Kent County Council’s care leaders tell Gill Hitchcock about the IT system which flags pressures on services, identifies spare capacity, and helps avoid a crisis
Credit: Lynne Cameron/PA Wire/PA Images
One IT system was crucial in enabling Kent’s health and social care managers to identify resources and organise care last winter. After snow hit the county and acute hospitals saw a steep rise in admissions of patients with upper respiratory problems, they turned to SHREWD, or the single health resilience early warning database.
The primary aim of this system to support informed decision-making. It does this by identifying stresses in health and care systems. Taking complex data from multiple health and social care services in real time – data about the availability of hospital beds, staff, and community services, for instance – it then presents the information so it can easily accessed and understood.
Looking back to last winter, Jacqueline West, health interface manager for Kent County Council, says: “Those patients needed to stay in hospital for longer before they were stabilised and could be discharged safely. But, with access to SHREWD, we could see this occurring by the rate of admissions and acuity of patients.
“The information meant we were able to project and plan for the oncoming discharges. As a result, we could manage discharges better, ensure a steady flow of patients out of hospital, and free up capacity.”
“You need to see data as near to real-time as possible, in order to be able to identify pressures and where people can help”
Jacqueline West, Kent County Council
SHREWD includes a conference call facility, as West explains: “The chair of the conference call will identify the actions needed from each partner. These are recorded on the system, and people are sent trigger emails or texts asking whether they have carried them out. Previously, people would go away and be trusted to act, but this records everything so that you know whether it has been done.”
Anne Tidmarsh, director for older people and physical disability at Kent County Council, says SHREWD helps by recording problems and identifying potential solutions.
“Everybody can now see whether there are beds, or whether an enablement service or domiciliary care is available,” she says. “For instance, over the whole of the winter there was a daily conference call where senior managers, including myself, were on calls about what had blocked the system. What I will do, while on the call, is to get information from the teams, Jacqui and colleagues and assistant directors, and because I have the SHREWD app on my phone, I can look for myself and see where there is capacity in the system.”
Tidmarsh adds: “Also, it provides me with text alerts as to where the pressures are. I can go to the team managers and say ‘did you know there is a pressure point coming up in an A&E department?’. Then we can start mobilising support to try and stop that escalating into more of an issue.”
Chief executive of health thinktank the King’s Fund, Chris Ham, says England’s NHS winter crisis had been predicted. But additional funding announced in the November 2017 budget arrived too late for hospitals struggling to cope with the expected increase in demand from patients.
The recommendations he makes to resolve the issue, including redoubling efforts to improve productivity and a different approach to funding, are long-term.
Could this IT system provide a more immediate solution elsewhere in the UK?
SHREWD was a long time in development by its supplier, Transforming Systems. It began as a response to the 2009 flu pandemic when winter plans in Medway revealed that organisations were often planning and working in siloes. At times of pressure, information and data were not shared effectively.
An evaluation in Medway by the University of Kent found that SHREWD was easy to use and needed little training. Information was simply and clearly displayed. The only occasional difficulties were with logging in and glitches attributed to upgrades.
After seven years of research and development in Medway, it was fully launched across Kent two years ago.
But, of course, it is only as good as the data which is fed into it by case officers, administrative staff and by automated feeds from emergency departments.
“When you’re on a conference call, you need to see data as near to real time as possible, in order to be able to identify pressures and where people can help,” West says.
“Everybody can now see whether there are beds, or whether an enablement service or domiciliary care is available”
Anne Tidmarsh, Kent County Council
“So, it’s important that this is done every day – and twice daily at times of pressure. A&E data has an automated feed into SHREWD and there can be updates every two minutes, if you programme it so.”
Could SHREWD, or databases like this, help to integrate services around patients, as advocated in NHS England’s Five Year Forward View? “Definitely,” says Tidmarsh.
“It is very much related to the patient who is in hospital and ready for discharge,” she adds. “We now have a much more integrated way of working. We have integrated discharge teams, integrated commissioning, the Discharge to Assess model, and Hospital at Home service. With SHREWD as an integrated tool to support it, it makes it an integrated system.”
West takes up the theme of integration, saying SHREWD has ensured that health and care providers across Kent work as one.
“It has literally brought all the partners together and the mutual aid that we can give each other is spoken about much more. This gives you the picture.”