Every hour of the day Cumbria Health on Call (CHoC) is providing a vital service to look after the health and wellbeing of people in the county. 

Its 450 staff operate from 17 clinical sites and provide emergency out-of-hours service 24/7, making it one of the major providers of healthcare in the county.  

However, increasingly the not-for-profit social enterprise is developing remote healthcare monitoring technology, which it supplies alongside its other services.  

"We have a trading history of being the people who are open, providing high quality clinical care when daytime surgeries are closed," says CHoC chief executive Susan Blakemore. 

"We tend to be the people that are providing care so other services can close down.” 

The organisation traces its history back to 1996 when GPs in the county formed cooperatives to create a better work life balance and share the burden of being on call.  

Its staff includes advanced practitioners and GPs, physios, practice nurses and paramedics with access to a fleet of 12 4x4 vehicles. 

It has treatment centres in the district and general hospitals at Carlisle, Whitehaven and Barrow, as well as in community hospitals in Penrith, Wigton and Kendal.  

In addition it is also the provider for six GP practices across the county with a total of 30,000 patients. 

It currently has its head office at Hilltop Heights, on London Road, Carlisle, but is due to move to new premises in Rosehill in the new year. 

CHoC’s client for all of its work is the National Health Service, in the form of bodies such as North East and North Cumbria Integrated Care Board and Lancashire and South Cumbria and North Cumbria Integrated Care Boards.  

It is also a pioneer in remote healthcare, which has become more possible and widespread with the growth of smartphones and digital connectivity.  

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CHoC first began providing such services seven years ago by running video clinics between patients in Millom and medics in Carlisle and has built on this ever since.  

During the pandemic CHoC launched its Oximetry at Home Service, which has been used by 1,300 people over the last two years.  

As part of this patients are given a pulse oximeter device which can be placed on their finger to take a pulse reading and determine the saturation of oxygen in the blood. 

Patients take their own readings and send them to a central database from their phone. 

The data is visible on an online dashboard for members of CHoC’s team who can then take action if there are any concerns. 

"The reason for the service being set up was to detect early signs of silent hypoxia, which was causing a lot of problems in some of the early Covid patients," says Richard McGregor, CHoC’s head of digital and performance. 

“We were able to identify the issue, add an extra layer of safety and probably put a lot of people's minds at ease.” 

CHoC then applied the same principles to its Blood Pressure at Home service, which is used to identify patients with hypertension.  

In this case people enter their blood pressure readings twice a day and if necessary are told to ring 111 or are called in for an appointment with a medic. 

When it was deployed among the 2,000 patients in the Alston community the number of people diagnosed with hypertension rose from 14 per cent to above 20 per cent. 

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"If you think of someone that is walking about with undetected hypertension and their risk of some form of cardiovascular disease, heart attack or stroke, this service will have saved lives,” says Richard.  

CHoC is also about to launch its INR at Home service, in which patients who take warfarin to thin their blood will remotely monitor their own international normalised ratio (INR) which measures how quickly it takes their blood to clot.  

This can then be used to determine how much warfarin they are prescribed.  

With patients using warfarin currently estimated to have around 10 face-to-face appointments a year to determine their dose, Richard says this has the potential to cut this number quite dramatically. 

“It could save 2,000 appointments in general practice and the resultant impact on patient’s lives and our carbon footprint,” says Richard. 

Most comprehensively, CHoC has developed a Virtual Ward Service, which uses a stick-on patch which people wear to monitor factors including respiration, step counts, blood pressure, heart rate, body position and falls - all of which are analysed by artificial intelligence systems to generate an opinion which can be reviewed by a human doctor. 

The data from the patch is transmitted to a central database in real time via the patient's smartphone. 

The technology has been used for patients with respiratory problems in North Cumbria Integrated Care Trust and there are plans for it to be used by patients with heart problems in the Republic of Ireland. 

In all of the remote services, the few patients who do not already have their own mobile phone are given one. 

If they fail to enter the data or the readings are not coming through for some reason they are contacted to check they are okay and provide a safety net.  

“We can either use patients’ own devices, provide them if they don’t have them and wrap around a service which supports them in using technology as well as ensuring robust governance and risk management controls to ensure a safe and beneficial service for everyone,” says Richard.  

The benefits include the ability to cut down on appointments and discharge patients safely earlier, freeing up NHS resources.  

This creates a large potential market in the NHS across the country.  

Richard says in time the monitoring, combined with artificial intelligence, could even allow people to predict when and how they are going to be ill. 

“Can you imagine a day where you know that you’re going to be ill before you’re ill?” he says. 

“Our ambition is to ensure that we are involved in its journey to ensure our patients benefit from all of the latest advances in technology enabled care.” 

As the demands of caring for people’s health become more complex due to factors such as an ageing population, increased levels of obesity and the pressure of the cost of living, CHoC’s head of business management Sarah Taylor-Howe says caring for people remotely may become more prevalent. 

"I think the changing face of healthcare going forward is going to be more about managing that population health and picking up problems that we might not have known about otherwise," she says. 

“I think the future is about taking healthcare to people and enabling access. There should be no barrier to healthcare.”