Memorandum by SchlumbergerSema (DD 31)
David Tait is MD of the Public Sector Business Unit
of SchlumbergerSema, responsible for the company's business in
the Health Sector in the UK.
With over 22 years' public sector experience,
SchlumbergerSema is a major provider of IT, business and medical
services to the public sector worldwide. Drawing on sector knowledge
and capabilities in consulting, systems integration, managed services
and products, SchlumbergerSema enables government organisations
across the globe to run their operations more securely, cost-effectively
Specifically, in the UK, SchlumbergerSema currently
supplies systems and services to the National Health Service Information
Authority, to the National Health Service in Scotland, to Health
Authorities and to Trusts. In conjunction with the Charles Wolfson
Foundation, SchlumbergerSema has developed and implemented the
"CALM" system in the Royal Shrewsbury Hospital which
was mentioned in the 2000 National Audit Office study as a beacon
of good practice in avoiding delayed discharges and cancelled
2. SUMMARY OF
This evidence addresses the issues set out in
bullets 1, 4 and 6 of the Press Notice of 13 December 2001. That
is, the necessity to improve management of the patient flow, clinically
prioritised, through hospitals and to improve co-ordination with
other agencies "downstream".
Many current difficulties of the NHS, such as
delayed discharges and cancelled admissions, can be addressed
better by improved information systems of the kind demonstrated
at Shrewsbury to make better use of resources rather than throwing
more money at them.
IT systems in the NHS are largely antiquated
and certain features of the procurement process militate against
innovation and effective implementation of good practice on a
We believe that the future solution, at a local
level, must lie in the effective implementation of Electronic
Patient Records and workflow management techniques that will encourage
the essential changes in culture without which efficiency improvements
cannot be made.
Techniques of the kind implemented in Shrewsbury
have real potential to substantially improve matters in a measurable
way inside two years (with hard evidence of real progress within
one year) and we believe that a centrally sponsored initiative
should be set up to test the techniques thoroughly.
3. THE FULL
1. We welcome the opportunity to input to
the discussion on Delayed Discharges.
2. It is our belief that the NHS must modernise
the way it works to join up the various agencies that provide
elements of care to citizens. A catalyst for this change would
be the introduction of new, patient centred IT systems. Modern
cost-effective technology will facilitate access to information
by all agencies either directly or via national brokering systems.
Existing IT systems too often act as a barrier to change and a
drain on resources.
3. Discharges from hospitals are often delayed
because arrangements, eg for aftercare or even transport, are
made at the last minute. With constrained resources this inevitably
makes arrangements difficult and enormous human effort is employed
to minimise delays. The National Audit Office, in their 2000 report
on Bed Management, pointed out that in the last decade the number
of beds in acute care had remained stable. But the corresponding
huge decline in community beds over the same period has caused
a logjam moving back up the patient process as far as acute hospitals.
This leads to blocked beds, delayed discharges and many other
4. Any delay in discharge is firstly a human
problem. The patient involved is recovering, they are anxious
to move onto the next stage, perhaps to get closer to their family.
But it also wastes valuable and scarce resources that should be
applied to subsequent patients. This delay, in turn, results in
cancellations of admissions. For the subsequent patient this translates
to inconvenience, disappointment and, in many cases, in deterioration
of their condition. This is a bad experience for the patient but
it also represents spiralling healthcare costs for the NHS to
re-arrange things, to continue care whilst the patient waits and
finally the further treatment of a patient who has deteriorated.
5. Implementing new technology systems based
on a patient centred care process will, we believe, pay immediate
dividends in terms of increased efficiency (measurable and demonstrable)
and will enable the NHS to provide the consumer oriented service
demanded by the public today and to meet the challenges set by
6. The NHS must gain management control
of the patient process. Modern IT systems can help achieve this
by providing tools that capture information as "incidentally"
(ie as the patient progresses through the process of treatment)
as possible throughout the care of a patient starting at the ambulance,
the General Practitioner or the Accident & Emergency department.
This ensures that the information is timely and accurate and can
be used to re-inform existing plans. Furthermore IT systems should
then use this information to present operational tools to improve
efficiency across the entire system not just in one agency such
as a hospital. Sharing of accurate information about the patient
throughout the treatment process (or "care pathway")
enables all agencies to perform more efficiently, and indeed more
safely through minimising the risk that lack of information will
lead to the wrong treatment.
7. The NAO Report into Bed Management commented
that the application of IT to bring about improvements in operational
efficiency had only been demonstrated at one hospitalthe
Royal Shrewsbury. These improvements were attributed to the implementation
of CALM (Clinical Applications for Logistics Management) as part
of the SemaHelix Hospital Information Management system. Here,
modern techniques of clinical resource scheduling in the form
of CALM, embedded within the patient process have been demonstrated
to reduce cancellations of operations by 40 per cent and to increase
routine bed occupancy by 10 per cent from a national average of
82 per cent within a year of implementation. The impact on the
NHS overall, if these results could be repeated nationally, would
be dramatic in terms of resource saving, in care outcome improvement
but most crucially in the patient experience.
8. Using the CALM approach, a health community
can manage the use of beds and theatre time to ensure that clinical
priorities are applied to the use of these resources. They can
plan bed allocations, staffing levels and negotiate discharge
arrangements in advance. Finally they can spot and easily react
to any changes in circumstances. The NHS annually cancels 50,000
appointments on the day of admission whereas Royal Shrewsbury
contributes almost nothing to this figure because they have management
control of their "factory". The factory metaphor is
not intended to connote any dehumanisation of the processrather
it points to a key issue which is that IT-based planning and resource
management techniques which are commonplace and essential in manufacturing
industry can be successfully applied, mutatis mutandis,
to the NHS. Indeed, getting the right clinician to spend the right
amount of time with the patient the first time is not just more
efficient but a major improvement to the patient experience and
their welfare prospects.
9. This is best illustrated by the winter
'97 'flu epidemic in Shropshire. Using the CALM tools the Royal
Shrewsbury was quickly able to identify the unexpectedly high
number of medical emergency admissions. They therefore adjusted
the resources available to elective surgery but were able to preserve
the clinical priorities so that minimum cancer waiting times were
maintained. This is just what society wants from a National Health
Service. This is an improvement in care but it also represents
an enormous reduction in costs.
10. We feel that too often, the NHS procurement
process for IT systems does not facilitate this process of adopting
and adapting modern IT systems insights. NHS procurements of IT
systems are frequently protracted, expensive and result in poor
decisions. The consequence is that change is avoided and innovation
stifled. In fact, over 90 per cent of hospital IT systems are
based upon administrative systems that stem from 1980's designs
11. The CALM component which has performed
so effectively at Royal Shrewsbury is contained within SemaHelix,
a system developed by SchlumbergerSema with vital support from
the Charles Wolfson Foundation. The approach is not simply based
on new technology and the concomitant lower running costs, but
crucially, embodies the important principle which puts the patient
at the centre of a "joined-up" care process. It helps
to break down the strong cultural and procedural differences between
administrative and clinical functions in a health service. This
is essential because many functions hitherto regarded as administrative
have clinical facets. So, for instance, Bed Management is no longer
a fire-fighting exercise but must be seen as a clinical management
12. We propose that the experience at Royal
Shrewsbury should be replicated in a dozen "incubator"
health communities (possibly some of those with particularly high
incidence of cancelled appointments) to demonstrate the general
applicability of CALM approach and to demonstrate the benefits
of efficiencies, improved healthcare and patient experience already
demonstrated at Royal Shrewsbury. The results of this programme
would be measurable within a year of implementation.
This evidence can only scratch the surface of
the issues and we would welcome the opportunity to give oral evidence
to amplify our views and our proposal.