Mobile units equipped by NHS Digital are helping a unique service in London protect some of the most vulnerable people in our society from TB, HIV and hepatitis.
Words: Catherine Levin, Editor, Emergency Services Times
The Find & Treat story is special. It takes a lot of dedication and hard work to find extremely vulnerable and socially excluded people and provide health care screening on the spot. While it might not be obvious why you would read about this in Emergency Services Times, it is clear from talking to Professor Alistair Story and Brendan Scott that the work they do goes a long way to stop people calling the ambulance service when their health reaches a crisis point.
Professor Story is the founder and clinical lead of NHS Find & Treat based at University College London Hospitals NHS Foundation Trust. He started out in the 1990s working tuberculosis (TB) prevention control, where there had been a shift from TB being in the general population to being found in some specific risk groups like those with a history of substance misuse and the homeless. He explained, “We have, until very recently, been the TB capital of Western Europe. TB is a communicable airborne disease, and it carries a very high risk of death if it is not treated. There is a public health imperative to diagnose it early.”
The creation of Find & Treat
He realised that the traditional healthcare model of visiting doctors in buildings doesn’t work for these groups, so he looked at what other countries were doing. He found progressive work in the Netherlands as they had moved from mass population screening for TB to a more targeted approach. This has resulted in very low rates of TB in the Dutch population, so Professor Story was confident that this was the right approach. After some initial testing of a mobile screening service in London in the early 2000s, he founded NHS Find & Treat in 2007.
Disrupting healthcare models
He explains, “Find & Treat has pushed the frontiers of how healthcare providers can invert the usual relationship of ‘you come to us’, because we are an outreach service. We’ve really stretched the boundaries of technical possibility where we are taking diagnostics to people and then connecting directly with NHS IT systems without having to physically visit them.”
It wasn’t always like that, as the mobile screening vehicle was decidedly analogue, with paper forms and a gradual evolution to sharing results on computer discs, sent in the mail to a hospital or other healthcare setting. It was long winded and often finding the patient again proved very hard due to the chaotic lifestyle of these groups.
In the last year, more than 10,000 people have used the Find & Test service, with around 10-15 per cent of them requiring treatment because of the diagnostics carried out on the mobile screening vehicle.
Since starting in 2007, the preventative principles of Find & Treat remain the same, but the approach has evolved thanks to advances in technology. With diagnostics remaining firmly on the street in the Find & Treat vehicle, Professor Story wanted to be able to push the results out to those who could act on them. He says that technology firm, Excelerate allows the service to move into the 21st century with the Digital Dashboard Management Interface (DDMI) now installed on the Find & Treat vehicle. “When I get on the van in the morning, all I need to do is press one button and it starts up all the different systems on the van. It used to take around half an hour to get everything ready every time we stopped at a new location. We have saved so much time on this one change and it has freed us up to see more people every day.”
The patient journey
Every patient is registered and is offered a chest x-ray as well as a range of tests for cardiovascular and other diseases. During the last two years or so, they have also done a lot of Covid testing. Brendan Scott is Operations Manager of Find & Treat; he says that service needs to be resilient and robust to do this as they don’t know where the vehicle will be deployed.
“We’ve struggled for years to engage with the wider health world around us, but thanks to Excelerate, we are now able to be connected, we can search for NHS numbers, we can draw on the data such as GP records and so on. It’s a world of difference and hugely helpful. We can behave as if we are in a hospital, but we can be anywhere with great connectivity.”
Accessing networks anywhere
In dense urban areas, they can be affected by network congestion, and in more rural locations, they can have trouble finding a network. The Excell 4G LTE long-range antenna on the roof combats congestion by giving us network priority by automatically locking-on to the strongest cellular signal available and they have what Excelerate calls a ‘bedrock of connectivity to allow any range of applications in any area.’
There is a flat-panel satellite on the roof of the vehicle. This low-profile terminal does not require mechanical components to steer towards a satellite enabling an always-connected experience whether stationary or driving.”
Brendan explains, “Satellite is reliable when there are no other connections available, should other communications fail, we can rely on it to keep us connected. This is particularly important in today’s climate, with increased demand on networks.”
Using the connectivity on the mobile screening unit, the healthcare worker can contact, for example, the TB clinic in St Mary’s Hospital in Paddington and send a unique link for them to see an image in the Find & Treat image bank. Brendan says, “They can download this quickly, sometimes within a few minutes of us taking the image in our mobile van which can be miles away.” Linking in with NHS systems is trickier, he explains, “We have to go through a secure gateway with a fixed IP address but that then gives us access to University College Hospital’s intranet to get into other IT systems.”
He adds, “For us, speed is of the essence. Because the receiving hospital trusts our information, they can arrange for the patient to be received through an accident and emergency department and straight through to the right department within an hour of them visiting us.” Professor Story interjects, saying that it also saves money because it stops them getting another x- ray and unnecessary additional radiation exposure.
Evaluating Find & Treat
Professor Story tells me that they have been working with a research team at University College London for the past decade and their work has been translated into guidance. “We are best practice in this country and recognised across the world through the World Health Organisation. Everything we do is evidenced and where possible subjected to rigorous evaluation, not least randomised control trials.”
The recent technology partnership between Find & Treat, NHS Digital and Excelerate is being evaluated during the autumn to establish how the technology has enhanced the service, where it has enabled cost savings, and where it has improved service times.
Find & Treat is an inspirational service, helping those who are marginalised to access healthcare and improve their life chances. They have ambitions to scale up the service to a national level and this will allow more people than ever to access healthcare on the street and with the technology helping along the way, this service will go from strength to strength.
www.uclh.nhs.uk/our-services/ find-service/tropical-and-infectious- diseases/find-treat-service