage
relaxationCatminit
CHRISTOPHER PLEDGER FOR THE TELEGRAPHRoger Burns can
see the results of
his hospital check-
ups within hours
from his home
computerurged GPs to encourage patients to be
more sociable and active by referring
them to classes and groups to reduce
reliance on painkillers and antidepres-
sants. Studies have shown that the
presence of potted plants in homes, the
workplace, schools and hospitals has a
mood-boosting effect and can also help
to lower blood pressure.
Tending to gardens is also
known to alleviate sad feelings,
while the social nature of group
gardening is thought to help de-
pression as it centres on a collective
goal, and prevents people worrying
about individual problems.
Dr Philippa James, one of the sur-
gery’s GPs, said: “I’ve seen how
our patients relax in the garden –
and how they then get involved
in wider events like picking litter,
which all adds to pride in our area.
“There’s a lot of evidence now about
how two hours a week in a green
space can lift mood – and then that
too has physical, mental and emo-
tional benefits. That’s some-
thing we need to harness.”
The idea is backed by the
city’s health commissioners,
who want to promote com-
munity support or ‘social pre-
scribing’ to improve
well-being in the city.
Many of the plants for the
scheme have been donated.4 **^ Monday 26 August 2019 The Daily Telegraph
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