Cambio acquires Cayder amid
renewed focus on UK and Ireland market





When Sue Horbury joined Oxleas Foundation Trust, she was given a very clear mandate. "I was specifically recruited to look at how we could use technology to mobilise our workforce, and how we could support getting them away from paper and having to come into the office in the morning," reports the clinical transformation lead at the south east London trust.

Four years later, and technology is now a day-to-day part of life for many nurses at the organisation, which provides community, mental health and learning disability services. Some 1,300 clinicians have iPads, and direct access to the clinical system.

At a recent Nursing Times roundtable, Ms Horbury suggested it was a move that had been nothing short of "transformational". The roundtable, held in association with Cayder, a Cambio Company, brought together a panel of experts from across the country to discuss nursing and technology.

The main question on the agenda: could technology, and the data it gathers, help nurses offer safer, better, more efficient care?


The panellists from Oxleas were far from the only ones to answer in the affirmative. Sara Nelson, programme lead for children and young people at Healthy London Partnership and registered nurse member for Bromley CCG, said she knew of another community trust with a similar mobile working setup.

The main question on the agenda: could technology, and the data it gathers, help nurses offer safer, better, more efficient care?

Not only was it increasing efficiency and nurse safety – by making it possible to know where individual staff members were – but it was also helping workload management. "If you get a call to say this patient needs help, you can see which nurse is the closest and who can respond most appropriately."

The roundtable discussion dispelled any notion that greater use of technology solely benefits community nursing, however. At Cambridge University Hospitals Foundation Trust, an electronic patient record was implemented in 2014, and all paper done away with.

Louise Roberts, a senior sister at the organisation, admits that it represented a "big, big change for everybody" but told fellow panellists "we would never go back".

"Just for simple things, like drug charts are all there online; if you run out of a drug you click a button and that sends a message to pharmacy, so you've got no more of this running backwards and forwards to departments to get drugs.

Ms Roberts argued the result wasn't just more efficient care, but nurses with a greater ability to deliver higher-quality care.

"It's just changed everything we're doing, and it has definitely given us more time to spend with the patient," she added. "Initially, when we first moved over, you looked around and every nurse was looking at the screen and not really looking at their patient, and now, a few years down the line, we do have much more time for patients."

Ms Roberts argued the result wasn't just more efficient care, but nurses with a greater ability to deliver higher-quality care. She pointed to the example of risk assessments all being easily viewable on the system.

"So you can see whether your patient's had a recent Waterlow score, or a manual handling risk assessment. They're all auditable straightaway."

The idea of technology aiding nurses to deliver better care was echoed by Andrew McGovern from Barts Health Trust. He spoke of a quality and improvement dashboard that electronically shares data collected from across the organisation – and how it had led to specific improvements in nursing care.

A crucial aspect of introducing new technology, said Mr McGovern, is to ensure any data is presented in an easily digestible form.

"I think falls is a really good example. We had one ward that relocated to have refurbishment work done, and the minute they relocated, the falls shot up – it was an alien environment and they were getting used to it," reported Mr McGovern, the trust's senior nurse for quality and improvement and development. "We introduced a falls rapid improvement programme over a 90-day cycle, and it made a huge difference."

Louise Hicks, the trust's director of development, added: "We have greater confidence in understanding where we're at with length of stay, safer flow and all of that. Bringing all data together and having a leadership overview enables us to much more rapidly make some decisions. So we can prevent the fall, we can reduce the length of stay, make a better impact for our patients' long-term quality of life as well."

A crucial aspect of introducing new technology, said Mr McGovern, is to ensure any data is presented in an easily digestible form. "Being able to see just rows and rows of numbers, while it's important, doesn't give a strong message to wards," he argued.

Fran White said she was aware of increasing numbers of organisations using software to make data more easily understandable.

"But when you use charts, for example, within a quality and safety dashboard, they can see quite clearly what that level of performance is like, and then from that generate some really great conversations about what they're going to do to improve things. And obviously once they've implemented and improved, the opportunities there to measure their performance over the coming months to see if the change has actually worked."

Fran White, project manager for the children's and young people's programme at Healthy London Partnership, said she was aware of increasing numbers of organisations using software to make data more easily understandable.

"There's quite a good system that's being implemented in various parts of the country, which is around pulling information from different parts of the system so you can drill down to patient-level data to view their journey. So it'll help with multidisciplinary working and informing discussion at the front line, but because it's all in one place and being pulled up it can start future planning as well and help inform that."

In short: if you want to reap the potential benefits from greater use of technology and data, then make it accessible and easy for nurses.

In short: if you want to reap the potential benefits from greater use of technology and data, then make it accessible and easy for nurses. It was a point made throughout the roundtable. Tina Hanlon, a former nurse and now clinical solutions director and implementation lead for PFM and implementation lead for COSMIC, said one aspect of that was making it clear why certain pieces of data needed to be collected.

"Nurses are more likely to take ownership and responsibility for collecting that data if they understand why they need it and the importance of it," she suggested.

Helen Goodman, chief nursing information officer (CNIO) at Royal Brompton and Harefield Foundation Trust emphasised the need to make the means of collecting information user-friendly. "Technology has got to go with the patient workflow," she said.

"I think nurses get put off if there's too many clicks; they just lose interest – they just want to get on with patient care. So I think it's really crucial that we put in the right technology and that we configure it well, and that we keep going back to it until it works."

One area in which all our panellists said they would like to see further improvement is the ease with which different sectors can share information electronically.

One area in which all our panellists said they would like to see further improvement is the ease with which different sectors can share information electronically. Muinat Anibaba, operational lead for long-term conditions at Virgin Care and based in Kent, said technology-enabled mobile working was working really well within her organisation.

"But where I think it slows down a bit is where we have to access a different kind of information or communication via the GP or acute care, and it just stops there, because then we have to go out, go back and ask, or get into their system."

It was a similar story for Joanne Strain, head of nursing at care home provider Four Seasons Health Care. "It would be good to integrate the systems," she argued. "My wish would be that there would be better integration, better working between the acute, the community and the care homes."

Karen Rodwell, matron for Bexley district nursing within Oxleas Foundation Trust, wanted the ability to electronically view information from social care. "Because that's really pertinent, particularly within the community but within acute as well – making sure we've got some sort of platform that we can actually see into their systems."

For Sarah Joseph, matron in orthopaedics at Kingston Hospital Foundation Trust, getting this right would mean improved nursing care. "I don't think we've got some of the accessibility for community teams into the acute sector right at the moment. If our local community teams could access the specialists earlier, you could probably stop people coming in," she argued.

"That would be quite exciting with portals, or telephone, or Skype."

It was a vision for the future that gave event chair Anne Cooper significant hope. Ms Cooper, chief nurse at NHS Digital, said that during a decade working in this area she had frequently heard the charge that nurses are slow to adapt technology.

"I actually think that's not true," she said. "I think nurses who are engaged in this space can be accelerants for change rather than being laggards." The roundtable discussion certainly seemed to bear out her opinion.

The Panel:

  • Muinat Anibaba, operational lead for long term conditions, Virgin Care
  • Anne Cooper, chief nurse, NHS Digital (roundtable chair)
  • Helen Goodman, chief nursing information officer, Royal Brompton and Harefield FT
  • Tina Hanlon, clinical solutions director and implementation lead for PFM and implementation lead for COSMIC, Cambio Healthcare Systems
  • Louise Hicks, director of development, Barts Health Trust
  • Sue Horbury, clinical transformation lead, Oxleas FT
  • Sara Nelson, programme lead for children and young people, Healthy London Partnership and registered nurse member, Bromley CCG
  • Sarah Joseph, matron in orthopaedics, Kingston Hospital FT
  • Andrew McGovern, senior nurse, quality improvement and development, Barts Health Trust
  • Louise Roberts, senior sister, Cambridge University Hospital FT
  • Karen Rodwell, matron for Bexley District Nursing, Oxleas FT
  • Joanne Strain, head of nursing, Four Seasons Health Care
  • Lisa Walklin, head of marketing, Cayder – a Cambio Healthcare company
  • Fran White, project manager, children's and young people's programme, Healthy London Partnership