Lancashire Care NHS Foundation Trust, which specialises in community mental health services, has 8,000 staff, two-thirds of whom are involved in visiting people across Lancashire and so are on the road a great deal.
The Trust is using mobile devices and software to revolutionise the way that its services are delivered. However, across the NHS as a whole it is a slow revolution, as health informatics director Declan Hadley told the audience at the Enterprise Mobility Summit 2014 in London yesterday.
"The NHS hasn't embraced the digital channel the way other industries and other parts of society have," Hadley said, contrasting the ubiquity of online banking with the relative rarity of internet hospital appointment systems.
"We're a people organisation. Technology can never replace direct human contact. Technology is a means to an end."
However, he said, things are changing, as delivering healthcare becomes a more consumer-led activity.
"We need an agile, mobile workforce to deliver the healthcare demands of tomorrow."
One change the Trust made early in its three-year-old mobility programme was providing nurses with the information they need including calendars, geo-data, appointments systems and reporting tools onto their mobile devices, to reduce paperwork and avoid trips back to the office to fill forms.
Another is around its buildings, which soak up 60 per cent of its non-pay budget.
"Most staff can now work in any building, we've reduced the ratio of desks to staff to encourage people to work in new ways, and we've given them technology to do so."
However, Hadley said that while money might be saved in the long term, especially around bulk purchase of mobile tariffs, this has not been realised yet, and that anyway this is the wrong way to think about such interventions.
"We started the project with the assumption that mobile technology would save loads of money, but the savings on transport, buildings and other efficiencies just don't stack up. You need to consider the wider transformational programme."
This programme is about people, process and technology, Hadley said rather than cost savings. The NHS is about delivering care, and the district nurses have been able to spend more time with their patients by making use of mobile technology. They have also come up with improvements of their own.
"The nurses came up with an idea for a mobile tool to manage medication and they can also get navigation and statistics. They also twigged that most of the homes they visit have internet access. They are now able to order equipment for the patient via an online loan store."
Instead of having to return to the office to place an order, for example for a ripple mattress for an elderly frail patient, they can now order it from the store, with orders placed in the morning delivered the same day.
"And with things like this you can reduce the chance that the patient will have to be hospitalised, that's what I mean by a transformational change," Hadley said.
The Trust uses an integration platform by vendor NDL so that software can be developed quickly on a platform-agnostic basis. Mobile workers are provided with cheap consumer devices with NDL providing a secure wrapper around the data and applications.
At first the nurses, many of them approaching retirement, did not take too easily to the technology but they are now extremely comfortable with using it.
"Recently it was mooted that we might have to take the technology off of them and there was almost a riot," Hadley said. "They were not prepared to go back."
And he said, this is just the beginning.
"We're on the cusp of transformational change with wearable technology. There are going to be all sorts of sensors and devices that can plug into your phone. This opens up all sorts of new pathways to assess and deliver care in homes."