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Learning to Walk

The tale of the man who is learning to walk again thanks to an implant of regenerative nasal cells has hit the headlines in a big way. Remarkable in itself, the successful treatment carried out by a team of British and Polish doctors holds out hope for the millions of people across the world who have been paralysed by a form of spinal injury.

Of course, as with any medical breakthrough the story comes with a caveat. The man’s injuries were caused by a clean stab wound, helping the possibility of regeneration and just as one swallow doesn’t a summer make, one success story doesn’t automatically lead to universal success.

But stories of this type do show the way in which pioneering work is continually going on under the radar, with dedicated teams working across the world to create lasting solutions for problems which affect millions of us. In fact, a Thomson Reuters white paper earlier this year predicted that 10 inventions which would change the world by 2025 included:

  • Greater understanding of the human genome leading to improved detection and prevention rates for degenerative diseases such as Alzheimer’s
  • Advances in RNA-guided genome engineering which would lead to the eradication of conditions such as Type 1 Diabetes
  • Advances in antibody production and targeting which will make cancer treatments more individual and less toxic
  • Improved management of disease thanks to DNA mapping at birth

Whilst important work of this nature continues, for the health profession generally there is a continuing drive to do more with less. Every breakthrough comes at a cost and with an aging population the strain on resources is ever upward. So when hip and knee joint degeneration means that the patient is unable to walk properly; the strain on the rest of the body can lead to multiple complications. For example a lack of exercise, and even something as simple as a regular walk can apply here,  can lead to cardiovascular disease, poor circulation, and increase the risk of developing type 2 diabetes.

An increasingly elderly population combined with the demand from the population at large to come up with solutions puts ongoing pressure on health services. Health practices including physiotherapists, osteopaths and podiatrists are not only looking for medical breakthroughs but are also taking advantage of the way in which technology can help to provide greater efficiency on a daily basis.  Areas such as the use of virtual assistants, electronic filing of records, on-line appointment and diary management and electronic payments are all under scrutiny in a drive to do more with less. And the more that the routine is automated, the greater the time available for research and patient care.

IT-related savings may not have the headline grabbing glamour of advancements in cancer care or mobility but nevertheless efficiency savings are the backbone of a drive to improve patient care. For not only do they save time and money, they also free up valuable clinical time, helping to increase the time which health professionals are actually spending with patients and that can only help everyone in the long run.

Prescribing Physiotherapy

New laws in Wales have opened up the way for physiotherapists, chiropodists and podiatrists to be able to prescribe medication to their patients. The change will bring Wales into line with England and Scotland which brought similar regulations into play in August 2013 and May 2014 respectively. The ability to prescribe medication is an important facet of physiotherapy and allied health services.

For a start, with physiotherapists and others prescribing medication as required, treatment pathways can be smoothed out with patients no longer having to wait for doctors to prescribe before they can continue a course of treatment.  Not only that, by integrating physiotherapy into the treatment/prescription mix, health professionals are able to deliver a more holistic treatment plan.  As a consequence, this practice speeds up recovery time whilst simultaneously reducing the burden on the rest of the NHS

Speaking about the new laws the Chartered Society of Physiotherapists said “We have noticed that the new powers have made a particularly strong impact in both neurological rehabilitation and in the treatment of musculoskeletal conditions, such as back and neck pain” whilst Welsh Health Minister Mark Drakeford said patients would get “a faster, more effective service with quicker access to the medications they need.”

Subject to training, other health professionals such as pharmacists and optometrists already have the power to prescribe. Moves such as these have the potential to have a profound effect on standards of patient care as well as making a more efficient use of health service resources. With increasingly busy lives and increasingly long lives, these resources are going to be stretched more and more unless further measures are taken to enable health professionals to optimise patient care. In fact, recent statistics have revealed that the number of those reaching the 100 mark has soared in the last decade, with (in 2013) nearly 14,000 people in the UK alone having passed that milestone with 710 living beyond 105.

Putting additional powers in the hands of those who need them is one way of helping our health services.  So too is any move which enables specialists to concentrate on clinical time rather than on administration time.  After all, if we are giving physiotherapists and other health professionals the tools which enable them to deliver a more holistic and complete level of treatment then the least we can do is ensure that their patient-facing time is optimised.

That’s where making the best use of technology comes into play. Measures such as on-line appointment books which patients or virtual receptionists can access remotely, electronic filing of patient records, or the ability to switch routine calls to a virtual receptionist service are all designed to free health professionals from routine administration tasks. Not only does this give those working in physiotherapy practices and other health services more time to practice the skills which they were trained for, they are also more able to take on additional clinical duties such as prescribing.

Working smarter not harder may seem like a cliché but it is one which can have a profound effect on patient recovery times and on the ability of health professionals to do their jobs to the best of their abilities.

Tackling Late Payments

The economy may be improving but late payment of invoices is still a problem for small business.  So say the Forum of Private Business (FPB) whose latest survey revealed some worrying statistics in respect of late payers.

According to the survey 23% of respondents say that they have seen an increase in the number of late payments whilst 29% report that the number of days payments have been delayed beyond the deadline have also increased.  In the light of this, respondents have called for better publicity in respect of late payment issues as well as a range of sanctions for late payers to include barring persistent offenders from government contracts.

Responding to the survey’s findings, FPB Chief Executive, Phil Orford MBE said “upwards of £30 billion remains tied up in late payments, costing a typical small business 130 hours a year to chase and meaning that a third are forced to seek external finance to cover the gaps in cash.”  Tackling late payments is a challenge which potentially affects every business and even those within the health sector are not immune.  In fact, businesses such as physiotherapy and osteopathy which rely on patients paying for treatments not only have to cope with potential late payers but also with a loss of income from those who fail to turn up for appointments.

Alongside diary management and appointment reminder solutions which aim to cut down on missed appointments, health practices may also wish to turn to secure card processing as a means of ensuring swift payment for treatments.  With booked appointments backed up by a pre-authorised card payment the health practitioner knows that they will receive prompt payment following the appointment.  And if the patient fails to turn up, a card payment can still be taken in accordance with the practice’s cancellation policy.

Pre-authorising a card at the time of booking doesn’t commit the patient to using that card following their appointment.  If they choose to pay by cheque or cash or to use another card then the pre-authorised amount can simply be cancelled.  This means the patient retains payment flexibility whilst at the same time the practice receives prompt payment; helping to smooth over cash flow issues.  The simple fact that a payment has been pre-authorised also helps to act as a spur to patients to keep their appointments, helping to reduce the number of gaps in a practice diary and ensuring that those who need treatment receive it promptly.

Improving patient outcomes

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know

Donald Rumsfeld’s comments on the presence, or otherwise, of weapons of mass destruction may have passed into folklore but they do encapsulate the dilemma facing anyone who seeks to move away from the tendrils of speculation and into a position of certainty.  Particularly so in the field of research where some studies result in ground breaking initiatives whilst others merely confirm unproven but seemingly obvious theories.

For example, a Europe-wide study into nursing practices has shown that a combination of nurse education levels and patient/nurse ratios can have an impact on patient outcomes.  Whilst the initial reaction to this report may be to dismiss it as stating the obvious, an already known known; studies such as these are invaluable in both proving the theory and in quantifying the extent of the problem.

So whilst we may have thought that we knew increasing the workload of nurses may lead to poorer patient care, a study which concludes that increasing a nurse’s workload by one patient is associated with a 7% increase in patient deaths can only serve to sharply focus the attention.    The report also concludes that in return for a 10% increase in nurses with degrees the risk of patient deaths falls by 7%; something which will be of comfort in the UK where with effect from 2013 all new nurses have to be educated to degree level.

Those working within the healthcare profession have always “known” that the more patients presenting for treatment equals the less time available for each patient and consequently the more likely that symptoms may be missed and care not be provided to the standards expected.  But studies such as this one highlight the effect of time and patient pressure.  For some the solution will be to educate further, to take on more staff; but when budgets are tight that is not always possible.  Finding ways to work smarter, to automate, to outsource the routine, to free up time for patients is the way forward.

Before this study we knew that time and education equalled improved outcomes but we didn’t know to what extent.  Now this part of the health service puzzle has moved from a known unknown into a known known and that has planning implications for all who practice healthcare and want to maximise patient outcomes.

Healthy advice

Stories of sandbags and dredging may have captured the headlines but lurking beneath the disasters is a danger which if left unchecked could cause even more misery for thousands.  That danger is the health implications of excessive rainfall.

On a day to day basis we don’t pay much attention to our waste.  Yes, we wash our hands but in general we don’t stop to consider where our waste goes.  We just assume that it is dealt with.  But with flood waters pouring into drains and septic tanks, our waste is suddenly a lot closer than we’d like to believe and that can cause long term health problems for the unwary.

In recognition of this Public Health England (PHE) has issued some guidance on “the potential health impacts before, during and after a flood as well as advice and support on the response and recovery.”  In addition to warnings about the dangers of sharp objects hiding beneath flood waters and advice on packing an emergency bag in case of evacuation the PHE advice also covers areas such as sanitation and food safety.  The PHE advice also brings to the fore the psychological impacts of flooding which can cause symptoms such as tiredness, distress, anxiety and sleeping problems.

Whilst the NHS is generally the first port of call for those whose health and wellbeing has been affected by the floods, in the longer term other health professionals will be drawn in to the mix.  Those such as counsellors and psychotherapists may be required to treat psychological traumas whilst physiotherapists, osteopaths and others look after people who have been injured whilst coping with the floodwaters.  Even the simple advice to move precious objects upstairs is going to result in a fair amount of back and other strains for those who are unused to such exercise.

With so many affected, in some areas already overburdened health professionals are going to be put under further pressure.  Finding ways to defer some of the day to day tasks such as telephone answering, diary management and the maintenance of patient records could help to deflect some of this pressure as well as maximising the time available for treatments.  Whilst at least the flood waters bring with them warmer weather which reduces ice slips and strains this is cold comfort to those who require treatment from weather related ills.  With the Government warning that things may get worse before they get better this is one story which sadly may run and run.

Booking time

The dawn of the ‘internet revolution’ may by now be lost in the mists of the past but it seems as though at last the benefits of internet connectivity have moved into mainstream living.  This Christmas more than one third of all shopping will take place on line with features such as click and collect proving popular.

As we toast the end of the year with internet tills ringing we are also shortly to be waving goodbye to another British institution.  The Government has announced that the paper car tax disc is to be phased out.  With authorities relying on purely electronic records the move will save time and resources.

In fact way back in the early days of the internet the benefits to be gained from the saving of time and resources were widely predicted but in the intervening period it has sometimes seemed as though all that the internet has done is bring more work.  In the early days ‘dial up’ was so slow that many people could get in their cars and drive to the shops faster than they could order goods online.  Now thanks to improved internet speeds allied with programmes designed with ease of use and speed in mind, the internet has at last come into its own.

One benefit of this improvement is the way in which health service providers are able to manage their diaries.  For the health practitioner the time spent in booking appointments is effectively ‘dead time’; time which is spent away from treatment and time which potentially impinges on another patient’s treatment.  That is why practitioners turn to services such as those provided by virtual assistants who can take calls and manage bookings on behalf of the health practitioner.

Now there is a new service available from Callagenix which not only saves the health practitioner from taking calls, it also saves the client from having to telephone.  Online booking enables clients to browse and book an appointment at a time to suit them.  This quick and simple appointment service perfectly ties in with the general move towards using the internet as the first port of call.  The service is flexible and practitioners can choose whether to accept new or existing clients via the online service as well as restrict online booking to certain treatments or to certain times of the day or week.  Time saving, easy to use and flexible; online bookings are a perfect example of the way in which the internet can make life better for all.

Papering over the cracks?

The Government has announced a funding boost of £500m to help to relieve pressure on the worst hit A&E departments.  Statistics have revealed that one million more people attended A&E in the last year compared with three years ago and this, particularly over the winter, has resulted in a virtual melt down of some services.

The funding is aimed at helping hospitals to prepare for the forthcoming winter and is designed to reduce or eliminate the “pinch points” which can so badly affect A&E services.  This should enable A&E patients to be treated promptly and provide alternate care pathways for those who currently see A&E as their only care option.

Hospitals which have been identified as being most affected have been invited to submit their proposals for funding.  These proposals may involve Accident and Emergency departments directly but could also cover areas such as taking steps to minimise hospital admissions from care homes by providing local specialists, increasing hours at walk in centres or pharmacies or increased social care provision or the provision of more services away from hospitals.

In announcing the proposals the Prime Minister, David Cameron, said:

“The additional funding will go to hospitals where the pressure will be greatest, with a focus on practical measures that relieve pinch points in local services. By acting now, we can ensure doctors, nurses and NHS staff have the support they need and patients are not left facing excessive waits for treatment.

Whether this new measure will be successful in reducing winter waiting times will be a matter for the future but it has to be said that it has not received universal acclaim.  The Alzheimer’s Society commented that “while today’s proposals could bring short term benefits, they will do little more than paper over the cracks,” and their comments were echoed by the BMA and others.

However, this is but one stage in an overall plan to provide continuity of care within the community, thereby reducing the pressure on hospitals.  This includes a £3.8 billion fund to “focus on joining up services, so that health and care services work more closely together, keeping people healthier and treating them closer to home.”

In the long term this will provide opportunities for health practitioners such as physiotherapists and osteopaths to provide higher levels of care outside the mainstream hospital system.  Those health care providers who have streamlined their services to maximise patient treatment time are in a strong position to benefit from this new health care ethos and to provide increasing levels of care continuity to their patients and the community in which they serve.

Harnessing the power of technology

Speaking at the Healthcare Innovation Expo 2013*, the Health Secretary, Jeremy Hunt, outlined the way in which innovation is to be used to drive the NHS into a future where it is “freed from the shackles of top-down bureaucracy.”  Giving the online seat booking innovation which transformed the air industry as an example Mr Hunt bluntly stated that “while they innovated, we stagnated.”

In a speech which touched on the Francis Report, culture and values as well as regulation and systems Mr Hunt highlighted the care and compassion which is at the heart of our health services.  He also called for patients to be put in the health driving seat.

One of the key practices which the Health Secretary believes needs to be implemented to transform the health service is the move to electronic patient records.  Giving examples of ways in which patient care can be improved by the use of electronic records, Mr Hunt said that a paperless NHS will have “massive implications for improved patient safety, genuine patient empowerment and self-management as well as scientific research.”

Of course it is not just the NHS which will benefit from electronic records.  Health practitioners both within and outside the NHS can find that electronic records will make a sizeable difference to their working patterns.  For example, the Clinic Appointments patient records service is already helping practitioners to streamline their operations.

With patient notes, documentation and X-Rays all available at the touch of a button the health practitioner no longer has to spend time in filing or searching for records.  This means more time spent on patient care and less chance of errors creeping in if important documents are mis-filed.  Combined with the Clinic Appointments’ virtual receptionist and diary management services the secure patient records service helps every health practitioner from a sole practice to a multi-unit facility to provide a streamlined and efficient service.

Health services in the UK are going places and those who are at the forefront of innovation and streamlined technology will be best placed to make the most of the new vision.  Putting patients first, innovating, bringing fresh thinking to health care; all these are on the Government’s radar.  The Health Secretary closed his talk, as we do this article, with this quote from Bill Gates “Never before in history has innovation offered promise of so much to so many in so short a time.”


Handing power to patients and professionals

As the fallout from the Francis Report continues to echo around the health sector it was refreshing to note an event recently which was purely aimed at innovating health care rather than indulging in recriminations.  Think tank Reform got together with Imperial College’s Institute of Global Health Innovation to draw attention to some of the positive innovations around the world which we may be able to learn from within the UK’s health sector.

Acknowledging that innovation can be defined in many ways, the event focused on three fundamental innovations which could improve the quality of care and patient outcome throughout the health service; workforce innovation, self care and personalised medication.

A shift towards personalised medication is only possible thanks to the leaps which science has taken in understanding the human genome.  With a greater understanding of personal risk factors comes the ability to target treatment on an individual basis.  We are already starting to see the benefit of targeted treatments in areas such as cancer and as our understanding grows the potential for more effective treatments is limitless.

Personalised medication does in part require a buy-in from the patient in understanding the risks of certain life styles and family traits and the next step is logically to encourage patients to take more responsibility for their care.  Self-diagnosis, arranging appointments directly with health professionals such as physiotherapists, managing self-treatment programmes is a step forward in understanding for patients but it will help to streamline the health service and target care where it is most needed.  For example, a patient with muscle or ligament damage needs to see a physiotherapist or osteopath straight away and making them travel the health nurse/doctor route first is a waste of resources and time.

This leads on to the third and most important change which the UK’s health services desperately needs, that of workforce innovation.  Doing away with rigid hierarchies and instead focusing on the individual patient means doctors, health care workers and support services all providing a flexible individual service.  Beacon Health Strategies, working with the poor, elderly and mentally ill in the USA has done just that. Over three years the flexible approach has reduced emergency hospital appointments by 60%, reduced suicide rates by a half and got 44% into work.

Innovation within the health sector won’t be easy.  It will require a sweeping away of the old hierarchies and a combined doctor/health professional service which is flexible and focused on patient care.  Those health professionals who have taken steps to outsource telephone answering, diary management and patient records and who are therefore able to maximise the time which they spend on patient care are in a perfect position to step forward into the new innovative, personalised era.

Going paperless

The Health Secretary, Jeremy Hunt, has set out plans for a paperless NHS by 2018.  In a speech to the Policy Exchange the Health Secretary said that a series of milestones would mark key stages towards the eventual goal.  These include hospitals being able to accept electronic records by 2014 with 2015 seeing electronic referrals in place.

In advance of the announcement a report by PwC suggested that over £4 billion could be saved within the NHS by better use of information and technology.  This includes automatic referrals, e-prescriptions and the smart use of technology increasing the time clinicians spend with patients thus leading to a reduction in waiting times.

This latest drive towards a paperless NHS has been broadly welcomed with the only scepticism coming from those who suffered from the failure of the previous attempt by Labour to bring in a centralised NHS system.  This latest initiative avoids the “monolithic system” pitfalls by enabling health providers such as GP Practices and hospitals to commission their own systems which will merely be required to share records with other systems.  This means that health providers can develop, store and manage records in a way which suits them, subject to central sharing protocols.

There is no doubt that digitising records can save time and money.  For example, the John Taylor Hospice near Birmingham has more than doubled the time clinicians can spend with patients simply by using laptops.  But the drive towards a paperless NHS can also benefit others within the health care sector.  Software such as that offered by the Clinic Appointments patient records service is already helping health practitioners to digitise their patient records.  This means that records can be accessed 24/7, there is no time wasted in finding or sorting records and with clinical notes, x-rays and invoices all centrally handled the health practitioner can spend more time on treating patients.

Combined with the telephone answering and diary management service this means that while an osteopath or physiotherapist is treating one patient the Clinic Appointments team can take calls, book appointments and the health practitioner can then call up the next patient’s details at a touch of a button.  With faster administration time and no more worries about losing patient records in fire or floods clinicians can concentrate on what they do best, treating their patients.

Contact us today to discover how Clinic Appointments can help your clinic. Book your free demo call now to learn more.