Healthcare science national delivery plan consultation: analysis of responses

3.0 Integration of Services in the Community

How can HCSs' involvement in delivering integrated services in the community be improved, thereby reducing costs and improving outcomes?

3.1 Summary of what you told us around integration

A significant majority of health boards were supportive of Healthcare Scientists involvement and expertise in delivering integrated services in the community, especially around the desire that ISO 22870 was made mandatory. Concerns were raised in how HCSs could be released from their current service delivery to be able to develop this area, especially around Physiology.

One health board response felt that the language of "reducing costs and improving outcomes" could be improved, possibly use elimination/reduced waste and improved outcomes.

Agreement across the responses that equipment registers should be established/maintained, but that this task should not be for the HCS lead but for Medical Physics departments.

Graph 9 shows the percentage and count of respondent's replies on all Integrated Services Proposals within the consultation document. Opinion statement replies have been categorised as Agree, Disagree and Mixed.

Many of the proposals in the NDP relate to equipment, the option of how we can impact on referrals to hospital clinics and reduce waiting times should be explored.

The Physical Science group felt that a board-based centralised replacement equipment programme overseen by the Physical Science workforce should be implemented in each NHS Board. However further comments were made that there is potential for a Scottish wide procurement approach that could achieve national standardisation.

The theme of Physical Sciences' comment that the use of medical equipment libraries achieve a more efficient use of equipment, with the potential to reduce the overall level of equipment in circulation. In reference to the use of equipment tracking, one health board gave an example that approximately only 40% of infusion pumps are being used.

There are examples of HCSs training GP practice nurses in spirometry, along with some boards utilising HCSs to train staff in rural GPs to perform oximetry for 'Sleep Clinic' patients.

There appears to be differences across the boards with regards to established Point of Care Committees, however generally the responses strongly support the involvement of HCS staff in POCT delivery. However, there are numerous examples that primary and secondary care providers do not follow POCT committees direction, with gaps in the governance around POC equipment.

One individual response, highlighted that "instead of management through POCT committees, the delivery plan should encourage the development of Medical Device Committees" also described as Health Technology Management elsewhere in a board response.

A couple of health boards reported that they have a 'Community Diagnostic User Group' working across primary care, diagnostics, radiology and cardiac physiology.

One response commented that the consultation did not give recognition to the important role that rehabilitation engineering plays within the community. HCSs play an important role in ensuring appropriate Health Technology Assessments are undertaken.

There are numerous suggestions for a Health Technology Management Committee, for responsibility of medical equipment in the community.

One response commented that "the delivery plan falls short on developing an NHS Scotland wide integrated equipment management network to reduce variability, standardise usage and reduce costs for bulk buy and repairs".

Some boards provide clinical portals to allow primary care access to images taken by a medical illustrator. The national use of Clinical Portals would allow more integrated services, potential for collaboration with eHealth technology.

The Scottish Ambulance Service have commented that they would require to be involved in the selection of training required for POCT in the community.

One individual response comments on the requirement for the introduction of Risk and Reliability Centred Maintenance (RCM) regimes at a national level that could be implemented locally, to reduce waste and maximise capacity around the management of medical equipment.