Community nurses embrace cost-saving agile working programme

How one tissue viability service is thriving from its prudent hot-desk switch 

How one tissue viability service is thriving from its prudent hot-desk switch 

North East London Foundation Trust (NELFT) community tissue viability nurse specialist Debbie Wickens is out on her daily rounds and is about to visit a man with a diabetic foot ulcer.

‘He was at a high-risk of sepsis,’ explains Ms Wickens.

Full-timer Ms Wickens leads a team of three part-time tissue viability nurses, working across Havering in London. Approximately nine months ago the team adopted the ‘agile working programme’ that NELFT believe will save around £4 million a year by 2019-20 across the community.

Debbie Wickens

NELFT extends from several London boroughs – including Havering and Dagenham – into Essex, around Kent and Medway. The trust has more than 180 buildings, but the aim is to reduce this number and save money on estates, with staff booking time to hot-desk at different ‘hubs’ around the region. By 2020, the trust aims to sell the Victorian-built Goodmayes Hospital, which costs £464,000 a year to maintain.

Instant communication

The agile working programme has seen around two thirds of the trust’s staff – approximately 4,000 people – be given internet-enabled laptops and a secure, instant communication software called Cisco Jabber.

It has removed the need for community nurses to report to a main office first thing in the morning or after appointments, and improved the accessibility of patient records through a shared record system.

Ms Wickens, armed with her laptop as she goes about her rounds, pulls into the street where her next patient is and explains the background behind the visit.

‘This patient is a good example of how agile working can help,’ she says.

‘A few weeks ago I had a message from one of our district nurses on Jabber – which is a bit like WhatsApp. She contacted me to say she was concerned about a patient and asked would I have a look at a wound photograph that was on our shared record system.’

Immediate working

Under the agile working programme, nurses can access real-time patient records from anywhere and then update those files immediately, in some cases with pictures.

‘The photo worried me and I dropped what I was doing to see the patient,’ Ms Wickens continues.

‘When I arrived, we identified he was at high-risk of sepsis and got him straight to hospital.’

Ms Wickens was again contacted through Jabber when the patient experienced a complicated discharge.

‘I was busy working in a leg ulcer clinic. But instead of going back to my office after the clinic to pick up messages, I got the message immediately and was able to adjust my schedule acccordingly.’

Ms Wickens believes there is a good chance the man would have lost his foot without prompt treatment.

‘It’s a win-win situation’

North East London Foundation Trust director of nursing for clinical effectiveness Susan Smyth believes the move to agile working was about embracing a cultural change

‘Shifting to agile working has been a challenge for the nursing teams, but we were supported well by the agile working IT team – who ensured that staff were happy with their devices before going to see patients.

‘I know from my own experience of what a challenge it was, as it was such a different way of working – but we can all see the benefits of agile working.’

She says colleagues have spoken of the benefits in typing up notes in a patient’s home, as they can check details, rather than handwritten notes needing to be interpreted an hour or more later back at base.

‘We believe we are seeing better patient-led outcomes, the nurses are getting more time with the patients and getting to see more patients – it’s got to be a win-win situation.’


Inside the patient’s house, a district nurse removes the dressing and Ms Wickens takes out her laptop to load the patient’s latest notes, as
well as an earlier photograph of the patient’s wound.

Once the procedure is complete, Ms Wickens types up some brief notes, uploads a new picture to the patient’s records and ensures she explains what happened to the patient’s wife.

Ms Wickens says: ‘I’m happy with the progress this patient has made from our initial treatment plans and we are now at a stage where I think we can save the foot and his mobility.

‘It is one of my good days, where you are pleased and proud of the job you do.’

She is soon back in her car and off to St Francis Hospice for the next patient on the list. 

On arrival, a doctor is attending the patient, so Ms Wickens takes the opportunity to pull out her laptop and start typing up the assessment from the previous patient.

‘You can make the most of every little moment,’ she says.


It is not long before Ms Wickens is in with the patient and when she returns, she decides to find a quiet spot in the hospice building to complete all her morning assessments from her briefly typed notes. These are then instantly saved to the NELFT database – or if there is no internet signal saved on the laptop and uploaded later.

‘Nurses will know previous medications, medical history, capacity assessment – all of that is available. It means things are less likely to be missed and it is a good way to audit,’ beams Ms Wickens.

‘I work on the pressure ulcer prevention working group and we’ve just set up a new electronic report so each team leader can make sure all essential information is completed and reviewed regularly.

‘That way at-risk patients can be highlighted electronically on the caseload and team leaders can redirect resources to those patients.’

NELFT believes the system has made nurses up to 9% more productive, with fuller case notes and less time travelling back to a singular base with individual PCs. Ms Wickens says the important thing to remember is to build in clinical supervision time and ensure the team still meets regularly.

Instead of the up to 40-minute trek to the main office after appointments, Ms Wickens visits one of NELFT’s four hubs in Havering – making her more accessible and visible to the district nurses.

‘We have lots of new staff who need that little bit more support and I can now be a face they know.’

Differences in care

For Ms Wickens, the new way of working is something all trusts should consider.

‘I realise there are organisational benefits, but to me it is about what difference it makes for the person I am caring for.

I truly believe agile working does improve care.’

To ensure all staff felt confident with the new technology, NELFT developed coaching for all abilities and built in training and supervision over a 12 to 16-week period.

The trust has opened ten hubs so far and has a new, purpose-built headquarter in Rainham, Essex, which houses 76 agile working spaces plus training and meeting rooms.


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