Delayed Transfers of Care - when a patient is ready for transfer from acute care but there are no social care facilities ready to receive them and therefore they are still occupying an acute bed in hospital – is a major challenge for NHS Trusts.  All too often, it's the process of sharing information between hospitals and social care teams that can contribute to delays. 

Admission Notifications (Section 2) and Discharge Notifications (Section 5) are a good example. Hospitals have a statutory duty to notify a patient's local authority if they are likely to need assessment for community care services.  Admission Notifications are used to notify social care organisations when a patient resident in their Borough who may require social care support on discharge, is admitted to hospital, and later a Discharge Notification is sent to advise when the patient is due to be discharged. This process ensures that social care support can be arranged appropriately, so completing and sharing the notifications quickly and efficiently is essential to ensure a patient's stay in hospital isn't any longer than medically necessary.

Typically, these forms are completed by hand by staff in acute trusts. Occasionally they're typed up by admin teams. But in most cases they're transmitted by fax machine - sometimes several times - before they reach the relevant social care department. 

Not only is this approach slow and costly, it's also prone to error if fax machines break down, lines are busy or paper runs out. The fact that each London hospital treats patients from so many different Boroughs and, therefore, has to communicate with multiple social care departments, adds to the complexity.

Introducing secure email

This approach is now changing as a result of an NHS London project (part of the Department of Health, Common Assessment Framework for Adults) which is gathering momentum across London. The project is focused on improving clinical care across London by exploiting existing IT infrastructure to simplify business processes and free up those providing direct care services to focus on patient care.

The project makes use of technology available in organisations today, and secure email domains such as NHSmail and GCSX, the secure email domain used by Local Authorities, so it's easily replicated and cost efficient to implement.

The project was piloted in Ealing Hospital and Ealing Social Care department in January 2011, "Initially, we ran process mapping sessions to scope the current process for sending information between the hospital and social care," says Sue Cooper, London Health and Social Care Information Sharing Project Manager from NHS London. "This was followed up with a session to identify how future processes could operate using secure email instead of fax. Further sessions involving the key stakeholders were held every fortnight to track actions and report progress."

As the project progressed, it emerged that neighbouring West Middlesex University Hospital and Hounslow Council were already beginning to exchange information securely, with the hospital using NHSmail and the social care department using GCSX. 

"That enabled West Middlesex University Hospital to also start sending patient information securely to Ealing Social Care department for those resident in Ealing," adds Keith Strahan, Programme Manager, NHS London. "As more hospitals and social care departments come on board, there's a domino effect as they bring others with them."

Faster, more efficient, cost effective

The benefits to be gained in using secure email instead of fax are numerous.

 "We've found the quality and legibility of information is better now that it's typed and emailed instead of handwritten and faxed," says Sue Hoogwerf from the Adult Social Care team in Kensington & Chelsea, another borough signed up to the NHS London project. "The process is much quicker and there are administrative savings.  It's a lot more reliable too. Information is less likely to go missing or be held up in a fax queue.  There's improved security of information and a stronger audit trail.  We're finding the process much ‘greener' as well because we're using far less paper," adds Sue. 

It's a similar story in Ealing, where the hospital and social care department estimate they're saving around 60,000 pieces of paper annually.

The sheer speed of secure email also means that information gets through without delay and social care support can be planned more efficiently. This could help prevent scenarios where, say, a social worker is unaware that a client is in hospital and ends up calling the police because they're unable to locate them.

Imperial College Healthcare Trust is currently preparing to introduce secure email and a more streamlined process for its admissions and discharge notifications.

"Currently our Section 2 and Section 5 forms are handwritten by ward staff in our three hospitals, sent to an onsite reimbursement team for processing and then faxed to social care," explains Jack Stamp, the Business Analyst leading the process transformation on behalf of Imperial.
 
"We send approximately 1,250 adult social care notices every month from the Trust," says Jack.  "So by streamlining the process, we stand to make substantial savings in admin costs and reduce length of stay by providing quality and timely referrals to social services."

Imperial's new process will piggy-back on existing hospital infrastructure - including NHSmail.  "Our aim is to set up the process so forms can be completed online with the patients demographic information automatically pulled from our patient records system. Once completed, the forms will automatically be emailed via NHSmail to the appropriate social care department. That will be a big time saver for clinical staff."

Multiplying the benefits

Currently, over 70% of London Boroughs and over 60% of London hospitals are involved in the NHS London project to introduce secure email for sharing information cross-boundary and the numbers are growing all the time.  Naturally, there is huge potential to use it for other patient workflows as well, for instance continuing care, end of life care, long term conditions and child protection.

In one Trust, for example, it's estimated that the use of secure email to share information for continuing care will produce total cost savings of around £50k annually – including paper costs, and the reduction of deferrals and associated bed days.

 "By working with NHS London, there are virtually no costs involved for hospitals in setting up workflows using secure email. But there are enormous benefits to be gained in savings and efficiencies for both hospitals and social care departments," concludes Keith.  "What's clear is that the more London sites that sign up to share information via secure email, the more the benefits will multiply for everyone."