Technology is being used as a catalyst to deliver sustainable and repeatable benefits for patients, clinicians, and hospital systems across the globe. Torbay and South Devon NHS Foundation Trust in the UK is one such example.
The CONNECTPlus app which is described in this article is a platform for managing patients with multiple conditions. In England, it is being used to reduce demand and cost.
But for medical tourism destinations such as the UAE, it offers a single digital health platform to manage patients' health journeys, from pre and post-treatment.
By using CONNECTPlus the patient’s treatment journey begins as soon as they book their treatment. The app enables health services to provide patients with condition-specific information and guidance wherever they are in the world. It provides them with the information they need to help them prepare and rehabilitate and can enable them to capture information about their condition to aid the diagnosis and post-procedure treatment programmes.
As one of the first integrated care organisations in the UK Torbay and South Devon NHS Foundation Trust provides high quality, personalised acute, elective, specialist, social and community care services to a resident population of over 290,000 people, plus about 100,000 visitors at any one time during the summer holiday season. They employ over 6,500 staff including frontline health and social care staff, such as nurses, occupational therapists, social workers, consultants, and physiotherapists who work in people’s homes and community settings.
The hospital, like almost all trusts in the UK, faces multiple challenges of budgetary constraints, shortages of health staff and yet growing demand from an ageing population. In South Devon, the population is on average around 10 years older than the UK general population and within the footprint, there are also towns with very high levels of deprivation. These factors bring increased pressures and demands to the health of the population and in turn the hospital.
In addition, COVID-19 has added to the pressures on the system, increasing the backlog of patients needing elective care and outpatient appointments. For example, the usual throughput of hip and knee replacement procedures is 600 per annum and the waiting list has now risen to around 1100. Approximately 75,000 people received treatment in their Emergency Department each year, and 41,000 treated in the Minor Injury Units. There are around 500,000 face-to-face contacts with service users and carers in their homes and communities each year.
The role of digital
The trust believes that digital health has a major role to play in addressing these challenges and, it will mean:
• Increasing capacity with limited resources
• Improving safety and quality
• Empowering citizens, patients, and carers
• Being data-driven
• Saving money
Their overarching digital strategy is a transformation strategy for outpatients which focuses on the following objectives:
• Reducing the number of outpatient appointments required by 30 per cent
• Shortening remaining outpatient appointments and facilitating the delivery of remote virtual consultations (target 50 per cent of outpatient appointments)
• Enabling staff to operate at top of their licence
To enable them to scale their use of digital resources, principally video and apps to support and transform their pathways of care to support patients and reduce demand, they formed a joint venture with an independent company, HCI.
HCI, with support from the Trust, has designed a unique, multiple long-term conditions app CONNECTPlus and the Trust has selected it as one of its principal digital tools to enable them to deliver the digital health strategy and achieve the transformation objectives for outpatients.
Designed with patients and clinicians, CONNECTPlus is an app that helps people with multiple health conditions. It gives them the information they need to help them manage all their conditions so that they can look after themselves better at home and reduce their demand on the health system.
They can keep a record of how their symptoms progress, the appointments and treatment activities they book and the medications they take so that they can take control of their conditions and are better able to get on with their lives and need fewer appointments.
When patients do need an appointment the trend data they can provide enable more remote and virtual consultations reducing the number of face-to-face appointments.
The early evaluation showed a reduction in rheumatology related appointments of up to 50 per cent and seven hours of weekly nursing time released from the rheumatology education programme for patients being prescribed new medications. Within six months, the waiting times for MS clinics were reduced significantly. These early results gave a strong enough indication of the impact of CONNECTPlus to support the delivery of the objectives set for the outpatient transformation programme.
The hospital has shorter waiting lists and can focus their resources on the people that really need their help and offer better ways of supporting people to manage their conditions and live their lives more independently.
Adel Jones, Director of Transformation and Partnerships at Torbay and South Devon NHS Trust says of the app: ‘I have real confidence in the product because actually, it's been designed by patients and clinicians so that it meets their needs’.
Patients have also responded positively to the use of the app saying: “I believe this app is a tool for empowerment. It is actually something that encourages you to be resilient, it gives you the tools to work with the information, and notice some progress for yourself and think yea, I can do this, I can cope,” Valerie Bailey, App user and MS patient.
As a result of the successes achieved at Torbay and South Devon NHS Trust, HCI now provides services to multiple trusts across the UK. It has the largest library of health and care videos in the UK, now standing at around 1,000 videos and is the provider of the National Video Library to NHSx, part of NHS England www.healthandcarevideos.uk. This library supports the patients of secondary and primary care right across England.
2021 brings an accelerated approach to the implementation of CONNECTPlus in the hospital with 15 additional conditions being added across multiple pathways including multiple conditions in Cardiology, Ophthalmology, Gastroenterology, Respiratory and Diabetes, plus a pilot programme in planned care for Hip and Knee replacement where the app will be used for preoperative education, to create a remote joint school, and post-operative monitoring to reduce post-procedure appointments by 80 per cent and achieve savings of £216,000 each year.