University College London Hospital Trust (UCLH)

UCLH’s Find and Treat service offers front-line screening for tuberculosis, HIV, and hepatitis B and C to vulnerable populations across and beyond London. The Find and Treat mobile vans provide chest x-ray screening, advice, and practical assistance, relying on wireless connectivity. Previously, scans were taken by a radiographer and stored in the van’s database. 4G dongles were used to transfer the images to the hospital for review, but poor connectivity often delayed this process, requiring patients to be retraced for treatment.

NHS England’s Future Connectivity team worked with UCLH and proposed two wireless connectivity solutions to be used on board the Find and Treat service van.

The first option was a 4G and 5G cellular connection with a non-bonded SIM. The second option added a LEO-ready satellite system. Both options were compared for effectiveness. A service van was modified with high-tech tools and software to enable real-time remote diagnosis and referrals on board the mobile health unit. This included a digital portable x-ray camera, artificial intelligence software, a tele-radiology network to allow the remote reading of X-rays using the trials flat-pack satellites.

The trial lasted 7 months, from October 2021 to May 2022.

The trial provided stable and reliable connectivity, delivering significant health benefits:

1. A 90% reduction in DNAs: Improved connectivity allowed quicker diagnoses on the mobile van, enhancing the referrals process for vulnerable patients, especially for conditions like TB.

2. Better utilisation of clinical time: Improved connectivity eliminated the need for a radiographer to travel with the van, saving an estimated £18k annually. This model could allow one radiographer to work on multiple vans.

3. Time saving of 33 hours per month in clinical time via the ability to label patient samples immediately with access to patient records: The new connectivity solution meant that the Find and Treat team was able to access key patient services such as the Summary Care Record and Spine This allowed them to access the information they needed to generate patient labels there and then on the unit. Previously, as there was no connectivity to SPINE, the labels were handwritten, and then once at the healthcare setting (where there was connectivity) they had to generate new patient labels and then un-bag and re-bag and re label the samples, which was a time-consuming process.

4. 215 extra hours of screening time: Faster connectivity sped up technical setup and shutdown, saving 60 minutes daily for additional patient screening.

The 4G and 5G connectivity combined with the non-bonded SIM proved to be the most effective connectivity solution.

Satellite connectivity was the least effective but may improve as low earth orbit technology advance. This remote care model aligns with the NHS Long Term Plan, improving health outcomes for vulnerable people. The solution is scalable and there has been some interest in adopting the solution for wider use.

Lessons learned

Allow generous lead times for procurement

The Find and Treat team at UCLH encountered challenges with the availability, procurement, and price of the technology which led to delays in being able to start the trial.

Seek guidance from internal information governance teams

Roaming healthcare provision brings the additional complexity of data security and ensuring  roaming connections are secure. It is recommended that all information governance standards are followed and work is conducted in line with the Data Security and Protection Toolkit. 

Consider operational set up costs

The trial required significant investment, but the team expects cost savings and recovery of expenses within three years.