to-face’) outpatient appointment at their local renal clinic.


“In preparation for a telephone consultation, patients take their blood tests in the normal way. Patients are also asked to provide up-to-date blood pressure and weight readings (which can either be taken at home or at the family practice).


“Telephone appointments are scheduled to last 10-15 minutes and the patients ring in at designated times. Letters are sent to GPs in the normal manner. Blood test forms are sent out to patients along with their next appointment time.


“Interestingly, those patients engaging with the telephone clinic report an increased sense of empowerment in managing their condition as the main benefit.”


This kind of innovation in service design means that not only is the interaction between patient and clinician more convenient (and cheaper for the patient); it reduces the amount of emissions due to travel whilst also cutting the amount of resources which need to be provided by the trust for each appointment through the use of ICT.


The Campaign for Greener Healthcare has links with many different projects with the use of ICT a major component in reducing trusts’ carbon footprint.


“It’s not as if we have found some kind of special ICT system which can reduce carbon emissions. Rather, we look at totally redesigning care pathways and see how ICT fits into that redesign. Given that the NHS needs to reduce its carbon emissions by around 80 per cent, there needs to be a significant redesign of care pathways.


“One facility which we believe will be useful in this process is the map of medicine, which is a web based tool which allows clinicians to map out patient pathways. Whilst the map is useful because it allows you to generate a centrally held expression of a care pathway. It also means that everyone, including primary and secondary care, involved in that pathway has to


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come together at some point to discuss how that pathway could be changed. Sometimes it is the first time that such a discussion has happened in an organisation.


“Then once the pathway is on the map it is more straightforward for those involved in the design to decide how to deliver the service. Sometimes additional (and wasteful) activity is added to care pathways, because there has been no clear agreement on what the right thing to do is in a given situation. Although there has been a lot of work done on making care pathways more efficient, there are still a lot of conditions where care pathways have not been mapped out properly.”


Whilst the map of medicine is an example where ICT can help in the design of greener healthcare, trusts are also employing ICT itself to increase efficiency which then reduces waste which, in turn, reduces carbon emissions.


“Recently, Nottingham University Hospital NHS Trust began using Wi- Fi telephones, which enabled staff to contact each other without needing to put calls out over the public address system. As part of wider, more integrated IT system at the trust, this is helping to remove wasteful procedures from pathways.”


Frances also believes that greater efficiencies can be gained by using more centralised IT systems in the NHS instead of having lots of different ones, which make it harder to transfer data from one system to another, therefore creating waste in the wider system.


“This results in a lot of investigations being duplicated either because one organisation is unaware that an identical investigation has already been carried out or because results are too hard to access. If there was an effective central patient records system in place, this waste could be reduced.”


An example of this kind of system working is the Chronic Kidney Disease Electronic Advisory Service, which originates in Bradford.


“This is where the patient record which is held at the GP surgery is made available, through a request for advice, to the renal consultant at Bradford Hospital.


“Through this service, clinicians can clarify the most appropriate care pathway, for example by asking advice as to


Frances Mortimer


whether a particular case needs to be referred or not.”


Given the costs of referring a patient to a consultant, it is clear that this kind of system has the potential to bring significant cost savings along with providing a better level of patient care, because of a greater sharing of patient information.


“Better access to information, together with improved communication between clinicians, has led to a reduction in renal referrals in Bradford. A similar example is a telemedicine pilot carried out by Manchester Cardiac Network, which is based around immediate reporting of ECGs carried out at GP surgeries.


“This means that when someone comes in with an irregular heartbeat, instead of making a referral, the patient is connected to the ECG in the GP’s office, which is then connected to the remote reporting system, which has expert cardiologists at hand to deal with the data.”


Along with reducing the amount of unnecessary referrals, this system has improved patient outcomes.


“Because the test is being carried out while the patient is symptomatic, clinicians are much better placed to make an accurate diagnosis, rather than perhaps missing the abnormal finding when an investigation is carried out at a later date.”


Clearly, if ICT systems are used more effectively, the NHS will be able to deliver better, cheaper and more environmentally friendly healthcare.


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