Innovation in Healthcare by Maritime Media

Innovation in Healthcare

For page turning technology visit: innovationinhealthcare.org

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Innovation in Healthcare is published by:

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Innovation – going the whole hog!

Platform for change

As the NHS gears up for transformation, the NHS Clinical Commissioners organisation aims to provide a unique platform for CCGs to access practical support

New clinical commissioning system preparing to go live

The pace is picking up in terms of establishing clinical commissioning groups (CCGs)

Safe havens

Haven Health Properties delivers state-of-the-art premises to enable the provision of innovative and inspiring healthcare

Publisher

W H Robinson

3millionlives

Associate Publisher

JULIEN WILDMAN

Improving your access to telehealth and telecare

E: julien.wildman@mar-media.com M: +44 (0) 7801 478425

A modern revolution

Designer

JUSTIN IVES

The prime role of clinical commissioners is to improve the population’s health. Innovation and redesign will be their tools, says Michael Dixon, chairman of the NHS Alliance

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E: justindesign.co.uk

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Telehealth is transforming patient care and lowering healthcare costs

Smart solutions

How can actively engaging patients improve clinical outcomes and increase practice productivity?

The power of change

Throughout NHS history, significant advances in medicine have depended on brave innovation

Putting DVT management into primary care

DVT can be clinically very difficult to diagnose, but early recognition and appropriate treatment can improve clinical outcomes.

Fast, flexible, fit for purpose

IT solutions can be small and beautiful, too. Mindy Daeschner of psHEALTH discusses how a new approach to IT can help drive innovation and make it happen in days or weeks, not months and years

A driving force

Independent transport provider Medical Services is working with existing software programmes to improve patient experience and provide Trusts with efficient, economic services

Health protection services for the next decade: from HPA to PHE 33 Paul Cosford and Eric Bolton of the Health Protection Agency look at the work of the organisation and its forthcoming merger with Public Health England

Innovative thinking for long-term conditions

As we age as a population, everyone will have one or more long term conditions – only the majority of people don’t know it yet, says Gilmour Frew, Director NHS Improvement

For page turning technology visit: innovationinhealthcare.org

Using social media to engage, listen and learn 39 Smart Guides to ENGAGEMENT for better commissioning

Building for the future of NHS healthcare Haven Health is a leading specialist development and investment company which provides high quality, innovative and sustainable healthcare premises for the primary care and community care sectors.

Contact us for expert advice and premises solutions or visit us on Stand H31 at the Commissioning Show 2012. Haven Health Properties Limited, 48 George Street, London W1U 7DY T: 020 7467 4840 F: 020 7467 4841 E: ylandau@havenhealthproperties.co.uk

www.havenhealthproperties.co.uk

Nutrition: the importance in early Alzheimer’s disease

A link exists between nutrition and the risk of Alzheimer’s disease, supported by an increasing level of new evidence

Improving Public Health

Making your sexual health budget go further

Turning on to telehealth

2012 looks set to be the year telehealth takes off

How Access and Continuity can work hand in hand

Harry Longman explains why Patient Access is an innovation transforming primary care

NHS Diabetes

One of the greatest challenges commissioners face

The power of touch

How using touchscreen technology improves patient engagement

From hospital to home

As diagnostics move away from the hospital and into the GP’s surgery and even the home, “...the upcoming years may well be known as the age of diagnostics”, according to Janet Woodcock MD, Director of the Centre for Drug Research & Evaluation, US FDA

Building public support for change

Smart Guides to ENGAGEMENT for better commissioning

Meeting your match

How to find the right healthcare technology, with the right patients – at the right price

Putting patient care in prime position

After being a patient for a day, Sue Hodgetts Chief Executive of the Institute of Healthcare Management explains the importance of complete patient care

Prescriptive measures

Kym Lowder at PCC explains how to get the most value out of medicines spending

Engagement for commissioning success

Smart Guides to ENGAGEMENT for better commissioning

Fit for life

Professor David Peters and Helen Cooke from the College of Medicine look at how programmes such as Fit as a Fiddle demonstrate what healthy ageing services should look like

Face to face with the future of healthcare

With the Health and Social Care bill now passed into law, the changes that will introduce a primary healthcare-led NHS are underway. Delegates at the Commissioning Show will find out everything they need to now about the changes

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Innovation – going the whole hog! The prime role of clinical commissioners is to improve the population’s health. Innovation and redesign will be their tools, says Michael Dixon, chairman of the NHS Alliance

Innovation in the NHS, to date, has been a patchy thing. It has involved heroes and heroines elevated to grand status or hounded out of their jobs, when things go wrong. This has created a risk averse service, where playing safe has become the default option. Where innovation has led to success and visibly sustainable success, too often it has remained the success of one organisation or geographical area. Too infrequently, has it had the rapid take up required elsewhere and too often has innovation that worked in one place failed to be cost effective in another.

Leonardo da Vinci claimed that he did not so much carve statues out of marble but used his abilities as a sculpture to release the figures that already lay within the marble. That must now be the NHS’s new approach towards innovation. To release innovation at the frontline, to encourage and nurture it and to recognise that it will often hit its target but sometimes miss. To accept that every innovator and every entrepreneur has their off days and that you cannot homogenise and standardise innovation brilliance or innovation.

Clinical Commissioning Groups run by frontline clinicians were themselves designed to be a focus for innovation driven by frontline clinicians working with patients. The priority of the NHS in this new clinical led phase must be to release such frontline innovation. That must be the priority for anyone working with the National Commissioning Board or its local offices, who is concerned with innovation. If we have learnt anything over the least few years it is that centrally directed innovation is an oxymoron. In short, innovation must come from within. From allowing it to happen. It can be suggested, supported but never successfully imposed.

In medicine, we all know that innovation can frequently have short term success. NHS changes, like offering new treatments to an individual patient, often work because they are seen to be innovative and because of the enthusiasm of those giving them and those receiving them. That is to say this enthusiasm and a “can do” pioneering attitude had been often part of their recipe for success. Consequently, centralised innovation strategies that attempt to bludgeon frontline clinicians and organisations into accepting innovations that have worked elsewhere are doomed to failure. Because innovation is a frame of mind, an emotion, an enthusiasm, an ability to inspire and a determination to make a difference. These can be neither proscribed nor prescribed from the centre.

Michael Dixon, chairman of the NHS Alliance

INNOVATION IN HEALTHCARE

Online pageturner www.innovationinhealthcare.org

Time is money why not save both? Improve patient care by taking only 8 minutes to rule out DVT by D-dimer testing, and only 12 minutes to rule out heart failure by NT-proBNP testing. The cobas h 232 can: Reduce unnecessary referrals1 Save time1 Save money1 Help you follow NICE2 and SIGN3,4 guidelines

‘Commercially available with NHS evidence to support adoption’ iTAPP*– in support of the QIPP agenda5†

The cobas h 232 system – an easy decision to make For further information, phone 0808 100 99 98, email burgesshill.cardiacpoc@roche.com, or visit www.roche.co.uk References: 1. HSJ. December 2011. www.hsj.co.uk/resource-centre/best-practice/ care-pathway-resources/why-shifting-dvt-m gement-into-primary-care -can-improve-clinical-outcomes/5037987.article [Accessed 29 March 2012]. 2. NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care August 2010. 3. SIGN National Clinical Guideline No 122. Prevention and Management of Venous Thromboembolism. December 2010. Roche Diagnostics Ltd. Charles Avenue Burgess Hill RH15 9RY United Kingdom Company registration no: 571546

4. SIGN National Clinical Guideline No 95. Management of Chronic heart failure. February 2007. 5. Presentation by John Warrington www.imsta.ie/node/350 [Accessed 29th March 2012]. * Innovative Technology Adoption Procurement Programme. † Quality, Innovation, Productivity and Prevention.

Platform for change As the NHS gears up for transformation, the NHS Clinical Commissioners organisation aims to provide a unique platform for CCGs to access practical support

As Clinical Commissioning Groups get ready to take on their commissioning responsibilities and deliver the NHS of the future, the coalition of the NHS Alliance and National Association of Primary Care is working in partnership with the NHS Confederation, to create NHS Clinical Commissioners (NHSCC). NHSCC is a new membership service that is being established to give clinical commissioners and clinical commissioning groups a strong independent collective voice. It will provide a unique platform of for CCGs to access practical support to enable transformational commissioning at a local level, and helps CCGs continually improve and develop. It will provide collective representation and advocacy that gives clinical commissioners a strong and effective voice in national policy-making and public debate, with opportunities to influence, learn from and develop shared solutions to complex healthcare challenges with colleagues from other CCGs and across the whole of the healthcare industry

NHS Alliance and NAPC, as well the wider policy development influencing, and industry leadership role of the NHS Confederation . CCG leaders will know too well that, now that the health reforms have become law, the journey is really just starting. For these reforms to produce the vision of an NHS that is more efficient, effective, engaged with patients, local populations and communities, and which is led from the ground up, clinical leaders will need a single, strong and independent voice. The shift of power, from national and regional organisations to CCGs, health and wellbeing boards, local providers and patients, will

require policy makers, the NHS Commissioning Board and other national bodies to create national structures and frameworks that will propel and facilitate, rather than stifle and slow down change. But more importantly it will require CCGs themselves to step up to the leadership task, working together with each other, the public, and with partner organisations to pave the way to transforming the health of their communities. Dr Michael Dixon, a senior member of NHS Clinical Commissioners, explains: “The NHS is going through one of – if not the most – transformative changes it has ever gone through. CCGs are the cornerstone of this transformation, which will deliver healthcare

NHSCC will draw on a wealth of experience and expertise in clinical commissioning, which has been gained over more than a decade of passionate work around clinically-led commissioning carried out by the

INNOVATION IN HEALTHCARE

Online page turner innovationinhealthcare.org

PRIMIS On your marks... good data gives your organisation a head start The new PRIMIS Hub membership scheme provides unique access to a range of free and subscriptionbased primary care data quality and clinical audit tools, learning resources, and a community of thousands of health informatics professionals.

Introductory offer ends August 2012. Visit Kerry and Jacky at the Commissioning Show 2012 (stand AA36) for more details, or contact enquiries@primis.nottingham.ac.uk quoting code IHC2012.

Improve the ďŹ tness of your organisation www.primis.nottingham.ac.uk

that is better for patients, more cost-effective for the taxpayers and which is engaged and in tune with the needs of local communities. “For this to happen, commissioning has to be done in a completely different way. Innovation and leadership will be terribly important. And clinical commissioners will need a strong collective voice that will serve as a catalyst for change and which will allow them to negotiate their way through this transformation from a strong platform. NHS Clinical Commissioners is precisely that.” Dr Charles Alessi, another senior member of NHS Clinical Commissioners, emphasises that the new path for the NHS is one of co-production between manager and clinicians. “This period of transition will be a little bit messy and difficult. Change is not always easy. Clinical commissioners need a united voice to articulate their requirements, as opposed to having a host of different organisations acting on their behalf. As the independent, collective voice for clinical commissioners, NHSCC will be a positive force for change and have more leverage with the government and other bodies to ensure CCGs are happy with how things are progressing.”

“we are on this journey together and we will be learning from each other. Therefore NHSCC will also act as a hub for sharing good practice, managing the health agenda and the process of clinical commissioning.” Both the NAPC and the NHS Alliance have a long history in supporting clinical commissioning. As Julie Wood, clinical commissioning lead on behalf of NHS Clinical Commissioners, explains: “We are in a good place to share our knowledge, expertise and experience in supporting clinically-led commissioning. And, by having a partnership with the NHS Confederation, we will also be able to draw from a wide range of skills to help us ensure that clinical commissioning and CCGs are able to deliver the vision of a liberated NHS.” Mike Farrar, Chief Executive of the NHS Confederation, agrees: “Clinical commissioners face a tough challenge to get ready ahead

of April 2013, but we know CCG leaders are already rising to it. We are keen to do everything we can to support CCGs as they are authorised and established, and in particular to help them connect with the rest of the NHS and wider healthcare care industry to aid preparations. The NHS Confederation is delighted to be working with the NHS Alliance and NAPC as part of NHS Clinical Commissioners, and to contribute to a powerful unified voice on commissioning issues.” As Woods concludes: “People involved in this are passionate about clinical commissioning and our purpose is to create a solid, inspiring and practical platform that will attract CCG members, to join forces and help both shape the development of the new independent collective voice, but also to help us shape the priorities that NHS Clinical Commissioners will focus on as we continue on our journey to realise the ambitions we have held for so long and are now enshrined in legislation.”

As CCGs carve their way towards authorisation and beyond, Dr Alessi points out that

“The NHS is going through one of – if not the most – transformative changes it has ever gone through. CCGs are the cornerstone of this transformation”

INNOVATION IN HEALTHCARE

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Commissioning Board Authority

New clinical commissioning system preparing to go live The pace is picking up in terms of establishing clinical commissioning groups (CCGs), with nine months until the new system goes live in April 2013

Across the country, groups of practices have come together and identified the shape and configuration of their CCG. It is a fantastic achievement that these geographies were agreed in May and we have 212 proposed CCGs covering the whole of England coming forward for authorisation in four â&#x20AC;&#x2DC;wavesâ&#x20AC;&#x2122; from July to November 2012.

This was a real landmark in the work to establish the new clinical commissioning system and means that every practice is part of a proposed CCG, and every proposed CCG has a date scheduled for its authorisation application. Most importantly, it means that everyone living in England will be covered by a CCG from April 2013.

It is important to emphasise that for patients registered with a GP practice, the responsible commissioner will be the CCG of which that practice is a member. For unregistered patients, the responsible commissioner will be the CCG in whose area they live. In the future, CCGs will also be responsible for ensuring access to emergency and urgent care for anyone within their geographic area at the time of need. The new clinical commissioning system is based very firmly on three key principles: that patients in their communities should be at the heart of everything we do; that clinicians should be in the driving seat in shaping services; and that we should focus on outcomes based on sound evidence. CCGs are the cornerstone for delivery of these aspirations. GP practices know their patients and largely serve specific communities with whom the practice has had a relationship for many years. They already act as the hub of care for their patients; linking patients with other clinicians and ensuring that, through the registered list and the single, lifelong record, all the care patients receive is coordinated in one place. This model is envied around the world and is key to

Dame Barbara Hakin National Director of Commissioning Development NHS Commissioning Board Authority

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INNOVATION IN HEALTHCARE

GPs and their practices are being placed centre stage

delivering better care, better experiences, better outcomes and improved safety. So it is only logical that practices should be at the heart of determining how the range of local services can best meet their patients’ needs. Good commissioning is mainly about bringing together all those with expertise and an interest in care in order to arrange the services which can deliver these quality outcomes. As a result, there is a huge responsibility on the CCG to involve patients and the public, the wider clinical community, and the full range of health and social care colleagues. There is also a lot going on to shape the rest of the commissioning system. This means putting in place all the elements of the NHS Commissioning Board’s (NHS CB) own architecture, the national support office, regional teams and local area teams. The NHS CB will be responsible for ensuring the whole commissioning system works together and that the £80bn of taxpayers’ money is turned into the best possible outcomes for patients. It will support and oversee CCGs which will have the majority of this resource, as well as commissioning specialised services, primary care services, prison and military health services, and many public health services, on behalf of Public Health England. With regard to primary care, the NHS CB will commission primary medical services, primary dental services, community pharmacy and primary ophthalmic services which are currently commissioned by PCTs. It will be responsible for the GMS, PMS or APMS contracts that GP practices hold for providing primary medical care – and it will have a duty to commission these primary care services in ways that improve quality, reduce inequalities, promote patient involvement, and promote more integrated care. The NHS CB will be a single organisation and will, wherever it is appropriate to do so, take a consistent approach to managing the contract with practices, whether that be a GMS, PMS or APMS contract. CCGs have a huge part to play in driving up the quality of primary medical care but CCGs

will not be performance managing primary care contracts. Another key plank of the system will be dedicated commissioning support organisations. While CCGs will be able to buy their support services from wherever they choose, we need to ensure they have the full range available to them from day one. Many independent and third sector organisations can offer great niche commissioning support or highly sophisticated tools and products to aid commissioners. But the capacity and capability to deliver the full range of commissioning support sits with highly experienced individuals currently in PCTs, and we must ensure this expertise is supported to deliver the best range of services from which CCGs can choose. In the final analysis, success will be predicated on whether healthcare services deliver better outcomes which meet people’s needs, whether these services deliver integrated care, and whether local communities feel they have a real voice in shaping services which suit them. The key vehicle in ensuring this happens will be the local health and wellbeing board. These vital structures are still in their early development but need to

INNOVATION IN HEALTHCARE

be the focal point for communities, bringing together patient and public representatives, alongside all the players who commission or provide care in the locality, in order to ascertain the needs of the population and outline the overarching strategic plan on which individual components will be based. Clearly, GPs and their practices are being placed centre stage in a way we have never seen previously. CCGs will only be successful if the majority of practices seize this opportunity and make the CCG their own. CCG leaders are already emerging, trusted to oversee much of the day-to-day aspects of clinical commissioning. But without the support of the majority of their practice colleagues, primary care and the wider clinical community, their task will be too great. It is the contribution of all teams, through their connection with their patients, and others who provide care, which will make the difference. There is more information on the development of the new clinical commissioning system and you can sign up for regular bulletins for CCGs and commissioning support services at the NHS Commissioning Board Authority’s website.

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Safe havens Yvonne Landau, MD

From the dawn of the NHS in 1948, the 1950s-60s ushered in an era of innovation with the concept of a healthcare service that was free and accessible to all for the first time. GPs tended to their patientsâ&#x20AC;&#x2122; needs from local surgeries, typically occupying the front room of their family home. Patients waiting in the hallway, phone calls at all hours and the telephone message machine were very much features of life for any GP and his family, whose home was effectively the centre of healthcare for the local community. Growing up as the daughter of a rural GP, those formative years must have left a lasting impression on Yvonne Landau, who in the year 2000, together with co-director Michael Luckley, went on to establish Haven Health Properties, a company that specialises in third party development (3PD) of high quality purpose built premises for the primary care sector. Since then, it has delivered a significant number of state-of-the-art premises throughout England and Wales, all of which facilitate and enable the delivery of innovative and inspiring health care.

Haven Health Properties delivers state-of-the-art premises to enable the provision of innovative and inspiring healthcare

There are still thousands of GPs trying to deliver modern 21st century healthcare services from outdated, cramped premises in converted residential or retail buildings which are not remotely fit for purpose. It is a fact that 50% of patients still receive their primary care in unsuitable premises, which inevitably places constraints on the quality of services they receive. The aspiration to be working in high quality, fit-for-purpose premises is not just a service objective for GPs seeking to secure the future of their practices, it is also an essential requirement for the delivery of an expanded range of medical activity. Premises are a vital part of the operational infrastructure necessary to deliver an innovative and integrated primary care service. With GPs at the forefront of commissioning and many of the GP shadow and pathfinder consortia currently focused on the redesign of clinical services and implementing initiatives to ensure integrated pathways of care and improvements in patient care, there is an increased emphasis on delivering more services locally in a primary care setting. The need for modern, purpose-built primary care premises is absolutely paramount if these clinical aspirations are to be met.

modern primary care premises

Fast forward to 2012 , and despite the huge advances in the provision of medical services and the fact that some excellent primary care buildings have been delivered in recent years, for many GPs the reality of their surgery premises today has changed very little from that early residential based model.

cqc registration

This need will become even more apparent as Care Quality Commission (CQC) Registration of all GP Practices becomes mandatory from April 2013 and the requirement to meet all CQC registration standards, for each level

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of clinical activity offered to patients, could eventually block the functioning of non-compliant surgeries. CQC registration applies separately to the buildings to be used for service delivery from the services themselves. Practices seeking to provide, for example, higher levels of minor operation procedures, will need to demonstrate that the facilities being used to deliver the service meet the required specifications, infection-control and quality standards before the practitioner or clinician can perform the procedure concerned, even once they hold the required operating licences. Any leniency shown in the early years of the CQC regime, in terms of premises standards enforcement is not likely to extend much into the future and will certainly not favour Practices operating out of older premises that are not big enough to meet their needs, nor fit-for-purpose in terms of standards and specifications. Comparing one surgery building, with a given number of consulting rooms and other medical facilities, with another of the same capacity will increasingly focus on the clinical standards and levels of infection control being delivered, not just on the amount of space. Surgeries may even consider developing new buildings that are not significantly bigger than their current premises, if the new facilities will allow them to grow and develop the depth and range of services offered to patients, not just follow the traditional growth model.

INNOVATION IN HEALTHCARE

premises funding

As Clinical Commissioning Groups (‘CCGs’) take on budgetary responsibilities and commissioning functions, in readiness for their statutory powers coming into force as from April 2013, it is essential that decisions over primary care premises improvements, and the funding of new schemes, are made at the level of local-health-economy budgets and not as part of a centrally controlled process that cannot be sensitive to local requirements. Each time a new development proposal goes forward for funding, the revenue commitment that is asked for should be seen as a catalyst to unlock a wide range of benefits for the local health economy, not just to provide new space for local Practices. It is in this context that the affordability position should be assessed and the required revenue funding secured.

procurement

Reduced public sector expenditure means that every GP commissioning consortium must ensure that it obtains value for money for the NHS, this applies to premises as well as services. Of the many methods used to procure new healthcare buildings including PFI, LIFT, Procure 21 and so on, none has proved more cost effective than Third Party Development (3PD).

This tried and tested method enables high quality primary care premises to be provided by a 3PD Partner who takes on every aspect of the development process including sourcing and securing a suitable site. The development partner undertakes all of the responsibility for the delivery of the project including financial thus eliminating risk for GPs or the commissioning body. Value-for-money is confirmed through the District Valuer’s Report on the project. It is anticipated that this aspect of primary care premises developments will continue unchanged, at least for the foreseeable future, as the new Commissioning Group and Board structure come into force and take over the funding reins from the old PCT structures next year. But this is not just about saving money, it is also about the quality premium in delivering more holistic levels of service for local people in a primary care setting as part of local community facilities, rather than large remote institutions. The opportunity to migrate secondary, daycase and outpatient activity into primary care settings with new facilities should help save money at local health economy level, as well as providing better services for patients, that are also locally accessible.

more services within a primary care setting

Routing more activity along primary care pathways will fit with local commissioning strategies and allow the same activity to be delivered at cheaper prices than hitherto, as well as helping to reduce unscheduled admissions and the incidence of unscheduled care in the first place as patients overall are encouraged to live healthier lives. The concept of Quality Premium can be considered in this context, alongside the QIPP benefits that new facilities will help bring about. Promoting health and wellbeing is as important as treating the sick. The opportunity for other health related organisations to make use of new Primary Care Centres, not just the practices themselves, allows meeting rooms, educational space and the resources of the centre as a whole to be used to promote healthy living as well as a wide range of integrated services. These may include health education, counselling, citizens’ advice, complementary medicine, exercise techniques and a range of other therapies. Haven Health’s expertise lies in its ability to deliver world class premises, while at the same time, ensuring value for money for the NHS.

CASE STUDY Port Talbot Primary Care Resource Centre By Michael Luckley, Development Director of Haven Health local need

This innovative project was born out of local need. A relatively deprived area, with a great industrial heritage, the greater part of Port Talbot is located south of the M4 motorway. When Haven Health was appointed to this project, the core primary care service for this area, with a population of 30,000,

was delivered by four GP practices and the Health Board from five separate buildings; six including the hospital.

improved and enhanced services would be provided for the patient population.

The Health Board’s plan was to both expand and concentrate the service into a single location from which a wide range of

strategy

INNOVATION IN HEALTHCARE

It was from this strategy that the concept of a Primary Care Resource Centre was

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Modern, fit-for-purpose premises like this are an objective for many GPs

born. Finding the right site took time. At 6,000 sq.m. the scale of the building dictated a requirement for over a hectare of land. It also had to be located centrally having regard to the patient population. A site adjacent to a supermarket and retail park, in an ideal location and well served by transport communications was secured.

Early consultation with the local community was a crucial and tremendously beneficial part of the overall process. The theory behind the Resource Centre strategy was that not only would the NHS benefit from a rationalised and more efficient service but at the same time the patients would receive a better service.

On walking in to the Resource Centre, the patient journey begins with the main “street”, which runs all the way through the centre of the building and is open to the glazed roof. This facilitates both horizontal and vertical connections and it was appreciated from an early stage that if integration was to be properly facilitated in the building it would be important to allow one occupier a visual connection with the others.

integration and co-operative working

project brief

At an early stage, two key project parameters were laid down. First, each of the four Practices wanted to retain its identity and its patient list, as indeed did the Health Board, the Dental School, the Voluntary Service and the Local Authority that were also going to share occupation of the building. Second, the building needed to facilitate the integration of the full range of primary care services that these providers had to offer.

Including accommodation that is shared by the different occupiers is also important in this respect. The space allocated to the practices (GMS space) has a minor surgery suite, a health promotion room, as well as clinical and meeting rooms that they all share. In addition, there are training and education rooms, a kitchen and a staff break-out area that are shared by all of the occupiers in the building. This brings staff together in both a professional and informal environment to promote co-operation and integration.

However, it was appreciated by all that a building can only do so much and to be ultimately successful, significant changes and innovations in working methods would be required. At the point at which construction work was commenced the job specification for the role of “Resource Centre Manager” had been drafted. Running the building would present its challenges, but exploring the potential benefits to be gained from a collective approach would need to be managed. A Management Committee was formed to allow the occupiers to share their views and make joint decisions, promoting a sense of “ownership” of their workplace.

an innovative building facilitating excellence

The building has been open for nearly three years. Notwithstanding the fact that it was built with a considerable amount of vacant/expansion space, it is now full. The building is appreciated for all that it offers and the process of integrating, improving and making the primary care service in Port Talbot more efficient continues. The project is already considered a resounding success. In a future where improvement and efficiency of the NHS healthcare provision is likely to be driven by rationalisation of acute care and the expansion and integration of primary care, the Port Talbot Resource Centre is perhaps the future, today.

design process

The design team took to the challenge. Through a series of design workshops and steering group meetings involving all key stakeholders, the main design criteria were established and initial floor and site plans drawn up. The design development process lasted four months. It was then tested for the final time before submission of the planning application. Bringing 30,000 practice registered patients, not to mention the patients registered elsewhere, but using the ancillary services, under one roof posed a number of problems.

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INNOVATION IN HEALTHCARE

Background On 5th December 2011 the Department of Health published the headline findings from the Whole Systems Demonstrator (WSD) programme, the world’s largest randomised control trial of telehealth and telecare services. The potential for telehealth and telecare is enormous and the Prime Minister, David Cameron has made clear the government’s commitment to work with industry to improve the lives of three million people. The WSD programme was established by the Department of Health (DH) to evaluate how the use of telehealth and telecare services can support people with long term health and care needs to live independently. The three year research project aimed to create the largest evidence base for telehealth and telecare in the world.

The WSD Headline Findings • • • • • •

45% reduction in mortality rates 20% reduction in emergency admissions 15% reduction in A&E attendances 14% reduction in elective admissions 14% reduction in bed days 8% reduction in tariff costs

Headline findings have been released for telehealth and show that these services can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E. The findings for telecare will be available soon.

Paul Burstow the Minister of State for Care Services reaffirmed his commitment to 3millionlives at a parliamentary reception held on 19 January 2012 which showcased the work of the whole systems demonstrator programme. He confirmed the approach to delivery of telehealth and telecare and launched a Concordat between the Department of Health and the telehealth and telecare industry.

“This new approach is set to improve the quality of care for 3 million people, increase their independence and dignity as well as reduce the time they spend in hospital. It is only by the telehealth industry working together with the Department of Health and other stakeholders, that this will be possible” Paul Burstow MP, Minister of State for Care Services

www.3millionlives.co.uk info@3millionlives.co.uk

3millionlives is supported by the Department of Health

Why has 3millionlives been developed? The Department of Health (DH) believes that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services. Implemented effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on long term NHS costs and improve people’s quality of life through better self-care in the home setting. On 19th January, Paul Burstow MP, Minister for Care Services committed to work with industry, to support the NHS, social care and professional partners in 3millionlives in order to achieve this level of change.

3millionlives objectives • For the Department of Health (DH) to create the right macro environment to support the uptake of telehealth and telecare including aligning the incentives for the NHS and social care and providing health and social care commissioners with the right incentives to commission telehealth and telecare as an integral part of care pathways • For industry to develop new business models and appropriate ways for the market to engage and for the NHS to commission telehealth and telecare services at scale • To increase awareness and visibility of the potential benefits of telehealth and telecare to stakeholders who commission and deliver services • To place a strong emphasis on patient education and empowerment, so that people are fully informed about the benefits that technology can provide in managing their health and care • To place a strong emphasis on supporting professionals and leaders so that they are better able to understand the benefits that telehealth and telecare can bring to their patients and to their working practices • To put the NHS and UK industry at the forefront of telehealth and telecare globally; developing significant opportunities for UK plc

Why telehealth and telecare? • Potential to make significant health improvements and quality of life impacts for people with a high dependency on the NHS, local GPs, social services and local hospitals. • Provides a means to increase the availability of NHS clinical support by allowing local practitioners to be in permanent contact with those people less able to look after themselves. • Can help improve the reach of the services that the NHS provides, looking after those who are often ‘invisible’ from the main acute services. • Helps keep people out of hospital and avoids all the pressures this can put on them and their families.

“Since I have had telehealth I have not had to go to hospital or visit outpatient services... I feel safe; telehealth is the best thing that’s ever happened to me.”

“Because of my nursing experience I was thrilled to hear these things were being developed to help protect vulnerable people and help them maintain their dignity so they can feel like they are still capable of carrying on themselves. I feel safer and it helps me to retain my independence”

www.3millionlives.co.uk

“Home visits from the GP and district nurses are not so frequent as they used to be...most importantly my hospital admissions as an inpatient have reduced, in the last 31 months I have spent 10 days as an inpatient compared to eight to ten months a year. Being on telehealth has given me full control of my life and independence...” Telehealth improves quality of care, increases dignity and independence and saves money.

Benefits for Individuals • More effective self care • Improves quality of life for carers

“The matron picked up a deterioration in my condition immediately and I was rushed to hospital for life saving surgery.”

• Less travel and disruption for routine check-ups • Retention of dignity • Increased confidence to manage own health • Fewer stressful, unplanned hospital admissions

Benefits for Health and Social Care Professionals • Through risk stratification, professionals can identify those people in their practice who have LTCs and could be better supported if telehealth were adopted • Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes • Professionals see less impact on family members / carers of people with LTCs as they start to take more control of their own health • More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care

Benefits for Commissioners • Deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers • It significantly reduces the incidence of A&E usage and unplanned admissions thus reducing the disturbance on elective planning • It makes more efficient and effective use of available clinical teams by reducing unnecessary home visits • It involves people far more in the management of their own healthcare

www.3millionlives.co.uk

“I've seen telehealth have the most incredible effects on individual patients because it opens up the 8,000 hours every year when they are looking after themselves, for themselves. Patients change from suffering an illness to managing a condition so the results can be much better than even the closest professional attention can achieve. Britain has the expertise to be world leaders in this whole new way of caring for people and the opportunity for individuals and communities to reap the benefits.” Dr Atul Kumar-Beurg, Former Clinical Director of Newham Whole Systems Demonstrator “Moving care closer to home can both improve the patient experience and reduce the pressure on the health service and telehealth has to play a central role in facilitating this change. WSD is just the beginning, telehealth has so many possibilities – don’t wait, act!” Dave Tyas, Service Improvement Manager – Telehealth and Long Term Conditions, Peninsula Community Health, Cornwall WSD “Telehealth is an enabler for both patients and clinicians empowering patients to be in control of their own health and allowing clinicians to better manage their patients and be more pro-active in their approach.” Sharon Lee, One of the lead clinicians involved in the Kent WSD programme and specialist community matron, Kent

Where can I find more information on WSD? www.dh.gov.uk/health/2011/12/wsd-headline-findings www.2020health.org/2020health/Publication/telehealth.html www.kingsfund.org.uk/topics/technology_and_telecare/index.html www.innovateuk.org/ourstrategy/innovationplatforms/assistedliving/dallas-delivering-assisted-living

How can I get involved? The aims of this campaign will not be achieved overnight. Four main industry associations have come together, with the Department of Health, to provide the initial leadership and collaboration to get the programme underway. These include: • The Telecare Services Association (TSA), representing the telecare and telehealth industry • The Association of British Healthcare Industries (ABHI) • Intellect (representing the IT industry) • Medilink UK (Life sciences industry support organisation with a specific interest in telehealth and telecare). Through these associations, member organisations are represented, providing input and support. Detailed plans for the campaign including governance, are in the early stages of development, with key stakeholders coming together to share their views.

Further details about 3millionlives can be found at: www.3millionlives.co.uk Email: info@3millionlives.co.uk

Is research within reach of your patients? Clinical research is vital to the development and improvement of patient treatments across the NHS. So much so, that the duty to make patients aware of relevant research opportunities is part of the NHS Constitution. According to an Ipsos MORI poll1 published in June 2011: 93% of the public want their local NHS services to be encouraged or required to support research, and 72% would like to be offered opportunities to be involved in trials of new medicines or treatments if they suffer from a health condition that affects their day-to-day life. However, a poll conducted by the Health Service Journal last year shows that research is viewed by two-thirds of healthcare professionals as peripheral in NHS Trusts2. Sponsored by the Department of Health, the NIHR Clinical Research Network is part of the “research arm” of the NHS. We offer practical, hands-on support and resources, to enable NHS organisations to engage in high-quality clinical trials for patient benet. For more information on the Clinical Research Network, and how we support NHS Trusts, visit: www.crncc.nihr.ac.uk Or visit us on Stand B5 at NHS Confed

The NIHR Clinical Research Network t: 0113 343 2314 e: crncc.info@nihr.ac.uk w: www.crncc.nihr.ac.uk

Supporting research to make patients, and the NHS, better Commissioned by the Association of Medical Research Charities, the Breast Cancer Campaign and the British Heart Foundation.

Commissioned by the NIHR Clinical Research Network

A modern revolution Telehealth is transforming patient care and lowering healthcare costs

It is a fact that average European life expectancy is increasing by 12 months every five years and prevailing healthcare services will require considerable financial investment to meet this seismic shift in demand. Budgets are tighter than ever and cutbacks are being made across the public sector. 15.4 million people – or almost one in three of the population in England – suffer from at least one long-term condition, a number set to rise by 23% over the next 25 years. It is also a fact that older people’s care is heading towards a crisis point. The UK health system is costing too much and will become an unsustainable component of GDP by 2020.

Although our population is living longer, our society is becoming less well. Sedentary lifestyles and poor diet are making us more prone to serious disease as a result of factors such as obesity, smoking and alcohol. The number of people diagnosed with diabetes in the UK has almost doubled since 1996 to 3.1 million, and diabetes accounts for 9.7% of hospital admissions and 20% of hospital bed days. An estimated three million people are affected by Chronic Obstructive Pulmonary Disease and it is the second largest cause of emergency admissions in the UK, whilst Chronic Heart Failure accounts for a total

of one million inpatient bed days and hospital admissions are due to rise by 50% over the next 25 years. Integrated, preventative healthcare is consistently cheaper and more effective than emergency medical treatment. So this is where our focus for affordable development must lie – by increasing accessibility to technology for physicians and nurses, and by empowering patients to manage their own health increasingly through telehealth programmes. The care process, therefore, becomes patientcentric: reducing anxiety, avoiding unplanned hospital admissions, cutting GP appointments and improving medication compliance. Most importantly, telehealth puts patient care at the heart of the service, through active daily management from the comfort of their home. The need to drive down NHS costs and increase the quality of care is recognised in the Operating Framework for the NHS 2012/13, which highlights that tele health offers opportunities for delivering care differently and more efficiently. The use of this technology in a transformed service can lead to significant reductions in hospital admissions and lead to better outcomes for patients.

Telehealth mproves self-care and captures a fuller, more accurate picture of a patient’s medical history

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INNOVATION IN HEALTHCARE

“There are enormous savings to be made from the implementation of telehealth that could be reinvested in patient care,” says chief executive of Telehealth Solutions John Dyson. “We estimate that these savings could be more than £1bn per year which makes the adoption of this approach a real and pressing necessity.” Dyson says transforming the way the NHS delivers healthcare services is about working with clinicians to support them in “understanding and embracing these new technologies”. Dr Julian Neal, a leading GP agrees. He says one of the challenges in embedding the use of new technology in the NHS is that health professionals “feel threatened that it will make them redundant, but I have never seen technology make people redundant”. He adds: “What it means is that in the same amount of time professionals can manage more patients, we can up-skill some people in terms of triaging and we can deliver a much better level of chronic disease management. Telehealth Solutions is already revolutionising the care of patients with long-term conditions through the Home Pod, and recorded studies to date have revealed considerable and demonstrable improvements in standards of care, efficiency of operations and financial bottom line. For example, in a recent Telehealth Solutions programme with COPD patients in Argyll and Bute, Scotland.

Scottish Enterprise awarded NHS Highland the 2011 Life Sciences Innovation Award for its work using Telehealth Solutions technology on the Isle of Bute – its third award in 12 months for this project. If you would like to know more about telehealth and how Telehealth Solutions are driving down the cost of providing healthcare, but at the same time improving quality and clinical outcomes call Hannah Lowish on the contact details opposite.

For more information, contact: Hannah Lowish Tel: 0800 8600 786, quoting innovate Website: www.thsl.com

“COPD is one of the diseases with the highest admission rates to hospital and we have a lot of revolving door admissions from patients with COPD, who were in and out all the time because they did not have access to specialist respiratory services, particularly on the island of Bute,” said Maggie Clark, long term conditions manager for Argyll & Bute Community Health Partnership. “We thought there must be a better way to do this and with telehealth coming in we looked for a new solution.”

Telehealth Solutions is already revolutionising the care of patients with long-term conditions

INNOVATION IN HEALTHCARE

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Smart solutions How can actively engaging patients improve clinical outcomes and increase practice productivity? Patient involvement in health decision-making and delivery is now a central theme of national and local policy in the NHS.

protocols to collect information on specific diseases or general health and lifestyle, for example alcohol consumption, diet and smoking habits.

Some forward-thinking GP practices have embraced this philosophy and are now enabling patients with long-term conditions to monitor themselves at home to create data that will ultimately be captured within their electronic health record (EHR), using HomePod-type technology.

The benefits of these approaches are numerous: engaging patients more actively in their own care by offering them access to information enables them to make more informed choices about their condition and treatment. Alongside condition monitoring, this improves self-care and captures a fuller and more accurate picture of a patient’s medical history.

Other GP practices are using similar telehealth technology to enable patients to conduct standard medical checks in the waiting room ahead of their consultation – with the results posted automatically into their EHR. Both these solutions use smart technology comprised of a strong, touch-sensitive screen, and a range of medical device peripherals – for example, a pulse oximeter, weight scales and a sphygmomanometer – to capture vital signs combined with qualitative clinical

Telehealth Solutions has conducted a series of interviews with practice managers, GPs and patients in practices where SurgeryPods have been used to conduct standard medical checks in the waiting room. It found that there were significant time savings both for nursing and GP staff, and similar time savings for patients. We estimate that the total time savings would be equivalent to one healthcare assistant for a practice size of 10,000–12,000.

The interviews suggest that immediate benefits to the practice come in three main forms: »» More time to care, as unnecessary nurse/ HCA/GP appointmentsare are eliminated and GPs have immediate access to relevant vital signs information in consultations. »» Improved, or easier-to-achieve, performance indicators for processes like the Quality and Outcomes Framework (QOF), due to better gathering of relevant information. This in turn increases the earnings of the practice. »» More accurate data, because “white coat syndrome” is reduced for blood-pressure measurement and both patient-health and alcohol questionnaires, in particular, are answered more honestly. The Red House Surgery in Hertfordshire is using the SurgeryPod to enable patients to record their weight, peak flow, pulse and blood pressure in the waiting room prior to their consultation. Fully interoperable with all major practice management systems software, the SurgeryPod automatically posts data directly and securely into individual patient records without clinical supervision via a network connection. Dr Michael Ingram, a GP at the surgery, said: “General practice is changing with longer consultations, more complex problems and increasing expectations. This means that health prevention and routine checks are more difficult to fit in.” He added: “This solution is ideal, as efficiency is improved via automatic data collection and the patient is offered an active role in their own healthcare.”

Telehealth puts patient care at the heart of the service

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Case study: Argyll and Bute On the islands of Argyll and Bute off the west coast of Scotland, patients with chronic obstructive pulmonary disease are using HomePods to avoid being admitted to hospital. The devices were initially rolled out to 16 patients across the two islands in March 2009 to allow clinicians to remotely monitor health and decide when hospital admission is required. The HomePod trial, which is being funded by NHS Highland and Argyll & Bute Council, initially started as a pilot for patients with lung disease, but the devices can be used to monitor a variety of common conditions including heart disease and hypertension. The telehealth system assesses: »» General health status »» Coughing, sputum production, colour »» and consistency »» Whether the patient’s ankles are swollen »» Oxygen saturation and blood pressure through peripheral equipment. Using the kit, patients can monitor their vital signs on a daily basis, checking things like lung function and blood pressure. Once the information is processed, it is sent on to the patient’s GP or community district nurse to be analysed. Any changes occurring in a patient’s condition can be detected and acted on very quickly. Each device costs £1,300 to install in a patient’s home, but according to long-term conditions manager for Argyll & Bute Community Health Partnership Maggie Clark, they are already paying for themselves. She is so convinced telehealth SAVINGS systems like these are the way of the future that a further 60 patients are set to receive them in the coming months.

Telehealth Solutions commercial director Mike Evans says using the device offers patients an “unprecedented sense of freedom and also peace of mind that they are taking charge of their own health”. “Crucially, it also removes the temptation for self diagnosis, either through books and magazines or on the internet, which is all too common, but which can also be very dangerous. “For today’s NHS professionals, many bound by budget constraints, offering patients the chance to take charge of their own health where appropriate – and with remote medical guidance – is a fantastic step forward,” he adds. However, Clark does admit to initial scepticism and suspicion among parts of the medical profession at the introduction of the telehealth system. “Fortunately we had one nurse who could see the benefits of it from the start and become a community champion for it, and most GPs came on board when they saw that any increased workload that it generated was appropriate and not down to having to use the technology,” she says. Despite the evidence that it works well, however, she says the team is still having to do a lot of work to break down the barriers in the medical profession and convince clinicians of the benefits that telehealth can bring.

“COPD is one of the diseases with the highest admission rates to hospital and we have a lot of revolving door admissions from patients with COPD who were in and out all the time because they did not have access to specialist respiratory services, particularly on the island of Bute,” Clark explains. “We thought there must be a better way to do this and with telehealth coming in we looked for a new solution,” she adds. She says the touchscreen device, which is very similar to a tablet PC, asks patients a series of questions. According to their responses, it prompts them to act in ways that will improve their condition and educates them at the same time – which Clark says is “probably the biggest bonus”. “The device also checks their oxygen saturation levels every day and their blood pressure and weight weekly. A community nurse will check these results every day and contact patients by phone or home visit or ask them to come in to see their GP depending on the results.”

INNOVATION IN HEALTHCARE

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The power of change Throughout NHS history, significant advances in medicine have depended on brave innovation. From the discovery and first use of antibiotics to the first immunisation or the first organ transplant, innovators have taken risks and challenged orthodoxy. Clinical and managerial conservatism combined withorganisational bureaucracy often retards rapid implementation of proven new treatments. Telehealth is an example of an innovative treatment that has been slow to be adopted despite a wealth of published evidence from the UK and abroad demonstrating its power to improve clinical outcomes while simultaneously reducing the use of healthcare systems for chronic obstructive pulmonary disease, diabetes, heart failure, depression and post traumatic stress disorder.

In December 2011, the government published evidence from its Whole System Demonstrator programme that confirmed the power of telehealth to deliver four major wins: improved clinical outcomes; increased speed of delivery of clinical care; significantly reduced unscheduled and elective care; and reduced total NHS expenditure. The government believes 3 million patients with long term conditions may benefit from telehealth and plans to encourage the adoption of largescale telehealth programmes through its 3millionlives campaign. For the government to succeed in delivering its telehealth aims and for large numbers of patients to benefit from telehealth, three things need to happen. NHS commissioning bodies throughout the UK need to be persuaded that for a modest investment in telehealth there are significant short to medium term savings to be made. This will require leadership from

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clinicians who may be initially sceptical and an understanding from financial controllers that telehealth provides a powerful tool to achieve cost efficiencies. Second, clinicians in primary care must be reassured that, although telehealth will require some redesign of delivery systems, it should always complement rather than undermine current systems for delivering managed care to their growing number of patients with long-term conditions. Finally, local health economies need to be provided with real working examples of how telehealth can deliver cost effective care that fully integrates primary and secondary care. Dr Julian Neal is a senior GP partner at Portsdown Group Practice in Portsmouth and medical adviser to Telehealth Solutions

INNOVATION IN HEALTHCARE

Case study: Portsmouth In Portsmouth, a partnership between a group of GPs at the Portsdown Group Practice and Telehealth Solutions has been set up to develop a range of telehealth products that are “clinically led and financially driven”.

integration between secondary and primary care and reduce lengths of hospital stay. Bournemouth, Poole and Dorset Just

Drawing on the practice’s 30,000 registered patients and with the help of health economists, the practice plans to gather robust clinical and economic data to convince other medical professionals that telehealth works, and contribute towards delivering the government’s ambitious telehealth agenda. Senior partner Julian Neal says the practice has experienced “the power of telehealth to increase the ability of its chronic disease management teams to care for thousands of its registered patients with long term conditions by utilising central triaging systems”. “This has reduced the burden on overstretched staff. It’s a remarkable winwin situation for both patient and practice.” he adds. The practice has already rolled out telehealth devices to some of its patients with chronic obstructive pulmonary disease and from March that will be extended to a cohort of patients with diabetes. Local hospital consultants have been keen to get involved with the work. Partha Kar, consultant diabetologist at Portsmouth Hospitals Trust, thinks the power of telehealth’s clinical algorithms will increase

Case study: Dorset Just over two years ago, NHS Dorset and NHS Bournemouth and Poole managed to secure some regional innovation funding from the government to help kick start its telehealth service across the county in order to help patients self manage their long-term conditions, with particular attention on those patients with COPD and chronic heart failure. The PCTs are aiming to roll out a telehealth service to 300 patients this summer, with each patient assigned a “key” healthcare worker in the form of a community matron, district, or practice nurse. These will work with the patient to gain a greater understanding of their condition using telehealth to reach a “personalised goal”, along with self management of their condition. According to Julia Marston, telehealth project manager at NHS Dorset, the primary care trusts have benefitted from some “fantastic engagement” with health professionals, who have “helped shape the project from the bottom up”. She says that the PCTs believe that telehealth can offer “real benefits to both local patients and the wider health community”.

INNOVATION IN HEALTHCARE

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Putting DVT management into primary care DVT can be clinically very difficult to diagnose, but early recognition and appropriate treatment can improve clinical outcomes. Shifting DVT management into primary care can save money as well as improve outcomes

In 2009, South West Essex community services, now part of North East London Foundation Trust, established a DVT service based at Brentwood Community Hospital aimed at improving DVT diagnostic services for nine GP practices in the Brentwood area, serving a population of 74,000 people in south west Essex.

Patients presenting to their GP with symptoms suggestive of a DVT are referred via a phone call to the service, with the patients’ details then sent electronically or by fax. The referral process has been made as simple and streamlined as possible in order to reduce the administration burden on referring GPs and their practices. The centre is able to accept the referral via the phone call and

the patient is sent directly to the centre to be seen as soon as they arrive. No appointment system is in operation, reducing patients’ waiting time once they are referred. Patients are initially assessed with a Wells’ score and those with a low probability score for DVT are then offered a D-dimer test using the cobas h232 point of care system from Roche Diagnostics. This quantitative diagnostic system needs no subjective interpretation and, in association with a low probability Wells’ score, allows the nurse to safely rule out DVT in primary care, ensuring only patients at higher risk are referred for further imaging tests. The service also benefits from an onsite Doppler scanner, enabling fast and costeffective diagnosis. The Brentwood service is entirely nurseled, with the exception of the clinical lead senior consultant haematologist Dr Andrew Hughes, which means that while the centre operates efficiently, atypical presentations can be assessed and managed quickly on-site.

Brentwood Community Hospital

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Wells’ score

D-dimer is a specific fragment of cross-linked fibrin that circulates in the blood stream for several days following a thrombotic event, such as DVT. It is produced naturally as part of the normal clotting process, but can also be found in increased quantities in the blood in abnormal clotting processes and so the presence of D-dimer can indicate the occurrence of unwanted thrombotic events. The use of D-dimer with a clinical decision rule such as the Wells score can reduce treatment costs by decreasing the need for costly imaging techniques for patients presenting with suspected DVT. Patients with a low probability Wells’ score and negative D-dimer can be discharged, with careful safetynet instructions to seek further medical advice in the case of persisting or worsening symptoms, or patient concern. results of the service

The DVT service sees, on average, 250 patients per year. With each acute DVT presentation costing approximately £500 per patient if referred to secondary care, these patients would have represented a total cost of £125,000 a year. However, all patients can now be assessed and managed in primary care with an approximate annual saving of £60,000.

Dr Hughes commented: “This service is highly cost-effective. The DVT service is better for GPs and patients clinically and practically, yet also offers a cost-saving to service commissioners. Efficiencies like this are essential for helping the NHS to deliver better services more efficiently, now and in the future.”

Savings are also made in time, as well as in costs. Following a suspected DVT referral to Brentwood, it takes approximately 30 to 60 minutes for a patient to be seen and assessed, including carrying out the D-dimer test, which takes eight minutes to give a result. The majority of patients referred to the DVT pathway by GPs do not have DVT, but point of care testing and diagnosis using the D-dimer test enables rapid identification and treatment of appropriate patients at low or higher risk of DVT, enabling appropriate further management. Patients also report that being able to have their condition assessed more rapidly and in a primary care setting is much less stressful for them.

benefits of the service

»» Point of Care D-dimer testing allows patients with suspected DVTs to be safely assessed in a primary care setting »» A negative D-dimer in association with a low probability Wells’ score helps to rule out thromboembolic events »» The use of POC D-dimer testing with a Wells score can decrease the number of patients who require referral to secondary care for a Doppler scan down by up to 50% »» A primary care-based initial assessment service is easy to access for both GPs and patients with clear benefits for both »» By decreasing the number of secondary care referrals, significant cost savings can be made.

Tel: 01444 256926 E-mail: joe.whelan@roche.com Web: www.roche.co.uk

cobas h232 point of care system

First appeared in HSJ 15th December 2011

INNOVATION IN HEALTHCARE

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Fast, flexible, fit for purpose IT solutions can be small and beautiful, too. Mindy Daeschner of psHEALTH discusses how a new approach to IT can help drive innovation and make it happen in days or weeks, not months and years Healthcare – like charity – begins at home, but should it now stay there too? According to Sir John Oldham, the Department of Health’s national clinical lead on quality and productivity, we have no choice. Sir John has warned: “If we continue to manage people with long-term conditions as we do now [predominantly in hospitals and clinics], the NHS is not sustainable.” Meanwhile, the evidence on the benefit of selfmanagement is overwhelming, he points out, “in terms of reduced visits to GP surgeries, reduced unscheduled admissions, better outcomes, less errors. The list just goes on. It’s a no brainer.”

Connecting for Health – the mammoth, costly IT programme that was set up in 1998 (originally as the National Programme for IT) – was a necessary but, due to sheer scale, difficult implementation. And its size makes it less flexible than ideally any system should be. Developments move fast in IT and it’s easy for large systems to get left behind. Indeed, Sir John Oldham warned last year that self-care using technology in patients’ homes will not necessarily be what is currently available. ‘Shortly it will be the Facebook generation that has long-term conditions,’ he said. ‘They will want to download apps about their conditions.’

Ingolv Urnes, psHEALTH Prinicipal, agrees: “Anyone planning to use more technology needs to think about fast, flexible improvements that can be constantly updated. At psHealth, we’re pioneering systems that can adjust to niche needs. These are almost bespoke packages that will help managers keep up not just with changes to healthcare practice such as a new drug or management technique, but also the latest offerings from Silicon Valley.” He adds: “The last thing an NHS IT manager wants is to be lumbered with a costly new system that could become outdated in the time it takes for his team to learn its application.

Patients prefer it, too: repeated studies find that whether the problem is chronic such as diabetes, or even more acute such as administering chemotherapy for cancer, helping the public to stay in control at home – and out of the sometimes overwhelming, often frustrating hospital systems, however well meaning and effective the actual care – lowers costs and improves outcomes. So if the grounds for increasing home healthcare are so compelling, why are we not doing more of it? At psHEALTH, an innovative company specialising in work-flow solutions and customised case management programmes, we believe that too much emphasis has been placed on large scale projects such as the NHS IT super-structure leading to public and professional confusion over what IT can actually do for healthcare.

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Systems innovation really does move that quickly. Expensive top-heavy programmes that are cumbersome to integrate can leave services looking old fashioned and simply not serving their patients well.” Experience backs up this point. Many managers know that increasing their IT packages for home healthcare makes sense – as legislative changes to GP commissioning begin to bed in, care will move faster from hospitals to the home and community. Competition will demand better documentation of health outcomes and tracking of resource usage – something smart pathways can deliver with ease. But still some worry that the process of change will take too long and that patients may even suffer if the programme proves to be unwieldy. Experience has taught managers that, in the past, large standardised IT packages have often been dropped into clinical environments with little regard to engaging with the actual users and local needs. These large systems have been sold as silver bullets, whereas the reality is that truly great systems should be allowed to evolve – with lessons learned and continuous input. And perhaps IT commissioners could take heart from the public, which has embraced health IT at consumer level: the explosion of smartphones, tablets and apps shows that the public is driving innovation in healthcare. By this summer, there will be more than 13,000 health apps intended for use by consumers available for download in Apple’s AppStore, according to MobiHealthNews’ latest report: Consumer Health Apps for Apple’s iPhone.

have their treatment slowed down, or even dictated, by a lumbering labyrinthine IT program that can’t adapt or be changed with any speed. Medical researchers are making exciting leaps forward all the time – the least IT developers can do is keep up. an agile solution

Adaptive Case Management (ACM) is a flexible patient and pathway solution built on the psHEALTH platform. It delivers better health outcomes by codifying local clinical protocols, including incorporating Telehealth solutions, and tracking pathway-specific outcomes. The approach ensures consistency and sophisticated management information, while leveraging the clinical judgement of healthcare professionals.

Its value is not just patient specific – ACM can be used to improve productivity in healthcare, something notoriously hard to define or do. In health terms, productivity is generally defined as “the cost to achieve a health outcome” so in case of elective surgery such as hip replacements, this can be easy. But in case of LTCM conditions such as high blood pressure, it is much more complex.

For more information, contact: Mindy Daeschner, Principal Email: mindy.daeschner@pshealth.co.uk Tel: 0845 50 50 120 Web: www.pshealth.co.uk

But the IT experts aren’t just asking managers to alter their thinking. There is a new philosophy – “Designed for Change” – emerging among the technology community, too. This is based on realities of life, where the primary focus is not on functionality, but on the delivery of a platform that can quickly be configured to evolve with new service designs. Central to this philosophy is extensive and iterative stakeholder involvement. This way, a prototype can be developed in a matter of days and then improved incorporating user feedback and lessons learned. An agile way of thinking is the norm at psHealth. We can get a new pathway up and running in a week. If a new medical breakthrough happens – one that needs IT back-up at home – patients should benefit fast. Not

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A driving force Independent transport provider Medical Services is working with existing software programmes to improve patient experience and provide Trusts with efficient, economic services

Medical Services is the UK’s largest independent provider of patient transport services to the NHS and private healthcare. The company has been at the forefront of the patient transport industry since it started in 2001 and is constantly working to improve the delivery of our services to our clients.

of the programmes Medical Services uses are now the industry standard, we have worked with the suppliers to advance their features and tune them to the specific needs of patient transport services.

There are a number of existing programmes that help the emergency transport services deliver their service, but Medical Services has led the way for their usage in non-emergency patient transport services by pushing for software and systems to be developed and implemented in a way that enhances our services. By streamlining the IT, Medical Services has improved booking procedures and data protection and realised real efficiency savings in time, personnel and accuracy. While many

online booking

Online booking is a facility that allows users at a Trust site to book transport in real time for their patients. Although this may seem like common sense, when we first began to pursue this functionality bookings were still either called or faxed in with printed copies of the transport orders sent out to ambulance crews. This resulted in enormous inefficiencies: lost data, lost time and inevitable data protection

issues when confidential patient details were traded insecurely between organisations. For some time, Trusts have wanted to be able to have greater controls over how they book and monitor their patient transport. Access to the online booking system is web based over secure N3 connections and gives the end user the ability to book, amend, track and cancel patients’ transport, thereby reducing unnecessary telephone and fax traffic. The ability to set user rights at varying levels allows the Trust’ senior managers access to a variety tools to see full, real time activity reports and monitor how the Trust’s patient transport provider is performing and how the Trust is using their patient transport services. Trusts have been very welcoming of such tools and this is now the industry standard.

online assessments

In 2007, the Department of Health issued eligibility criteria to help the NHS determine who was medically eligible for patient transport. The criteria is set up in such a way that it can be adapted to each Trust’s requirements according to their patient’s needs. Hand in hand with online booking, the online assessment feature is the next development in monitoring patient transport and allows a Trust to regularly assess the transport requirements of their patients against the Department of

Online booking allows users at a Trust site to book transport in real time for their patients

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A pilot scheme notes the location of the ambulance patients are alerted that their transport is close by

Medical Services is the UK’s largest and fastest growing non-emergency patient transport provider. Since it began in 2001 the company has grown to over 500 registered ambulances, 800 frontline staff members completing tens of thousands of patient journeys every week across a range of mobilities and clinical needs, from 25 locations located strategically across England and Wales

Health’s Eligibility Criteria, customised for each Trust’s needs and patient groups. Transport is a sizeable part of NHS budgets, and Trusts are keen to work within them, finding efficiencies and savings wherever possible. The web-based eligibility assessment tool allow users to transfer what was formerly a paperwork exercise into a more meaningful and coherent means testing of a patient’s need to access transport, with the added plus of monitoring user impartiality. It also allows the patient’s eligibility to be reassessed on a regular basis so that as their needs evolve, the transport service can adapt with them. Trusts that have taken this on board see this as a reliable method of demonstrating that they are addressing their transport costs and, equally important, ensuring that those patients who really need transport services have fair access to them.

geo fencing

Geo fencing is a feature used to capture time stamps relating to ambulance movements between the patient’s home and hospital. It is a facility that has been in use in the emergency transport sector for some time and helps the emergency provider to show that they are meeting their performance indicators. Taken a step further and incorporated into the Non-Emergency Transport Patient Transport Services world, this is used to aid providers by tracking the vehicles conveying patients to hospital appointments and home again. The

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tracing device automatically sends a signal from the vehicle upon its approach to a hospital and records a time stamp indicating the ambulance’s arrival. This means ambulance crews are not distracted by inputting data into handheld devices and can focus fully on the care and prompt escort of the patients within their care to their appointments. Medical Services has run a pilot where the location of the ambulance is noted and used to alert patients that their transport vehicle is close by and that they should prepare to be picked up. This gives the patient time to get ready without asking them to sit with their coat on and wait by the door anywhere from two hours before their appointment time. If patients are advised that their transport is imminent, they can be ready and time saved by a speedy pick up is translated into punctual appointments and improved customer service. These three examples show where we have taken existing software and worked with the developers to enhance the functionality in order to advance the service we provide to our clients. As forerunners in the industry, always open to new ideas and exploring new systems, Medical Services is setting the industry standards for patient transport services for the NHS in England.

For more information, contact: 0207 871 0387 Business Development Team www.medicalservicesuk.com

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Health protection services for the next decade: from HPA to PHE Paul Cosford and Eric Bolton of the Health Protection Agency look at the work of the organisation and its forthcoming merger with Public Health England The Health Protection Agency (HPA) was formed in 2003 to deliver an integrated approach to protecting UK public health through the provision of support, specialist services and advice to the NHS, local authorities, emergency services, other arms length bodies, the Department of Health and the devolved administrations. The HPA currently employs 3500+ staff across a network of regional microbiology laboratories and Health Protection Units located throughout England, as well as four national centres providing reference microbiology,

specialist diagnostics, national surveillance and epidemiology, specialist chemical and radiation services, biopharmaceutical research & development services, as well as a corporate headquarters close to the Department of Health in central London.

support both local authority public health service partners and other commissioning stakeholders, as well as the wider public, helping them to make better informed and therefore improved choices regarding lifestyle and the protection of their own health.

As part of the health and social care reforms, the HPA will transfer to Public Health England (PHE) in April 2013. The government’s aim is that PHE will deliver a much wider range of public health functions. PHE will provide a more comprehensive information and intelligence service to

The HPA will be the largest single component of PHE and its staff will continue to offer services and advice on reducing dangers to health from infectious agents, poisons, chemical and radiation hazards. The Department of Health has identified the operating model for PHE, which will also absorb other public health functions including: »» Some Department of Health staff »» Public health staff working in Strategic Health Authorities (SHA) whose functions will transfer to PHE »» Regional and specialist public health observatories »» The cancer registries and the National Cancer Intelligence Network »» The National End of Life Care Intelligence Network »» NHS Screening Programmes and UK National Screening Committee »» Quality assurance reference centres, plus some public health staff from primary care trusts and specialised Commissioning Groups

Rapid molecular testing for specialist clinical diagnosis

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HPA regional public health laboratories directly support front-line NHS pathology services PHE will also continue to provide Health Protection Services, including the provision of data and information to government to help inform its decision-making, and advice and guidance to people working in the healthcare and related professions in respect of standards and best practice. One important component of such Health Protection Services is the remit to provide emergency preparedness and response capabilities, including planning for health issues and risks that have the potential to threaten the population as a whole. The HPA (and PHE going forward) has well rehearsed response plans, systems and procedures that enable prompt and effective responses to a wide range of health threats, minimising the potential harm to the population. These emergency arrangements are regularly tested through multi-agency exercises and the HPA has a strong international reputation in the provision and design of health emergency preparedness training and exercising During 2012, one of the key aspects of this work will be the London Olympics and Para-Olympics »» Two new syndromic surveillance systems have been developed as part of the enhanced surveillance to ensure that any incidents with potential public health implications are recognised early and monitored closely. The first uses attendances to sentinel Emergency Departments (EDs) and the second monitoring consultations with out-ofhours general practitioners/ unscheduled care. Currently, 22 EDs are providing anonymised daily data on key illnesses. Although there is a concentration of EDs in the Greater London area, the aim is to have at least one ED reporting in each of the primary English regional areas »» The HPA will provide rapid molecular diagnostic testing for the investigation of food and waterborne outbreaks. New molecular assays have been developed for a wide range of enteric

pathogens and have already been rolled out and established in HPA Public Health Laboratories and Food Water and Environmental laboratories.HPA laboratories are also similarly equipped to respond to outbreaks of respiratory disease

Supporting this frontline capability are a further six food water and environmental testing facilities, as well as the HPA’s two national reference laboratories at Colindale (London) and Porton (Wiltshire). The HPA is unique in having this breadth of coverage and depth of expertise and advice.

The second aspect of the HPA’s work is the provision of both routine and specialist microbiological testing services through its network of Public Health Laboratories and reference centres. The HPA has a network of eight diagnostic testing laboratories across England, that work very closely with their pathology counterparts in various NHS trusts, providing a range of frontline diagnostic microbiology services.

The services that are provided by our frontline laboratories include: »» Routine clinical microbiology services to both primary and secondary NHS Trusts »» Specialist reference and molecular diagnostic testing (including access to real-time advancements) to support clinical diagnosis and public health responses

Consultations with out-of-hours practitioners will be monitored as part of enhanced disease surveillance during the Olympics

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HPA emergency response specialists play an integral role in preparing the healthcare community through training and exercising as well as assurances in respect of integrated service delivery so that those commissioning services from us, readily identify us as a first choice provider. One of our key distinguishing features is our ability to support our partners in the performance of their own routine microbiology work through the provision of stand alone expert advice, for example in the confirmation of difficult and/or suspected diagnoses, especially in respect of rare and unusual infectious diseases and/or the identification of novel and more dangerous pathogens. This full service or component diagnostic capability, is very well supported by the wider community health protection aspect of our services.

»» Expert clinical and microbiological advice and support of the above services including clinical results interpretation and prescribing advice, i.e a full sample script service »» Epidemiological surveillance and emergency surge capacity support All of this enables the HPA to provide a modern cost-effective and fully integrated public health microbiology and health protection service that is both fit for the challenges of the future and aligned with the new structures required of the Health and Social Care Bill. An immediate priority of the Agency during transition to PHE is, therefore, to actively engage and subsequently work alongside key NHS commissioners so that they can not only obtain the best value from the procurement of such services, but that those services also remain fully aligned with the requirements of the new health service structures. Public Health England will be unique in having a network of laboratories and Health Protection Units (HPUs) that are strategically placed across the country which already work closely with the NHS and Local Authorities. These laboratories and HPUs, together with our national centres, aim to deliver a total service including specialist consultancy and clinical advice.

The HPA also undertakes a number of commercial contract research services including pre-clinical assessment, vaccine evaluation, and the development, production, and manufacture of bio-pharmaceutical products. These contract research services broaden the income base of the agency, thereby offsetting the total cost of service delivery to the tax payer. It also permits continued reinvestment in research, facilities and infrastructure and rapid access, for example to emergent in-vitro diagnostic platforms, leading to the in-house development of novel technologies that can be used in the pursuit of our core pubic health objectives, such as ever more efficient diagnostic tests for influenza.

As we move into PHE we aim to continue to be at the forefront of new technology adoption and deployment, with a retained focus on improving patient and public benefits and a strategic vision that includes building strong partnerships with both new commissioning bodies and key pathology service providers, so that a range of synergies and benefits can be realised. In summary, with its proven track record for both responding to evolving and emerging health threats, and developing and deploying new and innovative methods, techniques and technologies, the HPA has been at the centre of innovation in healthcare for the 21st century and this record will continue into PHE.

This type of funding mechanism is currently uncommon within the public sector, but has already been acknowledged as central to the emerging role of PHE, along with its independence of expert advice. As we move into PHE and look to further develop our services, there will be a need to continue to provide clear information to all our stakeholders as part of the ongoing process of pathology service modernisation so that patients and commissioners alike continue to benefit from the delivery of an intergrated public health microbiology service offering. We seek to provide clear information about our expertise, capabilities and accessibility,

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Health Protection Agency, Porton Down, Salisbury SP4 0JG Tel: 01980 612725 Fax: 01980 612241 E-mail business@hpa.org.uk Web: www.hpa.org.uk

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Innovative thinking for long-term conditions As we age as a population, everyone will have one or more long term conditions – only the majority of people don’t know it yet, says Gilmour Frew, Director NHS Improvement

It is a certainty, if they live long enough, that everyone at some point in the future will develop a long term condition that may or may not have a significant impact on how they live their life.

ter services for the future by thinking more innovatively about service delivery in response to patient needs.

At the same time, as we age as a population, the overall cost of managing and caring for these patients could engulf GDP over time.

new approach

These truths make for an unsettling vision of tomorrow’s world. Yet this knowledge also provides a real opportunity to shape bet-

At NHS Improvement, we support a new approach to improving the quality and effectiveness of services for patients with longterm conditions – an approach that fundamentally redesigns the pathway of care, and involves changes in how we commission and

deliver proactive services, not five but seven days a week. The approach places emphasis on meeting patients’ needs and providing the support that will enable them to recover from ill health and self-manage their own health. At the same time, it ensures that support is there for patients when it is needed. Our strength and expertise at NHS Improvement lies in practical service improvement. We have over a decade of experience in clinical patient pathway redesign in cancer, diagnostics, heart, lung and stroke and we can demonstrate some of the most leading edge improvement work in England supporting and improving the patient experience and outcomes. We have worked with partners across 250 NHS sites, as well as 1,650 local GP practices, clinical networks and national charities.

We believe that to effectively manage longterm conditions and promote patient self-management, a much broader perspective of supporting people is necessary; one of managing their individual needs rather than one of managing them as individual diseases.

From these key areas a new pathway to patient wellbeing emerges

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There is also the issue of meeting patient needs seven days a week, rather than the five day service provided across the country, which results in delays to treatment and a flurry of activity on Monday morning.

living with

At this stage, the delivery of a detailed and comprehensive care plan is essential to coordinate care support and treat the patient, while at the same time providing the vital information that can help the patient to manage their own condition more effectively.

key areas on the pathway

Across the clinical pathways we work with we have identified four key areas where patients with long term conditions and their carers want improvements: »» stabilising the condition to get patients back to living their lives »» supporting patients to live their lives through monitoring and review »» timely intervention to the appropriate service when things go wrong »» providing choice and support towards the end of life. Additionally, there are opportunities for improvement in terms of the prevention of a long term condition or reduction of the morbidity associated with it.

finding out

This stage on the pathway involves appropriate testing for a condition, with rapid access to services to enable an earlier diagnosis and optimal treatment of the patient.

“At NHS Improvement, we support a new approach to improving the quality and effectiveness of services for patients with long-term conditions”

when things go wrong

The availability of care seven days a week, 24 hours a day is essential at this stage in the pathway in order to provide timely access to healthcare. By doing this, and providing the patient with advice that will help them to better understand and manage their symptoms, readmissions can be prevented.

towards the end

At this stage in the pathway, the emphasis is on supportive and palliative care, helping the patient to understand the progress of their condition and to be involved in planning in advance what care they will need, in accordance with their own wishes. The essential activities that encompass each of the four stages on the pathway are the provision of timely information that will educate patients and their carers about a condition, the need for detailed care planning and review to support the patient and their carers, the engagement of patients and carers in their own care, and the ability to transfer care across pathways and organisations seamlessly.

serving patients’ needs

A typical clinically-led approach is generally limited in serving a patient’s needs effectively. For example, patients with a long term condition tend to present multiple disorders that require co-ordination of treatment across a number of different healthcare pathways. In this case, the attainment of a better patient experience and more effective care lies in the level of collaboration between organisations and professionals and the ability to provide support and advice that will keep the patient healthy and at home for as long as possible. Here the ambition should be to help patients not only to add years to their life, but also importantly to add life to those years.

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“The attainment of a better patient experience and more effective care lies in the level of collaboration between organisations and professionals” profiling local populations

By taking a profiling approach to service delivery that involves classifying different groups of individuals within the local population, organisations would be able to identify the emerging needs of patients with long term conditions more effectively and better match services to those needs. They would establish: »» Those who do not, as yet, have long-term conditions. »» Those with long term conditions but who can manage their own health with support through: »» appropriate information and education »» proactive care plans with planned monitoring and review »» named care professional for advice and support and seamless transitions of care »» individuals involved as partners in planning/meeting their specific needs »» Those unable to manage their conditions without support. »» Those who have complex care needs that require support from a multi-professional team. Across the country, providers and commissioners are becoming increasingly aware of the need to innovate in this way. There are some excellent examples of the work being done that show the potential of change.

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CASE STUDY pan gwent frailty programme

by cutting across age, medical and social requirements to provide needs-based, rapid assessment, reablement and emergency care responses within a patient’s own home.

seven day rapid response and reablement

In Gwent, healthcare and social teams have moved successfully from a process-driven service for frail elderly to one that is patient centred. Multi-agency teams now provide 80% generalist and 20% specialist care, and patients benefit from GPs, district nurses, acute services, social services and ambulance services working together on their behalf. Because they have created a single point of access to services, a direct hassle-free route to providing the most appropriate care is assured and the integrated model Gwent has adopted better addresses patient needs

Specifically, the service model provides for people with either: »» chronic limitations on activities for daily living (including dementia) »» vulnerability including running on empty »» health, social care and housing needs. It was established after consultation with over 150 frail people on the best way to keep them “happily independent” in their own home. Community resources teams provide three levels of support; rapid response (within four hours), hospital at home services for up to 14 days and reablement (within 24 hours). Patients have access to services

24 hours a day, seven days a week, 365 days a year. Teams can avert crisis and provide better outcomes for patients and their families as a result. The changes have also realised fewer acute hospital admissions and shorter lengths of stay and because healthcare assessments are undertaken and social care problems are resolved quickly, fewer complex care packages are required. The multi-health agency and social care teams setting up the model established that: »» 50% of patients in hospital community beds did not need to be there »» people could be treated holistically rather than simply defined by their illness »» people could stay longer at home »» 60% of patients leave the care of the community resource team after eight weeks of support with no on-going care required.

CASE STUDY

moving on programme

access to the right care and information

ipswich hospital nhs trust

solihull community care nhs trust

Ipswich Hospital’s Cancer Information Centre, is the setting for Moving On, a programme providing peer support, education and guidance to cancer patients following an holistic assessment at the end of their cancer treatment.

GPs have worked together at Solihull Community NHS Trust to enable patients with end stage COPD to benefit from a more holistic approach to palliative care.

For two hours every week for four weeks, patients who attend the centre receive essential guidance on managing their condition from the centre’s clinical nurse specialists. This includes symptom management, emotional support, advice and information on all types of cancer, as well as looking at topics which may affect their return to normal life, or the quality of their lives. These typically cover goal setting, diet, physical activity, fatigue, relationship and sexual issues, returning to work, financial issues, worries and fears. The patient is involved in the development of their own future care plan, and any further support they may need is identified and arranged where necessary.

conclusion

While the case studies demonstrate the huge strides being made in improving care for long term conditions, such change remains sporadic across the country. They highlight how, through greater integration of services and collaboration among organisations, together with the provision of seven day support, we could provide the care and treatment patients, survivors and carers tell us they want – services that reduce the financial burden of long term care for future generations. *Our publication Effective pathways for long term conditions provides more on new approaches to managing long term conditions. Further examples of local level innovation in services is available on the NHS Improvement website: www.improvement.nhs.uk/ltc. For more on seven day services, visit: www.improvement.nhs.uk/sevendayservices.

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The Trust had already adopted the Gold Standards Framework palliative register across all of its 31 GP practices. Patients on this register access community services through a care pathway that supports holistic assessment, advance care planning and proactive care planning to improve the provision of their end of life care needs. However, the number of COPD patients benefiting from the register was limited. Working with 12 out of the 31 GP practices, a project team conducted a baseline assessment in each to establish the current position with end of life care for COPD patients. The team spent time in practices and community teams sharing information on the Gold Standards Framework prognostic indicators. Support for the work in GP practices also came from concurrent skills training in the care of the dying funded by the strategic health authority (SHA) and delivered by Education for Health. Two GP COPD champions were appointed to work with local practices helping them to identify COPD patients who were eligible for the Gold Standards register but who were not currently on it. As a direct result of all the work done, more COPD patients nearing the end of their life are able to access the services offered as part of the Gold Standard register. Communication between the community respiratory team and the end of life provision on the wards improved through the initiative, and overall relationships between patients, carers and their providers was better.

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Using social media to engage , listen and learn

{Smart Guides } to ENGAGEMENT

For better commissioning

Using social media to engage, listen and learn Smart Guides to ENGAGEMENT for better commissioning

Using social media to engage, listen and learn

Part of the Smart Guides to Engagement series, this guide helps clinical commissioning groups (CCGs) interact with service users, stakeholders and communities through social media. Applying these techniques should be part of the PPE strategy and resources that CCGs routinely deploy for listening and learning. Social media provide a new and more direct way to achieve this engagement and create assets for CCGs, especially with hard to reach or under-accessing groups. Examples include drug users or other disengaged groups and people who work full time whose time is pressured such as young parents.

What is social media? Social media is a generic term used to describe a range of online applications that enable – and specifically encourage – interactive communication between users. Millions of people around the world use social media to ask questions, network, learn and share their interests. Some, like Mums Net (www.mumsnet.com) have become nationally influential with their targeted audience.

getting involved in conversations with others. This makes it a particularly useful vehicle both for informing patients and for gaining their feedback. Used well, social media can be part of collaborative working and co-production. As well as having conversations and giving their opinions, visitors to social media sites also like to share information. This can have a powerful amplification effect (known as going viral), where articles, videos or images are shared between thousands or even millions of people. There are many social media platforms, but the most useful ones in the UK for patient and public engagement are: Facebook This started out a photo-sharing site for students but has become the most popular platform. Facebook claims to have more than 845m users worldwide and most are under the age of 30. Companies and organisations are increasingly using Facebook - as well as their websites - to put a face on their activity and interact with a generally younger, mediasavvy user group. The Facebook tone of voice is informal and friendly so corporate speak won’t do.

Among the G20 developed countries, Britain combines unusually high internet penetration with widespread use of social media like Facebook and Twitter.

Twitter Twitter is a vast, web-based messaging network, where each tweet is a single message that must be less than 140 characters long. It is more like texting than emailing.

The social media ethos is all about engagement, participation and relationship building. Every platform encourages its users to take part, by commenting on what they see and

Users can send messages both to people who are interested in what they have to say (their followers) or people who are interested in any topics they are writing about (via tagging).

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Twitter is best used via a separate dashboard application; otherwise the sheer volume of data can make it unmanageable. There are several to choose from (see the end of this document for the most popular options) and all are free to download. The best ones act in a similar way to a web browser and enable the user to search the entire Twitter network for specific topics, words or names. In this way you can monitor responses to your messages, subjects of interest or even how many mentions (or re-tweets) you get. Most Twitter users are aged 25 to 45 and the tone of voice is informal but often abbreviated because of the space constraint. There are a series of communication conventions: »» Handle - a user’s name or individual identity »» Tweet - a message »» Re-tweet - a message that has been repeated by someone else »» Hash tag - the # symbol, placed in front of a word to turn it into a search term »» The @ symbol - put directly in front of a Twitter handle, signifies a direct message to that person. YouTube A free website devoted to viewing, sharing and commenting on video clips. Government and NHS bodies routinely use YouTube to make video and podcast material widely available. CCGs can do the same and establish their own video channel. Blogs Originally called web-logs, and now shortened to blogs, these are small websites set up and

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run by individuals and organisations and used as a vehicle for their own writing. Blogs have become an essential marketing and publishing tool for most businesses. Unlike traditional publishing vehicles, however, they encourage interaction with their audience - offering them the chance to comment on what they are reading. Forums Often overlooked in favour of more glamorous platforms, forums have been around since the start of the internet. They are generally based around a specific subject area and work on a question-and-answer format. They can be powerful tools for patient participation because visitors to a forum will already have an interest in the topics covered (or they are seeking specific information). This means they are more likely to participate. Its diversity does not mean that social media is a free-for-all. There have to be ground rules and norms clearly laid out and accepted by people who engage with you. Moderation of social media traffic is not censorship but rather making sure that everyone respects the rules. Someone at the CCG who understands social media has to be in charge.

Cancer Research UK - working across the platforms

The charity has invested heavily in social media and has a dedicated team managing its Facebook page, Twitter account and a specialised forum called Cancer Chat. “The three platforms work in different but complementary ways,” says cancer chat manager Sarah Broughton. “We use the FB page to promote the forum and we get lots of new registrations that way. FB is very immediate and public, so people tend to go there for general questions, comments and conversations. Our FB team will refer people to us if they are seeking anonymity, have more specific questions or want to talk to a specialist nurse.

its policy team is currently using the forum to ask for patient opinion on various aspects of tobacco use and marketing. Facebook page: www.facebook.com/ cancerresearchuk?sk=wall Cancer Chat: http://cancerchat.cancerresearchuk.org/ index.jspa Twitter account: @CR_UK

How social media can help improve commissioning

»» Used in the right way, social media will enable closer involvement with a much wider range of people, including those who usually do not engage, thereby increasing the reliability of commissioning intelligence »» The nature of the technology means it is widespread in the community, so views can be sought and fed back into the organisation within days »» It enables greater individual patient, carer and citizen involvement in services, strengthening the commissioner’s mandate to make decisions and its ability to respond to challenge and scrutiny »» lIt is much less resource-intensive than traditional engagement techniques It enables commissioners to build better relationships with patients, leading to potential long-term partnerships.

Social media - far more than let’s have a Facebook page It used to be sufficient just to have a website. But NHS organisations soon realised the internet had to be part of a comprehensive communications strategy. They must do the same with social media.

“Twitter is used more as a promotion and publicity tool, though people do occasionally ask questions there too. All three platforms have become very useful for signposting to other, related services and for providing information.”

CCGs should not rush in without first having a plan about what they are trying to achieve, who they are targeting, with what messages, how they will respond to what flows back to them and - most importantly - what will happen to the intelligence that social media generates. To engage successfully using social media, CCGs need to do more than simply set up a Facebook page or get on Twitter.

The charity also uses the patient feedback it gets from social media to inform and influence its policies and campaigns. For example,

The lesson is: don’t waste your social media opportunities. Done badly, it can work against you. But done well - and it isn’t dif-

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ficult - it could expand your range of engagement assets. Your approach should be part of a comprehensive patient, carer and public engagement strategy, looking at what insight is needed, the knowledge you already have, who you need to fill the gaps and the best way to achieve this. It fits with the engagement cycle very well. All social media communication is a two-way process. It can be an effective tool for disseminating important messages, but expect, and make sure you invite, your audience to tell you what they think. The two-way nature of this communication has obvious positive implications for patient engagement: »» Use it to broadcast public health messages and information about your services, post questionnaires and even ask questions directly to specific groups of users and carers »» Use it to gain feedback from patients on your services, their wider care or their own individual health. Social media can help you listen and learn from asking this key question: Having experienced it yourself, would you recommend this service to someone else? Before starting any new project that will use social media, be clear about: »» What you are trying to tell people »» What you want them to tell you »» How you will handle what you learn. Answering these effectively will help you hone the messages you want to convey and get more targeted and useful feedback from patients.

Brighton and Hove Maternity Services Liaison Committee targeting hard-to-reach groups The MSLC is a group run by parents for parents and parents-to-be. It aims to answer people’s questions and help them get the best from local maternity and postnatal services. It either puts them in touch with health specialists or passes their feedback directly on to those professionals. Brighton and Hove PCT provided funding for social media training, which enabled the MSLC to set up its own website with a blog, Facebook page and Twitter account. The Facebook page is now very active and the Twitter account is used regularly to highlight topical posts, discussions and health messages.

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Chair Hannah Sherlock, says: “Historically it was quite a challenge to encourage a broad range of parents from different communities to get involved. But through using social media we have been able to reach a much wider audience and increase our engagement with them. After all, posting your views on Facebook only takes a couple of minutes which is less of a commitment than giving up a few hours to attend a committee meeting or fill in a consultation response. “On average I get one or two messages a week from local parents worried about something relating to their maternity care – and this often sparks correspondence which leads to direct improvements from service providers.” Blog: http://brightonandhovemslc.com/latestnewsblog/ Facebook page: www.facebook.com/brightonandhovemslc Twitter account: @brightonMSLC

Avoiding possible pitfalls Social media use is not an end in itself, even though it represents a big culture change for many primary care organisations. Traditional forms of engagement will still be necessary to target certain sectors - for example, elderly people and those who, for

whatever reason, do not routinely use electronic media. But don’t stereotype. Many older people are social media savvy already and see it as a convenient way to communicate, especially when getting out to meetings is inconvenient. Discussions can develop so quickly that control of agendas can be lost and the balance between proactivity and reactivity can be challenging. This is why the use of moderation must be carefully thought through and clearly communicated. Active management and moderation of all social media platforms is necessary for any project to be a success. This investment will generate a return in terms of patient participation but if their questions and feedback do not get a response they will quickly leave a community. Social media may improve outcomes in the long term but it won’t reduce costs. Use the right tone of voice for each platform and always communicate in a professional manner. Common sense should be the guide here - don’t say things on a social media network that you wouldn’t say in front of your colleagues! Social media is a public environment and rules on patient confidentiality should reflect this. Caroline White Associate Primary Care Commissioning (PCC)

Get Smarter - find out more How to guides: Facebook: http://bit.ly/hu91nT http://bit.ly/Im10YW Twitter: http://bit.ly/aCAqQL Twitter dashboards: http://bit.ly/b8JU62 Examples of how other health services are using social media: http://bit.ly/eev83n http://bit.ly/KC1vhH http://bit.ly/e72rXd Digital Engagement Guide: Ideas and Practical Help to Use Digital and Social Media in the Public Sector: http://bit.ly/GF8Jgn Patient Opinion: http://bit.ly/6TzSF For information about the other guides in this series: www.networks.nhs.uk/nhs-networks/smartguides

Acknowledgements Author: Caroline White Associate Primary Care Commissioning (PCC) www.pcc.nhs.uk Smart Guides to Engagement are a co-production by organisations and individuals passionate about engaging patients, carers and the public more fully in healthcare. The series editors are Andrew Craig and David Gilbert. Andrew is a partner in Moore Adamson Craig LLP, an organisation with many years’ experience in the involvement and engagement of users of public services: www.publicinvolvement.org.uk David Gilbert, director of InHealth Associates, has spent 25 years working in the field of health and patient-centred improvement across the UK and internationally: www.inhealthassociates.co.uk The editors would like to thank the authors for their generous unpaid contributions and the Department of Health for its support.

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“Providing Excellence in Healthcare”

Mednet Consult, a Healthcare Consultancy dedicated to providing advanced solutions serving diﬀerent aspects of the healthcare sector. We have extensive experience and consulting competence dealing with service delivery, clinical processes and digital technology. We currently work in collaboration with the NHS-provider and commissioning organisations, Department of Health, CCGs and private/commercial healthcare organisations.

Pathway Optimisation Mednet have been working with healthcare organisations to review service delivery models across pathways of care, with a speciﬁc focus on long term conditions. Assessments of the existing model of care have been undertaken on web based systems, designed by Mednet. The appropriate healthcare professionals in the organisation will complete these assessments. A full report will be generated; this will be agreed at project initiation and will give all the information required by the organisation. Speciﬁcally the report can show the existing resource and therefore lead to capacity optimisation and savings realisation.

Healthcare Training Mednet can work with a healthcare organisation to assess training needs using a web-based tool to stratify the healthcare professionals based on competency levels with an aim to provide a bespoke training solution to match their needs. This solution could be a two way communication web-based platform to disseminate up-to-date information to staff users effectively and efficiently using the media they prefer i.e. through a web-based portal, mobile phones (using apps), portable media such as CDs DVDs, and print media. Add-on features for the users such as discussion forum, file sharing, blogwriting, live chat etc. can also be enabled as an extension with an aim to support knowledge sharing.

Mednet Adherence Support Service (MASS) We have developed a proven working model, an end-to-end adherence support service for our clients to increase patient outcomes and reduce the cost of partial or non-adherence, which is also an eﬀective way to increase patient involvement, loyalty and attendance to medication. The model incorporates consultation, treatment reminders, and medical compliance aids, all supported by timely and eﬀective reporting. Consultation embodies formation of risk groups, patient education programme and shared decision making. Treatment Reminders can be delivered in the form of text messages, phone calls or mobile alerts using a mobile app. Live Medication Monitoring using compliance aids enables an alert system for medication reminder for the patients and a real-time system to monitor missed medication.

Digital Solutions We develop and manage customised digital solutions for various areas within the healthcare sector building a two-way communication platform allowing dissemination of up-to-date information to users effectively and efficiently using the media they prefer. Using state-of-the-art technologies, we develop web-based working model designed for Healthcare Professionals (HCPs) that aims to enhance their knowledge and expertise, advanced and accessible web applications for any healthcare setting, e-learning packages to meet specific individual training needs, mobile technologies that educate HCPs, graphic design solutions for 3D, Digital Graphics and Interactive Media, films and video tutorials that support education materials using experts in the therapy area. For more information:T: +44 (0) 113 827 2039 E: info@mednet.co.uk W: www.mednet.co.uk http://twitter.com/mednetconsult

Business Development Manager: Kirti Tandel T: +44 (0) 113 827 2039 Ext:- 554 E: ktandel@mednet.co.uk

Mednet Consult Ltd., Unit 1, The Kirkstall Park, Kirkstall Rd, Leeds, LS4 2AZ Company Registration Number: 06494718 VAT Number: 922862516

Nutrition: the importance in early Alzheimer’s disease A link exists between nutrition and the risk of Alzheimer’s disease, supported by an increasing level of new evidence

Alzheimer’s disease (AD) is an incurable brain disease that causes increasingly distressing symptoms. These start with memory loss and progress to an inability to perform everyday tasks, behavioural problems and a need for constant nursing care. These symptoms are associated with a progressive loss of nerve cells in the brain.1 Although amyloid plaques and neurofibrillary tangles are well recognised as hallmarks of AD,2,3 it is now recognised that the loss of synaptic connections between neurons is the strongest anatomical correlate of a decline in cognitive test performance, and is the pathological feature most robustly associated with cognitive deficits.4 Studies in patients with Mild cognitive impairment (MCI) and early AD have shown that synapse loss is an early anatomical correlate in the disease process. Synapse loss is greater in patients with AD compared with healthy controls.5,6 Formation of new synapses requires the synthesis of membrane phospholipids. Due to the increased rate of synapse loss, patients with AD have a higher requirement for new synapse formation.7,8 Risk factors for AD include age,9,10 while a family history of AD (in familial AD) and the presence of the ApoE4 genotype (in sporadic AD) are the most important genetic risk factors known for this disease.11,12

Other identified risk factors include female sex, low level of education, alcohol intake, head trauma, smoking, a diet rich in saturated fat, systolic hypertension, neurotoxic agents, oxidative stress, inflammation and infections.

Increased Hcy is a risk factor for AD and is associated with pronounced brain atrophy in patients with MCI and AD. Vitamins E (α- and γ- tocopherols) have also been reported to be associated with slower cognitive decline over 6 years and with lower risk of AD.23

What is less well known is that a link also exists between nutrition and the risk of AD. This link is supported by an increasing level of evidence from epidemiology studies. Data suggests that certain macro- and micronutrients play an important role in the decline of cognitive function and in the risk of developing AD.

A number of studies have shown that dietary patterns influence cognitive decline and the risk of developing AD. For example, the Mediterranean diet (higher intakes of fish, fruit, unsaturated fatty acids and of vegetables rich in anti-oxidants) is associated with a lower risk for certain diseases including AD and the slowing of cognitive decline as people age.24

It has been shown that a high intake of certain nutrients, such as saturated fats and trans fat increases the risk of AD, whereas other nutritional factors such as higher intake of vitamin C, vitamin E, flavonoids, unsaturated fatty acids and fish, higher levels of vitamin B12 and folate, and lower total fats are associated with a lower risk for AD or a slower cognitive decline.13-18 Several studies have shown a significant relationship between regular fish consumption (at least weekly) and decreased risk of developing AD and/or dementia18-21 or cognitive decline.22 A higher intake of folate has been reported to be associated with a lower risk of AD, presumably due to folate’s ability to lower toxic levels of homocysteine (Hcy) concentrations.14

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More recently, a study by Gu et al. reported that a diet rich in omega-3 polyunsaturated fatty acids (PUFA),25 omega-6 PUFA, vitamin E and folate, but with lower saturated fat and vitamin B12, was strongly associated with a lower risk of developing AD. This risk of developing AD was reduced by 40% in subjects in the top third of dietary adherence compared with those in the bottom third of adherence. Thus, epidemiological evidence indicates that specific dietary patterns and nutrient combinations can significantly influence the risk of developing AD. Neuronal membranes consist of phospholipids synthesized by the Kennedy cycle. The Kennedy cycle is for the formation of

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phosphatidylcholine (PC). Uridine, omega-3 PUFAs and choline act as precursors and the B-vitamins, phospholipids and antioxidants act as cofactors in this cycle of PC formation.25 Phospholipid formation depends on the combined availability of cofactors and precursors.26 The potential effect of nutrition has become a topic of increasing scientific and public interest. The literature demonstrates that people with AD have distinct nutritional requirements resulting from the body’s attempts to synthesise new synapses in response to the disease. The failure to address these additional nutritional needs in AD can aggravate known risk factors such as circulating levels of Hcy, oxidative stress, reduction of blood flow to the brain and neuronal membrane health, all of which contribute to the AD disease pathophysiology. Levels of omega-3 PUFAs have been found to be reduced in the cerebrospinal fluid of patients with AD compared with control subjects.27-30 Similarly, plasma folate has been found to be lacking in people with AD compared to controls, whereas vitamin B12, vitamin C and vitamin E have been found to be reduced by 27%, 40% and 30% respectively.31-34 In humans, circulating docosaehexanoic acid (DHA) can be obtained from DHA present in some foods and from the conversion of dietary alphalinolenic acid to DHA in the liver. In addition to the lower dietary intake of DHA, it has also been shown that de novo DHA synthesis in the liver is reduced in patients with AD.35-37 It has been shown that the reduced plasma levels of DHA can be restored by increasing dietary intake of DHA.38-40 These data demonstrate the need for a compensatory dietary DHA supply in patients with AD. Choline is an essential nutrient for all cells and the uptake of choline from the circulation into the brain decreases with aging.41

choline. Uridine monophosphate synthesis, another precursor needed for the formation of phospholipids has also been shown to be reduced in people with AD.

Nutricia specialises in the delivery of advanced

An increase in plasma B12 and folate levels decrease levels of toxic homocysteine, while low levels of B vitamins further reduce choline metabolism, reducing the amount of available choline. B vitamin supplementation has also been shown to slow brain atrophy in people with high baseline Hcy.43

medical nutrition for

Lower B-vitamin levels result in lower choline levels, which negatively affects choline metabolism. In patients with the highest baseline Hcy levels, the effect of B-vitamin supplementation on slowing brain atrophy was more pronounced. 44-49

nutrition company in

Together, these findings indicate that AD is associated with a number of nutritional deficiencies which can impede the brain’s ability to replace the synapses it is losing through the disease. Souvenaid® is a Food for Special Medical Purposes which has been developed to address the specific nutritional needs of those with early AD. It contains a unique patented combination of nutrients for the dietary management of early AD. Souvenaid® has been tested in 3 randomised controlled trials52-54 and there are plans for Souvenaid® to be made available in the UK in the coming months. In summary, the variety of nutritional deficiencies in early AD offer a novel target for the dietary management of this distressing, debilitating and costly disease.

the very young, the old and the sick. It is the largest specialist Europe and the market leader in the UK.

Mednet, a healthcare consultancy, are working with Nutricia to provide medical education for healthcare professionals across the treatment pathway in the field of dementia.

Article compiled by Professor Christopher McWilliam (Consultant in Psychiatry and Neuropsychiatry), Dr Nick Smith (Medical and External Affairs Manager, Nutricia) and Miranda Stead (Director, Mednet) References for this article are available on request: Stephen Bahooshy (sbahooshy@mednet.co.uk)

Contact: Mednet Consult, Unit 1, The Kirkstall Park, Milford Place, Kirkstall Rd, Leeds, LS4 2AZ Tel: +44 (0) 113 827 2039 E-mail: info@mednet.co.uk Website: www.mednet.co.uk

Adequate choline levels are required for building neuronal membranes and it has been shown that neuronal membrane breakdown is increased in patients with AD and studies show that aging brains fail to take up

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“Providing Excellence in Healthcare”

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Improving Public Health Making your sexual health budget go further

The NHS Clinical Commissioning Mandate puts public health firmly at the forefront of the clinical commissioning agenda, identifying that a new set of cultures and behaviours should be adopted in order to meet the public health need and meaning that Public Health will now focus on improving health as a whole and not just healthcare. Such services are being redesigned with long terms conditions in mind, moving the emphasis from the acute sector and addressing the public health need within a community setting. Essential to these behaviours is the requirement to procure effectively against that need and demonstrate value for money. Sexual health has been identified as a key part of the public health agenda, and one in which real and tangible savings can be made. Encompassing contraception, abortion, sex-

ual health promotion and disease prevention sexual health spans a whole range of services, all of which apply a huge strain on public health finances. As responsibility and accountability become an absolute of service provision, more and more sexual health providers are seeking ways in which they can ensure they make the most of their budgets. Barriers to efficient service provision often lie in historical and accepted methods of working. Sexual health services frequently operate out of different locations, offer different treatments and rely on parent organisations to procure their resources in a tried and tested method. Hospital pharmacies supply to public health services at established pricing, and little thought it given to the implications of such a legacy.

Furthermore, sexual health commissioners and experts at the forefront of service provision have limited exposure and experience of financial policy and purchasing. What is required is not only a redesign of the service itself, but of the back office functions and methods of procurement for the products needed to provide first class healthcare.

the changing market

Over the past five years the pharmaceutical distribution channels have changed beyond recognition with manufacturers streamlining the supply of their products to the market. In June 2010 Pfizer took the bold and unparallel move to supply their contraceptive product, Depo Provera, directly to Family Planning and Prescribing Only GP practices at a discount via PSUK. This innovative change in supply to Family Planning and Prescribing Only GP practices had a direct and immediate impact in the form of cost reduction and consequently a benefit to budget. In October 2011 Bayer and MSD followed suit and reduced the number of suppliers they use to supply the Family Planning Clinics and GPs. The difference in these distribution methods is that while hospitals and pharmacies are still able to buy these products, they are not in a position to receive, and subsequently keep, the discounts the products attract. With the discount now aimed directly at the organisation providing the service, the prescriber, the market place is set to turn on its head.

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the benefits

There are six domains for authorisation for CCGs, one of which is a “clear and credible plan to deliver the Quality, Innovation, Productivity and Prevention (QIPP) challenge within financial resources”. Consequently, when commissioning sexual health services, CCGs not only have to consider the desired outcome, but also ensure that it is arrived at in the most cost effective and efficient way. While the FPA has voiced its concerns that devolving the commissioning of sexual health services to GP-led commissioning groups may have adverse effects for people’s wellbeing and sexual health, it cannot be denied that in terms of cost effectiveness in directly sourcing the items required for service provision there are benefits: »» Cash savings – suppliers are able to offer a discount to the service provider »» Patient Experience in General Practice – in removing the discount from the pharmacy and giving it directly to the prescriber, practices are encouraged to buy the product in and gain reimbursement from the PPD rather than send the patient to the pharmacy with a prescription to collect the medicine and return to the practice. »» Vision of stock movement – as the headlines frequently report the UK pharmaceutical market is vulnerable to exporting. By selling directly to the prescriber the product is protected. The principles of QIPP provide overarching guidance for improving the commissioning of sexual health services. Quality is and of itself a fundamental element for all services, ensuring that a consistent baseline approach is adopted for standards and productivity. Promoting and ensuring good sexual health is, by its very nature, preventative as the associated costs of further treatment are avoided. The 2008-09 Contraceptive and Sexual Health report identified that 75% of women under 50 were using some form of contraceptives, the most popular method being the contraceptive pill at 25% of total contraceptive use.

NICE has championed a sustained and impressively successful campaign to increase the use of Long Acting Reversible Contraception, estimated to increase uptake by 7.7% and reduce the future cost of care. The question remains, however, as to whether these LARC products, or indeed any other form of contraceptive, are being efficiently and cost effectively procured in the first instance. In 2010 it was estimated that for every £1 invested in contraceptive services the NHS saved £11. These figures largely assume the contraceptives themselves cost the provider Drug Tariff price. If providers were to purchase at reduced costs from PSUK these savings, and the value that reinvestment could bring, would be substantial.

There is no doubt that redesigning service pathways has brought enormous benefit to both patients and the finances of the NHS. The tendering of sexual health services to providers dedicated to reducing the price per activity has resulted in a 40% reduction in costs in STI testing for the London SCG alone. The purchasing model PSUK offers represents the next stage in innovation in procuring for sexual health provision. From April 2013, the responsibility for commissioning sexual health services is dues to transfer to Local Authority Public Health departments and the NHS Commissioning Board will commission contraception through primary care (GPs) through the GP contract. At this point the requirement surely has to be to look beyond the patient pathway redesign and effect change in the very methods of obtaining contraception offered through these pathways.

reducing expenditure

In working with the pharmaceutical companies concerned with sexual contraceptive provision, Pfizer, MSD, HRA and Consilient, to name a few, PSUK has successfully reduced the expenditure of several major trusts, charities and organisations through better pricing, delivery and service. Furthermore, in the case of GP practices, the process of buying directly has ensured better patient care.

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For more information, contact: PSUK, 5 Alpha Court, Monks Cross Drive, York, YO32 9WN. Tel: 01904 558350 E-mail: enquiries@psuk.co.uk

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Case study In February 2011, PSUK began working with a sexual health provider in Northern England. It operates out of several hubs in a market town borough and the service is supported by the GP practices in the surrounding area who supply contraceptive services on behalf of the provider. PSUK analysed the existing purchasing methods and the pricing paid for key contraceptive lines. The service undertook an overhaul of its procurement methods and began purchasing from PSUK, at pricing arranged directly with the manufacturer. This took it away from traditional purchasing methods and granted it access to the discounts previously enjoyed by local pharmacies and the hospital pharmacy department. Within a 12 month period, the savings made on personally administered LARC products alone was £29,313.00. This money has been reinvested into the service. In addition to the monetary savings, working with PSUK afforded the service provider there were the additional benefits including: »» Contract pricing on key lines, including oral contraceptives »» Main billing account and 60 delivery points »» Streamlined purchasing of all contraceptives including condoms »» Reduced pricing on medical consumables For further information on how PSUK could reduced the pharmaceutical and contraceptive product expenditure for your service, please contact us directly (details on previous page).

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20th September - York York Racecourse

Is your practice challenged by... NHS initiatives including QIPP & Medicine Management? Reducing Costs? Prescribing Budgets & Constraints? PCT & Practice Connections? Forthcoming CCG Targets & Initiatives? Local Pharmacies or Pharmacy Competition? If the answer is ‘yes’ then the upcoming PSUK Conference “Striking a Balance: Managing Cost, Effectiveness and Productivity in Practice” could provide your practice with the help required to make sure your business is ready for the changes to come following the passing and implementation of the Health & Social Care Act.

Our Keynote Speakers & Workshops… Keynote Speakers

Key Workshops

Four keynote speakers deliver a vital insight into the key issue of the moment. Take advantage of the Q&A session towards the end of the event to ask any burning questions you may have.

– Develop an understanding of current challenges; – Create a discussion platform; – Provide an aftercare info pack to implement in practice.

› Michael Sobanja

› Practice Legalities – GP Contracts – Premises Leases/PCT Leases – CCG Constitutions

NHS Alliance Director of Policy

› David Sheppard

› Medicines Management

Practice Manager, Based in Cornwall

› Pharmacy: Understanding your Options; Realising the Benefits – Pharmacy Applications and setting up our own pharmacy – Joint Ventures - Working with Pharmacists – Premium and Lease Putting out a premises for tenders – Purchasing a NHS Pharmacy Contract/Pharmacy

– What is Meds Management? – Existing PCT structure – QOF & QIPP

› Dr. Mike Dixon Chairman - NHS Alliance, OBE & FRCGP

› Practice Finances*

› Kym Lowder

– Seniority Pay – GP Superannuation Certificates – Staff Restructure/Efficiency – Enhanced Services

National Prescribing Centre Facilitators

* Subject to Change

There will also be intervals in the day where you can meet with our preferred suppliers who are kindly supporting the event. Conference Costs per Event

Location for York Conference:

The Racecourse Knavesmire Rd, York, YO23 1EX - Just 5 Mins from York Station & 20 Mins from A1/M1. - On a regular bus route from the Station.

ALL Practices

Event Cost:

Non-Attendance Fee:

FREE

£37.501 + VAT

Non-Attendance fees will be charged in the event of non-attendance & failure to notify PSUK 24 hours in advance of the event start time.

Tip the balance in your practice’s favour by booking your place online today...

www.psuk.co.uk/events

Turning on to telehealth 2012 looks set to be the year telehealth takes off

Four years ago, the Whole System Demonstrator Programme (WSD) started assessing how technology could help people manage their own health. And just a few months ago, Prime Minister David Cameron announced that the government should implement telehealth nationally.1 The Guardian newspaper recently reported that the Department of Health (DH) is now at mobilisation stage and getting everything ready to offer telehealth to patients with chronic illness.2 Care Services minister Paul Burstow admits that one of the biggest challenges the DH faces is ensuring that other areas of the country are aware of the WSD’s findings.3 The headline findings are positive – a 20% reduction in emergency admissions and a 14% reduction in elective admissions.4 There are, of course, several barriers that need to be overcome if telehealth is to become more common practice – the strength of broadband across the UK being one of the main obstacles. The areas that

need telehealth the most are often the areas with less efficient broadband.5 The government, however, has put plans into place to improve broadband connections in the UK and Scotland.6 It is a long-running issue that the UK’s rollout of 4G is behind other European countries, such as Italy which went live with 4G in 2011.7 Culture Secretary Jeremy Hunt said that the government will allocate £362m to ensure that “90% of hard-to-reach communities with painfully slow internet speeds could have access to superfast broadband by 2015”. With that commitment in place, the headline findings of the WSD offer compelling evidence that telehealth can benefit those with long-term illnesses.8 Telehealth has traditionally been considered for chronic disease management, but a study in Italy suggests that it may also have a role to play in the surgical sector.

ismett: telehealth in action

Over the past decade, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione Hospital (ISMETT) in Palermo, Italy, has become one of the leading organ transplant centres in Europe and a major referral centre for other Mediterranean countries. More than 1,000 transplant procedures have been performed (liver, kidney, pancreas, heart and lung transplants) with outstanding clinical results. ISMETT’s one-year survival rate for liver transplant recipients is the highest in Italy. At ISMETT, transplantation is not the only solution to end-stage organ failure and associated complex diseases. Specialised procedures include surgical, radiologic, and endoscopic techniques, as well as medical therapies to treat severe diseases and avoid transplantation. ISMETT’s specialists work closely with UPMC (an integrated global health enterprise based in Pittsburgh, US) and its internationally-renowned transplantation teams, and are supported by advanced diagnostic services, offering patients the most sophisticated therapies available. Patients travel from all over Italy for surgery. 30% of ISMETT’s beds are in the high dependency Intensive-Care Unit and the average postoperation hospital stay is 28 days. In order to speed up hospital discharge for post-liver transplant patients and to allow for recovery at home, in July 2011 ISMETT initiated a telehealth monitoring study based on the use of the Intel-GE Care InnovationsTM Guide.

Telehealth enables a two-way dialogue between patients and healthcare staff, making patients feel better monitored

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the promise of

virtual care co-ordination

Developing a sustainable model for healthcare delivery is of vital importance to ensure that the ageing population receives quality healthcare and a supportive environment that fosters healthy, independent living. As an extension of telehealth—applied technology devoted to monitoring chronic health conditions—virtual care co-ordination establishes an active and dynamic support network linking patients with clinicians and doctors. Using computer-based biometric monitoring, two-way videoconferencing, educational tools and logic-based evaluation techniques, patients gain more control over the management of their chronic conditions while being comfortable within their home environment. This approach helps provide quality, cost-effective treatment of long-term diseases, encouraging healthy behaviour and providing positive feedback to guide the health process. Treating the whole person in this manner is an emerging field referred to as integrative care. While telehealth technology, such as the Care InnovationsTM Guide, currently focuses on some of the most challenging chronic conditions – including CHF, COPD and diabetes – it could offer an extensible framework that can be customised for many other conditions. It can also work effectively as a component in wellness campaigns, to help support the healthy lifestyles of individuals before chronic conditions can develop. Sustainable healthcare includes more than simply treating existing diseases: lives can be improved and healthcare costs reduced by encouraging and supporting behaviours and lifestyles that eliminate the need for more extensive medical intervention.

The overall goals of the study are: »» To improve the quality of life of patients, whose follow-up will be from their home instead of having to travel to the hospital; »» To provide physicians with the necessary information to monitor the patient’s conditions regularly; »» To reduce healthcare costs with shorter hospital stays and continued monitoring. The implementation of this study involved ISMETT’s medical practitioners, transplant co-ordinators, therapists and psychologists, in charge of the day-to-day monitoring through the Care InnovationsTM Guide, as well as nursing and technical staff for the installation of the equipment and training to the patient and his or her family given by Vivisol SpA. The use of the Guide enables nurses and physicians to monitor and support transplant patients from their homes, with the ability to check their general condition, collect biometric data, manage their treatment and offer face to face connection via video conferencing. In September 2011, the first patient was discharged and monitored at home using the Guide. So far, 26 Sicilian liver transplant patients have taken part in the study and have received care using the Guide for at least three months during their post-transplant followup. A similar number of patients have been used as a control group.

early results

ISMETT has observed that telehealth monitoring does help support early hospital discharge and the reduction of readmissions, since regular monitoring enables the healthcare staff to act sooner, where necessary, and thus avoid rehospitalisation. The study carried out at ISMETT is promising with regard to this point, as there have been no readmissions in the intervention group so far, while a few were observed in the control group. The ISMETT hospital reported that the use of telehealth monitoring systems, therefore, demonstrates that they can be effective in the reduction of healthcare costs.

Moreover, the Guide is able to collect and provide similar information relating to the patient as that collected during a continued hospital stay, with the advantage that patients stay in their own homes, so benefiting in terms of comfort. ISMETT found in the study that this new model of care can be effective even for patients with particular and complex clinical conditions, such as liver transplant patients in the immediate post-operative period, when they need to be constantly connected to their healthcare team. “Telehealth enables a two-way dialogue between patients and healthcare staff, making patients feel better monitored and allowing them to ask for immediate support”, says Giovanni Vizzini, head of ISMETT’s Department of Medicine. “Our preliminary results are very encouraging. As a whole, the study will involve 100 liver transplant patients and we hope that in the near future we’ll be able to extend this service to lung transplant patients and VAD patients.”

food for thought

The study is interesting food for thought for other medical practitioners. It indicates that telehealth is a feasible way of reducing healthcare costs not only for patients with long-term health conditions, but also patients that have had major invasive surgery. If hospitals can use telehealth to help reduce the amount of time a patient spends in hospital post-surgery, this must be helpful to the hospital in terms of reducing costs.

conclusion

In the UK, the future looks bright for telehealth. With government backing, patients and medical professionals may at last start to see some of the long-touted benefits in action. The ISMETT study offers hope to transplant patients and it will be interesting to watch other beneficial uses for telehealth emerge.

1. The Guardian, 4 March 2012, “‘Do nothing on telehealth and you let down your local community: Minister” 2. The Guardian, 4 March 2012, “‘Do nothing on telehealth and you let down your local community: Minister” 3. The Guardian, 4 March 2012, “‘Do nothing on telehealth and you let down your local community: Minister” 4. Department of Health, December 2011 “Whole System Demonstrator Programme Headline Findings” 5. The Guardian, 16 August 2011 “Rural broadband set for £362m boost” 6. The Guardian, 16 August 2011 “Rural broadband set for £362m boost”, 7. The Guardian, 14 September 2012 “Superfast broadband rollout is too slow, warns Culture Secretary” 8. Department of Health, December 2011 “The Whole System Demonstrator Programme – Headline Findings”

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www.patient-access.org.uk

How Access and Continuity can work hand in hand Harry Longman explains why Patient Access is an innovation transforming primary care

I’m an engineer and innovation has always been my daily bread. It’s a lonely furrow to plough as I found when working in the NHS, but I was looking for something which would explain why, whatever we do, demand into A&E goes up year after year. Perhaps it could have something to do with access to general practice? I dug deeper. I discovered a handful of GPs who had invented something so simple yet so effective that their patients were being dealt with in minutes rather than days, and I knew it was a winner.

going for over 12 years, many persecuted by the inspection regime, most feeling isolated and unloved. They were all over the country, inner city to rural, lists from 2,000 to 20,000. But all with similar stories to tell: doctors getting their lives back, receptionists not having to fight off the patients, patients themselves enjoying fantastic service from their own GP. All this is against a stream of stories in the press on the difficulty of getting GP appointments, guarded by the proverbial dragons.

The first few were in suburban Leicestershire, all reporting great results for patients and doctors. I found a way to broaden the search and within three months had found over 40 who were using a similar system. At least 20 were independent inventions, some

So what is the innovation? »» The patient calls the surgery in the normal way and is asked what is the problem »» The doctor calls the patient »» They deal with the problem together, now.

It’s not telephone triage because it’s your own GP, and they are not trying to put you off unless you are bad enough to be seen. They are solving the problem. The reason this is so effective is that it turns out only about one in three patients needs to be seen and experienced GPs are calling typically three patients in the time for one traditional 10 minute face to face appointment. This generates so much capacity that, having agreed a face to face is needed, the GP can always offer it on the same day. Most patients come in the same day, but they can ask for a later date if that’s what they want. Most GPs find with this system that they still have free slots most days, to do paperwork and go home on time. Or they are able to increase their lists for no extra cost, or in some areas simply deal with very high patient demand without turning people away. So why has such a simple innovation spread like wildfire, reaching as many as one in 200 practices in so short a time as 12 years? It lacked an identity, an evidence base, an organisation. I went back to the original research question on A&E, crunched huge databases (with the help of EMQO) and came back with the age-sex standardised, deprivation adjusted, p-value verified answer: patients of these practices were 20% less likely to visit A&E. With this new evidence, and £5,000 sponsorship from QIPP, the practices gathered for a

Dr Kam Singh, one of our GPs

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50% more patient contacts are made, and while telephone calls rise three fold, face to face appts fall 50%

Before, a patient seeing the GP had waited an average of 5.5 days. Now around 1. But they can choose what day to come, book ahead if they wish. Advised to ring on the day!

Tele cons rise 3 fold

25/7/11 Within 2 weeks, mostly same day

Face to face falls 50%

Previously, variable wait of 4-7 days

Data from Thurmaston HC, 1/5/11 – 12/11/11

day conference in London and the movement was born. What we needed now was evidence from practices of how it worked, and a means of helping others take it on. Now came the opportunity for some engineering. No-one had any idea how quickly the GP phoned the patient, but they thought it was quite fast. I measured it, in several practices, and found that a median time of 30 minutes was quite normal. Duration of call, median three minutes. Waiting time to see a GP, average a day or so. The numbers started to pour out, with data extracted from clinical systems. What would happen when practices changed over to the Patient Access method? For doctors, staff, patients, what help would they need? We developed the method, worked with some, and measured before and after. The case studies are consistent: instant effect of waiting time to see GP falling from one week to one day. Response time over the phone quickly falling below one hour. New findings, DNA’s fall by 80% – patients, when told by the doctor to come in today, come in. Within weeks, new effects emerge. At Thurmaston, the practice manager told me: “Stress in the practice has just melted away.” And in another aside: “The patients have stopped lying to us.” The story is repeated by others, and we find that patient behaviour changes as they don’t perceive a struggle any more to see the GP. They don’t need to exaggerate symptoms or argue with the receptionist. In turn, this means they don’t all have to call at 8.30 to be first in the queue, and the demand spreads out through the day, easing the pressure on reception. Four weeks after the change at Thurmaston, Dr Kam Singh tells me he has no patients to

see for his last hour in clinic. This has never happened before. A partner goes to the gym in a quiet lunch hour. A month later, Kam tells me that before the change they were about to hire another salaried GP, but now they don’t need to, they would simply have no work for them. £80,000 per year goes to the practice bottom line and Kam puts this on record. The economic case for Patient Access in practices is made. How do we design a programme of change that will help any practice? We know the method works across the full range of size, place, deprivation and style of practice, but needs to be adapted by each one. The innovation works partly because of the way it can be re-invented locally, but we are aware of pitfalls that some practices have fallen foul of and we hear of failures. A balance of guidance based on know how, yet flexibility is needed. Speed is of the essence, as practices want to make savings quickly and feedback of performance has to be integrated with the process for motivation and for informing change. Through application of theory, practice, trial and error, we develop a launch programme: »» Consensus – all partners need to agree to go ahead, at least for eight weeks »» Preparation – the whole practice team is involved in the change, each person has their own objectives, and we measure the situation before the launch day »» Launch – all is set up for the first day, patients informed, staff trained and ready. Surprises on the day are mostly pleasant – staff and patients experience something new »» Routine – over the next four weeks we feed back what is happening, take new measures, help with adjustments. This is perhaps when we are needed most, as

INNOVATION IN HEALTHCARE

there can be tough times, and perseverance is needed »» Review – with data gathered and charted, staff and patient feedback, what is the decision? Forward with the new system, or back to the old? The case is proving overwhelming. Case studies show similar patterns of change and stories from staff and patients. No-one says it’s easy, and GPs find the work intensive. Yet the refrain is: “I’m feeling more in control of my work, less frustrated, because I’m seeing the patients who need me. It’s more professionally satisfying.” What of the future? We have a movement which is growing week by week in strength, capturing attention from forward-looking practices and CCGs. The evidence base grows, and with interest from the universities of York and London, academic studies of the effects will soon be underway. The next conference in June will highlight research from new and established practices, and address issues such as clinical safety and rising demand which affect all. A foretaste of the next big finding: continuity has long been the strength of primary care, with the doctor-patient relationship at its heart. Under pressure from increasing practice sizes and access targets, difficult to measure, continuity has been on the slide. New research at a Norfolk practice demonstrates how we have turned the tide, doctors reporting continuity improving from 48% to 97%. At the same time, research from Leicester University, Chauhan et al in the JPH, shows that better continuity drives lower elective referrals. Hello, Mr Nicholson, we’ve got something more for your £20bn challenge.

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Diabetes: ‘One of the greatest challenges commissioners face’ Dr James Kingsland OBE Commissioning Network Lead, NHS Diabetes National Clinical Lead, NHS Clinical Commissioning Community Poor diabetes care and service provision leads to often preventable cases of blindness, neuropathy, amputation, heart disease, stroke and kidney disease. We must address inefficiencies and unwarranted variation in care across the NHS and accomplish a reduction in levels of preventable complications by our actions now. Meticulously improving the value and standards of the services people with diabetes receive is essential for a sustainable, free health service. The human cost of disjointed diabetes services and poor support for better self-care not only affects the individual but also their friends, family, ability to work and quality of life. There are, however, many shining examples of excellent diabetes care across the country. The goal now is to target those under-performing areas and improve sharing of good clinical and commissioning practice. Local, multi-disciplinary teams who work across organisational and professional boundaries are key to raising standards. NHS Diabetes is working hard to engage new and existing commissioners, to tackle shortfalls in diabetes care provision in their areas and provide the support and guidance needed to make a reduction in unnecessary spend and improve quality of life. Support for this work can be secured by using their web resource and by downloading their free, clear ‘At a Glance’ guide (visit www.diabetes.nhs.uk/commissioning). We use this site and resource locally on a regular basis and it has helped us shape and refocus diabetes care within our developing clinical commissioning group’s community.

The key facts: Prevalence of diabetes compared to other long-term conditions (Diabetes Health Intelligence 2011) 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00%

Diabetes Cardiovascular disease Coronary Heart Disease COPD Stroke 2010

2015

2020

In 2010/11, prescriptions for non-insulin anti-diabetic drugs in England cost £259 million,and the average spend per adult with diabetes was £110.79 £725m a year is spent on diabetes medication – 8.4% of the NHS drugs spend Around 60,000 people are diagnosed with diabetes each year, more than twice as many diagnosed with either colorectal or lung cancer 3.8 million people aged 16 and over are expected to have diabetes by 2020, an increase of 8.5 per cent on current levels 6.4 to 68.7 per cent - variation in the number of people with diabetes receiving all nine of the NICE recommended care processes across PCTs in 2009-10 24,000 people with diabetes are estimated to be dying each year from diabetes-related causes that could be avoided

‘Our commissioning resource will enable you to carry out the key commissioning tasks and deliver high quality, efficient and cost-effective diabetes services.’ Trudi Akroyd, NHS Diabetes Head of Commissioning In 2010 it was estimated 3.1 million people in England had diabetes, around 7.4% of the total population. With ever increasing obesity levels it is estimated this figure will rise to 4.6 million by 2030, or 9.5% of the population. Together with a host of complications brought on by diabetes and a life-long package of care for each person with the condition, the potential burden on the NHS is considerable. Supporting the commissioning of excellent diabetes services is a cornerstone of what we do at NHS Diabetes. Effective diabetes service commissioning is not easy and we understand it's easy to keep to business as usual. However we'll show you the risks to your patients and your budgets of not following a structured process. We think our model will save you time and money and lead to better care for all people with diabetes – the sooner you act, the sooner you'll be able to see the benefits. We have now sent every CCG a copy of our new ‘At a glance’ guide, designed to help commissioners navigate their way around the commissioning process for this complex condition. Concerned at the level of diabetes commissioning competency in the former PCTs, we developed a commissioning framework that describes the key interventions and supported it with guides we piloted in 78 projects across England. Our ‘At a glance’ guide pulls together the lessons learned from the pilot projects and describes eight practical steps to enable GPs and managers to carry out the key commissioning tasks and deliver high-quality, efficient and cost-effective diabetes services. Our commissioning approach allows delivery of four key outcomes: i. ii. iii. iv.

A local health needs assessment to help identify gaps in service provision, areas of poor outcome and future needs. Implementation of an integrated system-wide diabetes service. Promotion of supported self-management and collaborative care planning. Service improvements in local priority areas identified by the health-needs assessment process.

Each step is supported with detailed information on our website (www.diabetes.nhs.uk) and further diabetes information products, datasets and tools can be found via the NHS Diabetes-funded National Diabetes Information Service (NDIS). We are also encouraging greater numbers of commissioners to join our emerging Commissioning Network, which shares best practice and offers further support. As well as a forum to share experiences and best practice examples, Network members receive regular e-bulletins with the latest news to affect diabetes commissioning, diary dates, and signposts to further support. To join the NHS Diabetes Commissioning Network, email Ursula Anderson at ursula.anderson@diabetes.nhs.uk LRQLQJ oning

Order or download your free copy of the NHS Diabetes ‘At a glance’ commissioning guide, access other free online commissioning resources, and join the Commissioning Network at: www.diabetes.nhs.uk/commissioning Tel: 01912 292 947 enquiries@diabetes.nhs.uk

www.diabetes.nhs.uk

Supporting, Improving, Caring

NHS Diabetes is working to transform diabetes care across the NHS. We play a vital role in improving the services and quality of care received by the three million people in England with diabetes. We remain a stable and consistent voice at this time of unprecedented change in the health service and have been fortunate to be small and responsive enough to be able to adapt to the reforms, and continue delivery against our objectives. In bringing together our regional support teams to focus at a national level, we are now able to communicate our message more widely and address the poor awareness and education of diabetes amongst the general health community. We continue to demonstrate the enormous benefit to patients of creating and supporting well-organised, expert-led programmes and initiatives. Initiatives such as our best practice tariff for paediatric diabetes care which sees our standards for service providers become mandatory for the first time. And programmes such as our Safe Use of Insulin e-learning module, created in response to worrying levels of patient safety incidents recorded by our audits, and onto which around 80,000 frontline health and social care professionals have enrolled. We have exciting plans for this year and will continue to lead the way in taking ‘audit to action’ and ensure NHS organisations improve shared learning and reduce unacceptable variations in care. We must ensure they remain supported to deliver tangible, lifelong benefits to the ever-increasing numbers of people with, or at risk of, this complex condition. Our plan for next year will include: developing a local health needs assessment to help identify gaps in service provision, areas of poor outcome and future needs supporting hospitals to reduce diabetes medication errors on the wards and to improve inpatient audit results working hard to improve care for older people in care homes by providing tools, education and support for healthcare professionals to improve the quality of patient care continued support for better commissioning of integrated diabetes services by encouraging use of our tools, online resources and expert commissioning support team ensuring all paediatric diabetes teams in England meet the mandatory standards set out by our payments by results tariff through supporting regional paediatric network outcomes providing better access to robust health information and data by supporting developments in the National Diabetes Information Service supporting services to deliver the outcomes referenced in the NHS Operating Framework 2011-12 and NICE Quality Standards for Diabetes through networks of practice. Our networks of practice will run a free web-based lecture series, ‘meet the expert’ sessions, presentations of diabetes success stories, online forums, and provide a team of experts to help answer diabetes clinical and management issues you might be facing in your own organisation. We have a comprehensive library of guidance, success stories, support and information available through our website (www.diabetes.nhs.uk). We look forward to working with you, supporting you, and helping you to achieve excellent diabetes services for your patients this year.

Anna Morton, Director, NHS Diabetes NHS Diabetes prioritised its Safe Use of Insulin work after its 2010 Inpatient Audit indicated more than half of audited patients on insulin had an insulin prescription error during their time in hospital. Hypoglycaemic episodes were substantially more common in those who had experienced such errors than in patients who had no errors - such events have a serious impact on patient outcomes and on NHS costs. NHS Diabetes’ Safe Use of Insulin poster campaign, designed to increase uptake of its Safe Use of Insulin e-learning module among inpatient teams, was launched in May 2012. s

The Safe Use of Insulin course is free. Do the course. Save a life. If you’ve already completed the safe use of insulin training, ensure your colleagues have done the same and register for our other free module on the safe use of intravenous insulin infusion. This module is for healthcare professionals who provide care for adults on an intravenous insulin infusion. In the next month we’ll be launching a further two modules, one on the safe management of hypoglycaemia and the other on the safe use of non-insulin therapies. Keep an eye on the safety section of our website for more information:

www.diabetes.nhs.uk/safety

The power of touch How using touchscreen technology improves patient engagement

the challenge of patient engagement

Healthcare providers are expected to engage, listen to and involve patients. The Care Quality Commission (CQC) demands that healthcare services “provide service users with appropriate information and support”, enable patients to “express their views” and “involve service users in decisions”. Clinical Commissioning Groups (CCGs) are required to have “meaningful engagement with patients, carers and their communities” and The Patients’ Association recommends that CCGs “actively gain and publish patient feedback on the services they are providing”. Meanwhile, the Quality and Outcomes Framework (QOF) and Directed Enhanced Services (DES) reward GP practices for having a patient participation programme and measuring patient experience. Beyond the formal requirements, patient engagement goes much further. In a world of greater patient choice, it’s vital that healthcare services put patients at the centre of

everything they do, encouraging service design that gives patients what they need and want. This means providing patients with the right information at the right time, asking them questions and listening to what they say. However, patient engagement is not easy. It takes time, effort and money. Patients can be isolated, disadvantaged, and disengaged. They come from different backgrounds, face different challenges and have different needs. The great challenge is to have an effective patient engagement programme that’s inclusive and accessible for patients, while being cost-effective and easy to manage for healthcare providers.

interactive technology

– driving

an engagement revolution

Interactive technology is driving an engagement revolution. From touchscreen kiosks and handheld tablets to touch-sensitive windows and tables, this intuitive technology is being used to increase patients’ access to

information and enable them to leave feedback on services. With a combination of accessible hardware, bespoke software and related engagement services, Elephant Kiosks is at the forefront of this revolution, enabling patients to leave feedback in new ways and helping the NHS extend the reach of information to patients who may otherwise not have the opportunity or know-how to access it.

measuring patient experience

Touchscreen kiosks and handheld tablets enable service providers to run electronic patient surveys. Patients simply complete the survey by touching the screen, giving service providers instant access to real-time reports. Pennine Care NHS Foundation Trust recently launched 49 touchscreen static kiosks across the boroughs of Bury, Rochdale, Oldham, Stockport and Tameside & Glossop, delivering one of the most accessible surveys in the NHS. The survey is available in 10 languages, with automated audio, large text and pictorial symbols. Staffordshire and Stoke-on-Trent Partnership NHS Trust utilises the technology in a different way, with over 50 handheld devices running a selection of surveys, used out in the community by health workers. It ensures patients being treated in the community get the same opportunity to have their say on services as those in health centres and hospitals. Unlike paper surveys, results are submitInteractive kiosks and tablets allow patients to leave instant feedback or complete surveys about their experience of NHS services

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A real-time system allows NHS managers to act quickly on patients’ opinions and implement changes quickly and effectively

ted securely and privately by the patient, with no manual data entry or analysis required. Service managers are able to view real-time, online reports at anytime, keeping a daily or weekly track of patient experience across seven service teams. “The size of our project,” says Liam Norcup, project lead, “demonstrates the power of touchscreen technology to improve patient engagement on a large scale, while also saving money and staff time.” What is interactive technology? »» Touchscreen kiosks »» Handheld tablets »» Touchscreen tables »» Interactive window displays »» Touch-sensitive floors »» Motion sensitive displays

Touchscreen surveys also facilitate instant alerts to staff. So if a patient leaves feedback about an unclean waiting room, for example, an email is instantly sent to the senior sister. As explained by Barking, Havering and Redbridge University Hospital NHS Trust’s, this system means managers “can access results regularly, so can act on patients’ opinions to implement changes quickly and effectively”.

accessible patient information

Interactive technology provides a unique opportunity to ensure patients access vital information at the right time. Whether it’s a kiosk based in a pharmacy like at Cambridge and Peterborough NHS Foundation Trust, or out in the community and at GP surgeries as with C4G (Canterbury and Coastal CCG), the technology means information can be delivered at the point of service, in multiple languages, audio and video. It can act as a staff resource and patients can print information or email it to a personal email address.

making engagement inclusive

In addition to kiosks and tablets, Elephant Kiosks already provide touchscreen windows, floors and tables, and interactive holographic displays. With the opportunities this presents for service innovation, the biggest opportunity is to make services inclusive; to involve patients young and old, technically savvy or not, no matter what their language, literacy level or disability.

You don’t need to be technically savvy to use touchscreen kiosks and information can be provided in many different languages

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Case study

Bradford District Care Trust by Shahid Islam, service user & carer involvement project manager, Bradford District Care Trust Around 18 months ago, we installed touchscreen and handheld technologies across our organisation to collect feedback about specific teams and individuals, relating to performance from the service users’ viewpoint. Data is collected in real-time and centrally collated by Elephant Kiosks, which, among other things, ensure the technical elements run smoothly. The anonymised data is made available to individual clinicians, teams and wards. Graphical illustrations show how service users score a number of topics, ranging from quality of food to how well treatments were explained. Labour intensive tasks such as analysing data are automatically taken care of, saving a great deal of time and mental energy. Results show most respondents rate care in a very positive way. Where there are trends that deviate from the high standards, we can investigate further through inspection, audit or evaluation exercises, or rectify the issue immediately if it’s more straightforward. For example, we noted that 28% of inpatients were not provided information about the ward routine. A flyer was therefore produced in a participatory way, with information about the ward, including meal times and activities. This is now provided to all patients on admission. There are many further examples of small changes that have had a ‘drip-drip’ effect leading to service improvements, which are not always easy to quantify. This is exemplified by one doctor who stated: “By virtue of creating a system where people can score performance, one can’t help but ensure that standards are always high”. We have found e-feedback to be a powerful tool and a useful ally in our quest to increase the amount and quality of data. In an age where a great deal of activity is turning towards technology to improve convenience and outcomes, it’s only logical for feedback to follow.

“I started Elephant Kiosks five years ago after seeing the opportunity for accessible touchscreen kiosks to deliver vital information out in the community. We designed the UK’s first manually height-adjustable kiosk, accessible to wheelchair users and people with other disabilities. Since then, interactive technology has developed rapidly and so have we, but I never forget our founding principles – that technology should empower people to access information and directly engage with public services.” Annette Walker MBE, Managing Director, Elephant Kiosks

For more information, contact: Mark Worger Business Development Manager Elephant Kiosks 22 Signet Court Cambridge CB5 8LA Tel: 01223 812737 Email: mark@elephantkiosks.co.uk

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From hospital to home As diagnostics move away from the hospital and into the GP’s surgery and even the home, “...the upcoming years may well be known as the age of diagnostics”, according to Janet Woodcock MD, Director of the Centre for Drug Research & Evaluation, US FDA The NHS is changing, commissioning is changing and so is patient care. In light of this, how are your views changing? As a commissioner, how do you view diagnostics? In vitro diagnostics (IVDs) are an integral part of any investigation into a patient’s health. Blood, fluids or tissue hold the clues to build a case. But where do you see this happening?

at the point-of-care?

Previously, diagnostic testing always occurred in the hospital. A GP would refer a patient to a hospital specialist if they required a test. The specialists were effectively the gatekeepers of hospital resources. Technology,

however, has drawn testing out of the hospitals. Developments in rapid manual and miniaturised instrumentation technology allow revolutionary “point-of-care” (POC) tests to be undertaken by a GP. A GP can now rule out chlamydia or HIV with a swab or drop of saliva. POC tests can be used to rule out the need for more expensive and invasive procedures. »» Faecal Calprotectin tests are currently being used to differentially diagnose patients with irritable bowel disease (IBD) from patients with functional disorders such as irritable bowel syndrome (IBS). Calprotectin levels are considered a reliable indicator of the inflammation indica-

tive of more debilitating IBDs or even bowel cancer. This IVD can be utilised to avoid an unnecessary investigative colonoscopy. »» 140,000 patients per year come to primary care querying Deep Vein Thrombosis (DVT). With 80-90% of the referred patients not having DVT, there is a significant opportunity to reduce cost by identifying which patients can exclude DVT in primary care. POC D-dimer tests used in conjunction with a low risk probability score have shown that referrals have been reduced by 50%. There are obvious cost savings with this test, in addition to the benefits of any early diagnosis, such as the initiation of preventative treatments prior to final diagnosis.

“POC IVDs can save money and reduce demand on specialised services”

Recent developments allow revolutionary POC tests to be undertaken by a GP

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The value of bringing IVDs closer to the patient is in not having to wait for referrals, then for results to come back from labs

“Of 500,000 patients admitted with chest pains, only 231,000 are at immediate risk. 270,000 should not necessarily be admitted” in acute care?

POC tests are not the only way in which tests are creeping out of the lab and closer to the patient. While in acute care, blood sodium and gas levels can now be performed on the ward or even at the bedside. The value of bringing IVDs closer to the patient is in not having to wait for referrals, then for results to come back from labs. »» Diagnostic multi-marker tests, which include troponin and Heart-type Fatty Acid Binding Protein (H-FABP) to identify Acute Coronary Syndrome/myocardial Infarction (ACS/MI) and risk stratify low to medium risk chest pain patients, allow for earlier intervention, treatments and management of ACS/MI. This multi-marker can identify ACS/MI and risk stratify low to medium risk patients on the ward in less than 30 minutes, within three to six hours of chest pain onset.

the neutophil gelatinase-associated lipocalin (NGAL) test, renal expression of NGAL can be detected and acted upon within two hours. Using a drop of urine of blood plasma, the NGAL test gives results in just 10 minutes.

In the home? The future, then, sees more diagnostics in the homes of patients managing and self monitoring long term conditions from the home while using technology to share data with clinicians. Patients with diabetes are

already celebrated as successful examples of disease self-management; with many monitoring their blood glucose levels in order to adjust their diet and lifestyle accordingly, keeping them out of hospital. »» Non-invasive monitoring of asthma, for patients of all ages, can record breath sounds for analysis. A device can be attached to prolonged recording day or night, which enables the physician to obtain a true picture of the variation of the wheezing with time. »» Atrial Fibrillation patients who have been prescribed Warfarin usually attend clinics

Procedures for assessing renal function have not changed over half a century, yet acute kidney injury has been reported to be prevalent in 5-7% of all hospitalised patients and 30-50% of patients in ICUs. Current diagnostic methods, such as serum creatinine, only respond after renal function has deteriorated. With Diagnostic multi-marker tests allow for earlier intervention, treatments and management of ACS/MI

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In the age of diagnostics, IVDs are no longer hidden behind the scenes in the pathology laboratory

“It is not just diabetes patients who can benefit from tests that aid self-management” to have their International Normalised Ratio (INR) checked, every four weeks. Competent patients can monitor and manage their own INR levels from home with a simple finger prick and testing strip. »» A telemedicine approach to Chronic Obstructive Pulmonary Disease means that patients can be kept safely at home, while being able to generate essential data using simple to use devices equipped with Bluetooth to transmit data to clinical servers. So, in the age of diagnostics, IVDs are no longer hidden behind the scenes in the pathology laboratory. They are seen as the GP’s first port of call and part of the day-to-day routine in the home.

early diagnosis

The white goods next to a hospital patient’s bed are not washing machines but blood gas analysers. Bringing diagnostics further forward in the patient pathway saves precious minutes and money. The sooner a patient is diagnosed, the sooner clinicians can get to work. If patients can be kept out of hospital then the resources of our various healthcare institutions will be able to breathe a sigh of relief. These are pressing issues in a time when our population is aging and efficiency savings must be made.

BIVDA is the UK industry association representing companies that manufacture and/or distribute the diagnostics tests and equipment to diagnose, monitor and manage disease largely through the NHS pathology services. Increasingly, diagnostics are used outside the laboratory in community settings and also to identify those patients who would benefit from specific drug treatment, particularly for cancer.

For more information, contact: Doris-Ann Williams MBE British In Vitro Diagnostics Association (BIVDA) 1 Queen Anne’s Gate London SW1H 9BT Tel: 020 7957 4633 Fax: 020 7957 4644 E-mail: doris-ann@bivda.co.uk Website: www.bivda.co.uk Twitter: @BIVDA Increasingly, diagnostics are used outside the laboratory in community settings

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Building public support for change

{Smart Guides } to ENGAGEMENT

For better commissioning

Building public support for change Smart Guides to ENGAGEMENT for better commissioning

Building public support for

The way to make this happen is first to engage local people in decisions about change, as described in stage two of the engagement cycle. It’s counterproductive trying to drum up support about proposals for change that are seen as cut and dried or which the community has not been involved in formulating.

cal commissioning plans are important opportunities to identify and develop the basis of change »» You can’t always please everyone. Discussions about resources and what can be afforded should be transparent. Commissioners have to be honest about what can and can’t change and communicate openly about the benefits of change »» People who use services and communities will use the processes and the outcomes of them to judge the credibility of health and wellbeing boards and clinical commissioning groups.

Take account of these things

Get the governance basics right

before planning changes

first

»» Clinical commissioning groups should use their constitution and governance arrangements to show how they will listen to and respond to people’s views; also, how they will demonstrate transparency, inclusivity and accountability concerning change processes »» Some changes may be welcomed by people who use services and communities, especially when these are made in response to their needs and aspirations. But some may be controversial. Commissioners must work with people who use services, communities and their representatives so that changes are planned together »» Traditional public consultation is not an effective way to achieve consensus about change. There is a range of tools and techniques that can be used to develop collaborative approaches to change »» Joint strategic needs assessments, joint health and wellbeing strategies and clini-

Before seeking community support for change plans, CCGs need to ensure they have their governance basics right. This means being clear about the CCG’s accountability to the community in its constitution and in its responsiveness and shared decision-making with local people.

change

Part of the Smart Guides to Engagement series, this guidehelps clinical commissioning groups (CCGs) engage well with the public to build understanding and support for change.

It’s important to understand what accountability means. There are a number of aspects to accountability but two of the most important are: »» Competence and effectiveness - demonstrated through the authorisation and performance management processes administered by the NHS Commissioning Board »» Transparency and responsiveness - shown through opportunities for local people to influence decisions and have services shaped around their needs and aspirations.

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The authorisation process for clinical commissioning groups requires commissioners to communicate their core values and behaviours. Every CCG must have a constitution but this should not be regarded as a bureaucratic hurdle. The constitution is a plan and a pledge to local people and the NHS Commissioning Board about how the CCG will listen to, understand and respond to the needs and aspirations of the whole population. CCGs should be clear about how their governance arrangements will reflect principles of transparency, inclusivity and accountability. A shared understanding can help CCGs build constructive relationships and avoid confusion. »» Transparency is about providing a range of information in ways that people can easily understand and interpret. It is also about being clear how organisations are run and how people can influence decisions about strategicdirection and comment on operational performance. At its simplest transparency is openness and honesty »» Inclusivity transcends legal duties to involve and consult. It is about actively ensuring that different people and groups have their voices heard, and then showing how their views are to be listened to, understood and responded to in credible ways - even when it is not possible to do what people want. Other ways to describe inclusivity could be shared decision-making or co-production »» Accountability goes beyond formal authorisation and assessment. It is also about allowing others to make informed judgements about the CCG’s credibility, achievements and even failures. Safety,

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JSNA and joint health and wellbeing strategies: the vehicle for shared leadership

quality and financial management will always be at the heart of accountability. When CCGs work in transparent, inclusive and accountable ways, their reputations as organisations that are “good to do business with” will be strong.

Plan to collaborate from the start

People are likely to have greater confidence in CCGs if they are clear about how they will work with local people and stakeholders and what they will do once they have engaged. This means CCGs should plan early how they will work with, obtain and weigh up the views or intelligence received from people, groups and overlapping networks in their geographical area. An up-to-date map of organisations and networks is an essential resource. The local council or LINk should be able to help. CCGs can demonstrate their credibility and collaborative approach by engaging with patients and the public at each stage of the engagement cycle. CCGs can build early credibility through the way they work with the council and other health and wellbeing board partners to produce the joint strategic needs assessment (JSNA) and the joint health and wellbeing strategy.

or hostility by people in the community and those who use services. Their reasons must be understood and addressed. They may have been let down before or promised improvements that never materialised. CCGs need to understand any history - good and bad - around change proposals. They must be transparent at every stage about what it is possible to achieve given the challenges facing local health and care services. They must also be clear about their understanding of local views gained from their engagement with local people and organisations. Inviting people to share this understanding and even challenge it is part of the engagement process. Inviting challenge is worth it. People might even make more radical suggestions.

Radical solutions from engaged residents

CCGs should build sufficient time and resources into their commissioning plans to make collaborative approaches to change a reality. They should, however, also build in to their risk assessments time and resources for resolving disagreements and conflicts. Not everyone will agree with change, but it is better to find out early and take steps to address the contentious issues than to be surprised by opposition later.

Around Louth in Lincolnshire clinical commissioners shared the facts about local hospital problems with local people first rather than putting forward a preferred solution and found the public were amenable to a more radical solution. Around 80% supported downgrading the local A&E to an urgent care centre and completely changing the model of acute care. Public feedback shows that the quality of the new service is very high.

Making changes – taking the

Always go beyond the minimum

rough with the smooth

The NHS does not have a good track record when it comes to making transparent decisions about spending money or changing services. It may be tempting for commissioners to make decisions behind closed doors or with a small safe group of people they consult. This will not work. The public’s view of formal

Outcomes from health services are better when people who use services and local communities are engaged in their planning, design and monitoring. Making changes to health services can be risky. What appears to health professionals as a well-evidenced case for change can be regarded with suspicion

INNOVATION IN HEALTHCARE

consultations is that they are largely tick-box exercises about pre-determined outcomes. Relying on formal 12-week consultations alone can backfire and even polarise views. The Independent Reconfiguration Panel which advises the secretary of state about contested service changes has been critical of the consultation process, which has shown inadequate community and stakeholder engagement in the early stages of planning change. When consultations are done well, and are based on plenty of pre-consultation engagement, they can lead to effective dialogue and fruitful outcomes. CCGs should be clear about their legal obligations to involve and consult but they should not be fixated with traditional 12-week consultation processes. The results will be worth it.

Communicate honestly and earnestly – especially when it’s tough

Planning successful service change requires communicating honestly and continuously with a range of different stakeholders. A “do once” approach to communications won’t work. At best, people who use services and communities will embrace change because it is clear that professionals, politicians and communities (for example through health and wellbeing boards) have developed solutions together. At worst, change will become mired in controversy, subject to protest, trial by media and possibly legal challenge. It is helpful to reiterate three of the key steps identified by the Consultation Institute, which CCGs should follow to minimise the risk of this happening to their plans for change. It is really all about applying common sense.

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1. Always involve the users and carers – and start early There is only one place to start with any service review º with the people who use services and the community. Supplement any previous engagement activities or outcomes from formal structures and partnership discussions with some fresh perspectives. Too many change exercises begin as desk research or accounting projects. They should begin in the community with user and carer views. 2. Invest in facilitation skills Move beyond questionnaires and formal meetings. Data and numbers can be important, but most service change intelligence is about understanding people’s experiences - people who use services, staff and others in the chain of service delivery and patient experience. Teasing out what people think and enticing them to consider difficult aspects seriously is a job for a trained facilitator, an honest broker, who can draw upon specialist techniques. Bringing in an outsider to facilitate a difficult process can increase buy-in. 3. Build confidence through mechanisms such as local compacts Much better use can be made of local compacts with the third sector voluntary and community organisations. In the past, NHS organisations have been unwilling to stick to agreements, which has led to a lack of trust.

Consultation will always work better if people trust each other. If the third sector is going to play a bigger role in the future of public services, there needs to be a foundation of mutual respect upon which dialogue can be continued.

Understand the scrutiny process

Local authorities have a particular role to play in service reconfiguration through their scrutiny function (there is a separate guide on this subject). Currently, powers to scrutinise health matters are exercised through overview and scrutiny committees (OSCs). They have discretion to decide whether proposals for service changes planned by the =NHS are substantial and require the NHS formally to consult OSCs. Where plans for service changes cross local government boundaries, OSCs have to work together through joint committees. OSCs may also refer changes to the secretary of state. They can do this if, firstly, they don’t consider the consultation with the OSC to have been adequate and, secondly, if they don’t consider the changes to be in the interest of local health services.

Get Smarter - find out more The Engagement Cycle 2009. InHealth Associ-

Tim Gilling, Deputy executive director Centre for Public Scrutiny

ates for Department of Health: http://bit.ly/HwqRdc The Consultation Institute: http://bit.ly/3slMNb People and Participation: http://bit.ly/B8zPQ Centre for Public Scrutiny (CfPS) – Accountability Works for You framework: http://bit.ly/Hs1TiA Independent Reconfiguration Panel (IRP): Learning From Reviews: http://bit.ly/JyUNYu For information about the other guides in this series: http://www.networks.nhs.uk/nhs-networks/ smart-guides

Acknowledgements Author: Tim Gilling Deputy executive director Centre for Public Scrutiny www.cfps.org.uk

Smart Guides to Engagement are a co-production by organisations and individuals passionate about engaging patients, carers and the public more fully in healthcare. The series editors are Andrew Craig and David Gilbert. Andrew is a partner in Moore Adamson Craig LLP, an organisation with many years’ experience in the involvement and engagement of users of public services: www.publicinvolvement.org.uk David Gilbert, director of InHealth Associates, has spent 25 years working in the field of health and patient-centred improvement across the UK and internationally: www.inhealthassociates.co.uk The editors would like to thank the authors for their generous unpaid contributions and the Department of Health for its support.

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INNOVATION IN HEALTHCARE

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Meeting your match How to find the right healthcare technology, with the right patients – at the right price

In these times of financial difficulty, the NHS aims to achieve best value for patients and taxpayers from the technologies it buys. Meanwhile, suppliers and manufacturers must invest wisely and sell profitably. Our job is to match these requirements and support mutual success for the benefit of all.

tools, modelling and research help to establish where, for the NHS, the balance lies between price and effectiveness if an innovation is to become a “must have”. Likewise, using similar evidence, we steer industry not only away from costly mistakes, but also towards profitable prospects.

The Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) understands the challenges. Disconnections between innovators and purchasers frequently result in inefficiency, ineffectiveness, missed opportunities, wasted effort and unmet needs.

Re-funding by the Engineering and Physical Sciences Research Council (EPSRC) testifies to our successes. Industry regularly seeks support and evaluation of its developments. It is keen to benefit from our expertise, the rigour of our evidence gathering and our understanding of regulatory frameworks. Likewise, health organisations such as the Department of Health and the National Institute for Clinical Excellence come to us for vital guidance.

MATCH provides a rare, neutral space to explore these issues and get to heart of achieving value for money. Crucially, our

Industry and the NHS are each well-represented on our governing body. Many of our researchers are seconded to technology companies and have long-established healthcare experience. We understand user needs and the issues that face both health providers and those who develop healthcare technologies. Talk to us, so that we can match your needs.

knowledge-match

We can answer the key questions to increase value, opportunities, innovation, effectiveness, quality and health outcomes. »» How can a particular service operate more efficiently? Example: Our mapping and modelling of patient flows in Hillingdon hospital in north London has resulted in important breakthroughs in understanding how to improve the processing of patients through the A&E departments. »» Is a medical device better value than the alternatives? Example: MATCH has helped a company to show its customers that a fibrin sealant which reduces bleeding during orthopaedic surgery is better value than its competitors.

MATCH can answer the key questions to increase value, opportunities, innovation, effectiveness, quality and health outcomes

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INNOVATION IN HEALTHCARE

Many of MATCH’s researchers are seconded to technology companies and have longestablished healthcare experience

»» How should we decide which technologies to adopt? Example: We have developed a tool that evaluates the health economic benefits of medical innovations. It helps companies to work out the price and performance that would be required from their innovations to make their adoption cost-effective within the NHS. This tool is a potential boon to both manufacturers, as they try to adjust device specifications, and to the NHS, as it seeks maximum costeffectiveness in purchasing. »» Could enough be sold to make a profit? Example: Our research persuaded a major French manufacturer to abandon as noncommercial its development of a tissue engineered bladder or urethra. However, we were also able to show that the innovation had much greater prospect of success in hernia repair. »» How can a technology’s value be proved to healthcare purchasers? Example: The Centre for Evidence-Based Purchasing recruited us, in partnership with Nottingham University Hospitals Trust, to provide regular evidence and economic reviews of medical technologies. We have taken on our first study, worth around £30,000. Now we are applying to the National Institute for Health and Clinical Excellence so that we can continue to help them in the same way, since the CEP has been transferred to NICE. »» How can more complex innovations be adopted? Example: MATCH has been testing whether it is viable for hospitals to combine innovations from two separate companies to provide computer-assisted knee replacement surgery. The modelling has helped the two international companies considerably to examine the potential of what is a £100m a year global market.

»» What other new technologies might help patients? Example: MATCH has been able to help both the NHS and a medical device company to understand precisely where a new medical imaging device is needed. This research has allowed the company to make a critical business decision on the concept of the device, based on which patients would benefit and which healthcare staff would be using it.

match-making

We bring together industry, researchers and healthcare providers to tackle key questions: »» How can a particular service operate more efficiently? »» Would adoption of a certain technology significantly improve health? »» Is it better value than the alternatives? »» How should we decide what to do? »» Could enough be sold to make a profit? »» How can its value be proven to healthcare purchasers?

»» How can complex innovations be adopted? »» What other new technologies might help patients?

love-match

“The contribution of MATCH was essential to being able to assess the product and its likely success. What we have learned and the decisions we have taken subsequently depended very directly on MATCH’s involvement. In the future, we will be applying this thinking to our future needs – especially user needs and costbenefits thinking.” Dave Bogget, Managing Director, Moor Instruments

“Working with MATCH academics has challenged some of our assumptions and internal processes, particularly on the early identification and validation of a product’s value to payer and provider stakeholders.” Mick Borroff, Clinical and Reimbursement Lead for DePuy International

For more information, contact: Elizabeth Deadman Communications Manager Brunel University, Uxbridge, UB8 3PH T: 01895 266050 E: Elizabeth.deadman@brunel.ac.uk WWW.MATCH.AC.UK INNOVATION IN HEALTHCARE

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Putting patient care in prime position After being a patient for a day, Sue Hodgetts Chief Executive of the Institute of Healthcare Management explains the importance of complete patient care I went to my local treatment centre recently for an annual procedure, linked to a long term condition. The procedure isn’t particularly pleasant, but for me it’s about self knowledge and preventative care, so worth the discomfort. The doctor was late, travelling from another hospital. I wasn’t told, at least not until he was very late. The healthcare assistant called me out of the waiting room, opened the standard questionnaire and proceeded to fill it in, making assumptions about my answers, while making derogatory comments about doctors being late. She then asked me to change into a

gown. She had her back to me and was sitting at her desk with her computer switched on, playing solitaire. I was then collected by a nurse and taken into the operating room. The doctor arrived, apologised for the delay and then talked me through the procedure and commenced the investigation. I was kept informed, given appropriate pain relief and had a brief summary of the results of the procedure.

nurses were present – lots of banter, not much work going on. My results were printed off and one of the nurses, gave me a quick and very inaccurate summary of the findings. Had I not known any better, I would have been preparing myself for a major operation. I drove home.

mixed experience

I was then taken to the recovery room. I recovered! I was given water, offered tea and biscuits and asked to wait for my results. Two

As patient experiences go, this was a real mix. I was the victim of poor communication at a time when I was quite anxious, the observer of disrespect between professions, unprofessional behaviour and, to be frank a dangerous misdiagnosis by an unskilled practitioner. On the plus side, I was the recipient of expert clinical care, carried out in a sensitive manner, with an understanding of what the procedure was like for me and I was offered relevant pain relief. I observed excellent multi-professional team work. I reckon, on a scale of one to 10, that my experience would have been around five – average – as I experienced both poor and excellent care in the space of about 45 minutes. I believe that this snapshot of care would generally reflect most patients experience, but how could it have been better?

Sue Hodgetts Chief Executive of the Institute of Healthcare Management

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INNOVATION IN HEALTHCARE

improving patient care

Based on my experience and the experience of many others who find themselves as patients, the following would offer better patient care. The first thing that would greatly improve care is good communication. This is so important across the whole of the patient journey, from the GP to the specialist consultant, through to any acute care and back into the community.

cutting and the need for productivity gains does not give the patient confidence that the most is being made out of the taxpayer’s pound. There is no excuse in 2012 for the system to be anything but effective and efficient, with the overarching aim of providing individual care of the highest quality.

caring experience modern technology

In the wider context, the lack of effective communication across the sectors of primary care, acute care and community and social care can cause, at the very least anxiety, and at worst a delay in the healing process and an unplanned return to the acute sector. From an individual perspective, poor communication can cause unnecessary worry and a disproportionate amount of fear by poor and inappropriate casual diagnosis. A lack of communication causes the imagination to take over from logical and rational thought.

The future is here, it is just unevenly distributed! There is a plethora of examples of how to work differently with the aid of modern technology. From robotic teddy bears that help children to manage their diabetes, to mobile phone apps that help patients to manage their own care; IT systems can manage information more effectively than ever before. The modelling has been done, the costing underpins the modelling, it is just about being courageous enough to move into our technological age – an evolving process – which brings me to my next point of, skilling up staff.

communication is key

We have spent an extraordinary amount of the taxpayer’s money on communication training for all professionals, but the issues continue to persist. Part of the communication package is about managing the expectations of patients, so they know enough to be able to make a positive contribution to their condition and for events to happen when they are meant to, or if they don’t, there is sufficient warning and re-planning. An essential part of the over-arching communication strategy has to be about the underpinning values of treating both staff and patients with dignity and respect: treating people as individuals with individual needs and wants who have access to appropriate support to enable them to experience the best possible outcomes for them.

patient care systems

Second, patient care systems need to be improved. That is the management of an individuals care within the wider context of managing an organisation. This requires what is often described as joined-up thinking. To find “idle hands” at a time of redundancies, cost

This includes the education of patients and their involvement at every stage of their care. It is the patient, whose feedback will contribute to the improvement of their care and the overall improvement of the way the organisation delivers care.

competent workforce

The workforce for both now and the future, in order to deliver better patient care, needs a skill set that enables them to communicate effectively with individuals, teams, all levels of the organisation, the community (including pressure groups) and politicians/government, as well as retain a personal integrity that is grounded in a shared value base. The workforce also needs to be technologically competent, which will involve a continuous learning programme as the technology improves. Technology needs to be patient-centric, involving them in their own care and providing them with the best technology can offer that will help to solve the medical dilemmas that present themselves. Obviously the workforce need to be competent in the area they are trained to deliver in and strive for continuous improvement, but equally important is the understanding and delivery of all of the above in the context of running a successful business. Education and training, therefore, needs to be fundamental, both across and beyond the organisation.

INNOVATION IN HEALTHCARE

So when we talk about better patient care we include: »» Systems and available education that will enable a prospective patient to avoid illness by living a healthy lifestyle »» Should ill health be unavoidable, then the care a patient receives will include an effective communication strategy »» Efficient systems that provide seamless pathways of care across different sectors »» The use of appropriate technology that saves time, money, and supports the care pathway »» An effective workforce. The patient will have confidence in they skill level as well as their understanding of the patients individual situation. They will be confident, that despite the continuous changes in the structure of the health and care services the managers and clinicians who have a responsibility for their care will be trained to the highest level within their specialty.

avoiding a poor outcome

Poor care means: »» An inefficient organisation »» Staffed with overworked and under-skilled staff »» Using out-of-date equipment »» Probably in debt »» Poor leadership »» Poor networks and relationships across the community »» No budget for training and education »» And horror stories in the press about some of the outcomes as a consequence of the above So better patient care is a valid indicator of a safe and effective organisation, that is why it is of the utmost importance.

For more information please contact the Institute of Healthcare Management at enquiries@ihm.org.uk call 020 7620 1030 or visit www.ihm.org.uk

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Prescriptive measures Kym Lowder at PCC explains how to get the most value out of medicines spending

Medicines are the most common therapeutic healthcare intervention. There is anecdotal evidence that patients visiting their GP somehow feel short-changed if they are not clutching that little green bit of paper on emerging from a consultation. GPs and other clinicians can fall into the habit of continuing to prescribe a favoured medicine for a condition even when more cost-effective treatments become available. This background and culture has enormous implications for costs, patient safety and the optimal use of medicines. Medicines management/optimisation must be a key part of care and commissioning. Medicines management and procurement is one of the DH QIPP (quality, innovation, productivity and prevention) challenge workstreams. Last year, the King’s Fund identified improved medicines management as one of ten high impact issues in achieving better patient outcomes and efficient use of resources . The King’s Fund noted that prescribing costs “are rising at a relentless rate – about 7% in real terms – and account for 12% of the NHS budget”. The NHS Business Services Authority (NHSBSA) published figures in 2010 showing the annual drugs bill in primary care alone was £8.6bn. As well as ensuring cost-effective prescribing, medicines management can improve

patient safety and ensure patients are gaining the maximum benefit from their medicines. It relies on the collection of local data and comparing and benchmarking against both local and regional/national patterns. There is evidence that supporting clinicians, with guidance or through peer review for example, can improve prescribing . It can bring significant savings and outcome improvements without significant costs in establishing systems or in monitoring time. In 2007, the National Audit Office suggested that standardising prescribing practices for treatments could save the NHS more than £200m annually . Around 7% of hospital admissions have been attributed to adverse drug reactions – with up to two-thirds being preventable . Last year, the National Prescribing Centre (NPC) published a framework aimed at supporting CCGs as they grappled with medicine management and optimisation. This included specific competency statements for aspiring CCGs. This spring, Primary Care Commissioning (PCC) published a toolkit that aligns each of the NPC statements to one of the six authorisation domains central to the process. Each statement is accompanied by one or more suggestions for the type of evidence the CCG should have – or be developing – to show they are meeting that

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competency. Many of these highlight the need for clear organisational structures and job descriptions for appropriately qualified staff. Without these, it’s difficult to realise the improvements outlined below.

agree performance measures and appropriate benchmarking

It is essential to make the right comparisons. The performance measures and focus should reflect local priorities and should be adapted on an on-going basis in response to identified local disparities in prescribing patterns. When benchmarking, consider comparisons with regional or national data – a practice might be the best in prescribing for a particular disease or medication within a CCG, but all the practices within the group or even a cluster might be relatively poor performers nationally on that particular measure. The NHSBSA publishes monthly prescription statistics that can be accessed by primary care trusts, CCGs and also individual practices. National comparator data is also available on the QIPP section of the National Prescribing Centre website. Software prescribing support systems such as Scriptswitch and Eclipse are among the more established software support systems. Each can be tailored to support specific care pathways or prescribing priorities of a CCG.

INNOVATION IN HEALTHCARE

Such systems can audit changes in prescribing habits as well as facilitating such changes through identifying more costeffective or safer alternatives.

start with good data and sound interpretation

A good data analyst is essential and they should have time allocated specifically to medicines management. To be cost-effective, the analyst would generally be employed at central support services level, although some larger CCGs might directly employ one. Conduct medicine use reviews (MURs), practice audits and other peer review. Between one-third and half of all medicines prescribed for long term conditions are not taken as recommended . Use NHSBSA prescribing toolkits. Once collected, data should be analysed and interpreted with care. Variation in prescribing or the use of an expensive drug sometimes is sometimes justified. For example, an expensive new drug could allow services to be redesigned and disinvestment elsewhere in the system. Prescribing costs in a practice serving a high number of care homes are likely to be higher than those for a practice with a high proportion of students on its list.

commission community

look for indications of both over and under-prescribing

This means looking for outliers with high or low levels and costs of prescribing for certain conditions or certain medicines. As well as being costly, poor quality prescribing can lead to poor outcomes. Are outliers in the high use of NSAIDS – particularly diclofenac and Cox II inhibitors when alternatives are preferable – also outliers in other prescribing areas? There is a three-fold variation in NSAID prescribing rates between PCTs in England. However, possible under-prescribing should also be addressed – it could be a sign of under-diagnosis. For example, if the prevalence rate of a disease within a CCG population is around 4% but one practice is prescribing relevant medication for just 2% of its population, this could indicate under-diagnosis.

identify the medicines with the

Such services can deliver savings, reduce prescribing errors, deepen understanding of local needs and inform commissioning of local enhanced services. Build on services provided through the national community contractual framework, such as the new medicines service (NMS) and MURs. Supporting patients who are starting on new medication does produce results. One study has shown that 10 days after starting a medication, two thirds of patients were having medicine-related problems and one-third had stopped using the medication .

look for educational

opportunities, appraisals and revalidation and professional development

sessions to re-shape ingrained prescribing habits

Getting pharmaceutical evidence into practice can be difficult. Many doctors regarded beta blockers as contraindicated for heart failure treatment – rather than a treatment – several years after evidence to the contrary was widely accepted. Some doctors are still using diclofenac as their NSAID of choice when safer alternatives are available. Data on prescribing errors could provide the focus for a local education campaign. Guidance and peer review can support improvements in the quality and safety of prescribing.

highest volume of prescribing

in your practice/ccg as well as the most costly medicines

how are new drugs being

Look at prescribing in relation to national guidance, particularly from the National Institute for Health and Clinical Excellence (NICE). For example, use of newer oral hypoglycaemics and long-acting insulin analogues appears contrary to NICE guidance in some areas. NICE recommends the use of older agents, which often have a stronger evidence base.

pharmacy services to optimise medicine use

safeguards to ensure community-based clinicians, including pharmacists, are aware of the MHRA guidance around women prescribed isotretinoin?

In nearly half of PCTs, 90% of long acting or intermediate insulin items are for a newer insulin analogue at a cost of around £72,000 per quality adjusted life year for a type 2 diabetic. Similar figures would generally result in the refusal to recommend the use of a new chemotherapy treatment.

include medicines optimisation in all pathway redesign

Medicine is the most-used therapeutic intervention: it is therefore likely to be an issue in all care pathways. Consider costs, availability, access to medication, monitoring issues, patient support and advice and prescriber competencies. For example, when moving a dermatology service from secondary care to the community, are there

INNOVATION IN HEALTHCARE

used locally?

You can create a practice or CCG profile of the use of new drugs through using the NHSBSA prescribing toolkits referred to above and national comparators. The use of highcost new drugs can allow savings elsewhere. For example, the newer anticoagulants may reduce secondary care costs if used appropriately and services are redesigned to allow secondary care disinvestment. Kym Lowder is a PCC associate specialising in medicines management and prescribing.

PCC believes better health outcomes and better value start with primary care. We provide support for CCGs and practices including bespoke workshops, e-learning, online resources and a national network of experts.

For more information please contact: wendie.groves@pcc.nhs.uk www.pcc.nhs.uk

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Introductory offer ends August 2012. Visit Kerry and Jacky at the Commissioning Show 2012 (stand AA36) for more details, or contact enquiries@primis.nottingham.ac.uk quoting code IHC2012.

Improve the ďŹ tness of your organisation www.primis.nottingham.ac.uk

Engagement for commissioning success

{Smart Guides } to ENGAGEMENT

For better commissioning

Engagement for commissioning success Smart Guides to ENGAGEMENT for better commissioning

Engagement for commissioning success

Part of the Smart Guides to Engagement series, this guide looks at the benefits from engaging well to support commissioning success. Clinical commissioning groups (CCGs) that are smart about engaging with patients, carers and communities (PPE) will achieve the following benefits: Economic – recurring savings, value for money, decommissioning and reinvestment in line with quality, innovation, productivity and prevention (QIPP) principles Social – empowered communities, leaders of patient groups, community partners all helping lead change

specifically applies where there are changes proposed in the manner in which services are delivered or in the range of services made available. Domain 2 of the CCG authorisation process requires evidence of “meaningful engagement with patients, carers and communities”. This means showing how the CCG ensures inclusion of patients, carers, public, communities of interest and geography, health and wellbeing boards and local authorities and how the views of individual patients and practice populations are translated into commissioningintelligence and shared decision-making.

Good engagement unlocks big benefits

Relationship – with councillors and local leaders to avoid challenges and with stakeholders to work together and support change across the community. Commissioning success demands trust from individuals and organisations. Financial savings are desirable, but without trust they are not enough for success.

Good patient and public engagement (PPE) makes it easier to create change and savings because clinicians, managers and lay people work together for a commonly valued objective. A joint PPE business case with the local authority and key secondary providers has maximum impact by addressing common problems.

Compliance and beyond

Hertfordshire – understanding

Meaningful engagement with patients, carers and communities isn’t a one-off to satisfy domain 2 of CCG authorisation or the requirements of Section 242 of the NHS Act 2006.

and support for major service

Section 242 is the legal duty to involve current and potential service users or their representatives in everything to do with planning, provision and delivery of NHS services. The duty

changes

Commissioners and their major providers jointly engaged the public in major changes of services across the health economy before formal consultation on service pathway redesign. Hundreds of face-to-face clinician-led events and focused communications for local residents and staff cost around £205,000. A key

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public concern was transport and accessibility issues, now being addressed with transport providers. PPE initiatives were essential investments to enable public understanding and support for service changes estimated to save some £41m, including £14m recurrent savings plus £27m taken from acute and reinvested in primary care. Commissioning is a continuous process, so PPE must run throughout the commissioning cycle. A reliable way to ensure this happens is to use the engagement cycle, which identifies who needs to do what to engage patients, carers and the public at each stage of the commissioning cycle. There is no one-sizefits-all approach to engagement in commissioning. At each stage the engagement purpose is different, so how the CCG goes about it and who needs to be involved is different.

Engagement in a cold climate Successful engagement can make use of tight resources more cost effective than traditional ways of engaging. Help is available in the form of case studies showing engagement linked to benefits. For PPE business case creation, a decision support tool enables CCGs to quantify engagement costs and benefits, estimate return on investment and store examples from previous local engagement activities and projects. Links to these resources are included at the end of this guide.

Bristol, Bath and North Somerset – new pathway for termination of pregnancy

Creating a new pathway for termination

INNOVATION IN HEALTHCARE

The Engagement Cycle

of pregnancy incurred direct PPE costs of £41,000 but brought recurrent savings of £85,000 through increase of medical terminations and associated decrease in surgical terminations. The views of around 2,500 service users revealed that women were waiting too long for appointments and had to visit different sites to access services. A new pathway was developed using a 24/7 telephone service. Additional socio-economic benefits included improved contraception advice and reduction in unplanned pregnancies.

No PPE, no QIPP The challenge of achieving QIPP makes smart engagement imperative. “No QIPP about me without me” is how patients, carers and the community see it. That makes QIPP a huge PPE opportunity. Talking to customers of existing services and listening to what they tell you about what could be improved, stopped or done differently is essential. Small changes can make huge differences when replicated. Make sure people understand what they have contributed, what has changed and the benefits of new ways of doing things.

Tower Hamlets, East London – reducing A&E attendances A social marketing campaign was part of the PPE strategy to reduce the 30% of A&E attendances not thought clinically necessary. PPE helped get over the message about urgent care alternatives and appropriate use of A&E. The engagement campaign lasted one year and had direct costs of £36,000, set against anticipated annual cost savings of £211,000 through the reduction in inappropriate attendances.

Community-wide engagement

Sheffield – avoiding

assets

unscheduled elderly care admissions

Engagement events identified this priority. Participants were invited to challenge professional assumptions, generate new ideas and perspectives. Carers’ concerns were highlighted. PPE costs of £14,333 were offset by the £1,119,000 in anticipated recurrent savings from reducing non-elective admissions. QIPP decisions may be difficult. Not everyone will agree on difficult choices. Engaging well will ensure that service change options and financial implications are clearly communicated and community views are sought, acknowledged, valued and responded to in the decision making process.

Engagement partnerships with people and organisations outside the health sector generate shared assets for change and improvement across communities. Health and wellbeing boards and partnerships are opportunities for the NHS to promote integrated pathways and service reconfigurations. CCGs that grasp this opportunity will make PPE benefits central to how the CCG does business.

Accelerated community development - Solihull, Dartmouth and Wandsworth Resident-led engagement partnerships in these HELP (health empowerment leverage project) areas worked across health, housing, safety, environment and other areas to produce community-wide renewal strategies. Local ownership of change, more resilient

INNOVATION IN HEALTHCARE

social networks, improved outcomes that impact on health and reduced health inequalities justified the initial investment.

Getting patients and carers to lead change

One aspect of engaging well is to see frequent service users and carers as leaders for change. No lasting cost reductions, or improvements in quality, productivity and prevention can be achieved without people with long-term conditions (LTCs) being fully supportive. They account for around 70% of overall health and care expenditure. Commissioners should get local people interested in service change at the start to generate more radical ideas for change.

Radical solutions from engaged residents

In Louth, Lincolnshire clinical commissioners shared the facts about local hospital problems with local people first rather than putting forward a preferred solution and found them willing to consider a more radical solution. Around 80% supported downgrading the local A&E to an urgent care centre and completely changing the model of acute care. Public feedback on the quality of the new service is high. Patients can be leaders for change if they think new ways of doing things will bring higher quality and greater satisfaction. This will not happen by chance, nor is it a one-off fix. It

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requires engagement investment and high levels of trust. Moving in that direction takes the CCG closer to the QIPP goal of better and sustainable commissioning outcomes and lower recurring expenditure.

Croydon - improving diabetes services

User group views identified that intermediate diabetes services were not meeting needs. PPE surveys and focus groups engaged more than 800 patients and involved Diabetes UK. The patient-led intelligence fed into a new draft service specification and increased patients’ commitment to the changes. Direct engagement costs of £3,000 were set against anticipated economic return of £47,400 a year over five to 10 years through better adherence and a 5% reduction in admission. QIPP initiatives have to be co-created, so service users will know what quality looks like and how to demand it. The PPE message for QIPP is simple: engaged patients and carers can codesign services and will prefer the same pathways as enlightened clinicians.

Medway - redesigned local dermatology outpatient services

To reflect patient preferences for a service delivered locally, commissioners created a face-to-face PPE initiative with service users and staff costing £8,095 in direct and indirect costs. This is set against projected annual savings of £128,000 through efficiencies and has led to much lower waiting times and increased patient satisfaction.

Taking decisions together Shared decision making about commissioning needs an open process, accessible information and support for lay people to be involved, but the results are highly valued.

Desire for fairness is a strong

PPE ensures commissioning success

Here are some first steps to engaging well and achieving PPE-led change in your CCG: »» Identify the strengths and weaknesses of the CCG’s existing PPE assets. Strong assets include having well developed and active patient leaders and lay members networked within and outside the organisation, good experiences from past engagement initiatives, and endorsement for the CCG’s strategy from third parties like the local council and community bodies. »» See how you are applying these assets to achieving the CCG’s objectives.Use the engagement cycle to discover who does what well at each stage of the commissioning cycle. Ask yourself some tough questions: »» How robust is this user-focused intelligence? »» How does it inform our current plans? »» How are we refreshing, extending and communicating our customer insight? »» How are we translating it into future commissioning plans? »» Where is user-focused intelligence helping us to go as a health investor? »» How do we know that everyone is on the same journey? »» Make sure the PPE assets are working for you and you don’t have engagement gaps in the CCG’s objectives for clinical services changes - especially managing long-term conditions, avoiding unplanned admissions, avoiding falls in elderly people and so on. Share what you have learned both inside and outside the CCG. »» Develop comprehensive business cases for PPE relating to commissioning objectives. Each QIPP objective needs a business case and PPE should be integral to it.

Get Smarter - find out more The Engagement Cycle 2009. InHealth Associates for Department of Health http://bit.ly/ HwqRdc

motivator to get involved

In Oldham, commissioners and the local involvement network (LINk) created a citizens’ health commission to explore ways of underpinning fairness when commissioning for Oldham’s health needs. Its practical recommendations were adopted into the commissioning process and into a new engagement model between the CCG and the LINk.

The NHS Institute and InHealth Associates are updating the engagement cycle for the new commissioning landscape. To receive this updated guidance please email “Engagement Cycle” to patientexperience@institute.nhs.uk

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Engaging Well case studies: http://bit.ly/HwqRdc Economic case for PPE and business case support tool http://bit.ly/H2u7v6 NHS Networks - Commissioning Zone: http://bit.ly/H8Xz57 Andersson E, Fennell E, Shahrokh T for Involve 2011. Making the Case for Public Engagement: How to Demonstrate the Value of Consumer Input: http://bit.ly/H5AKlP For information about the other guides in this series: www.networks.nhs.uk/nhs-networks/smartguides

Acknowledgements Author: Dr Andrew Craig

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Fit for life Professor David Peters and Helen Cooke from the College of Medicine look at how programmes such as Fit as a Fiddle demonstrate what healthy ageing services should look like

The College of Medicine is an alliance of doctors, nurses, allied professionals, practitioners and patients. It is committed to a patient-centred NHS and a new relationship between science, clinical opinion and patient choice. It is also committed to a more cost-effective NHS, providing better opportunities for individual and community health and self care. The College runs an annual award programme and this year invited applications from healthy ageing projects at the forefront of delivering patient-centred care. We were looking for projects that are helping to create resilient communities and whose work makes use of an integrated approach, embraces patient-

participation, and aims at evidence-based care. We wanted to know above all how what they are doing adds to the wellbeing of the local community. Choosing between the diverse range of applicants was a real challenge, but after much deliberation, site-visits and lots of discussion among the judging panel (key judge Dr David Oliver – National Clinical Director of Older People’s Services), we were delighted to declare a winner: Fit as a Fiddle, an Age UK wellbeing programme, with Well UK South West Wellbeing as the runner-up and, as our “Small is Beautiful” runner-up The Older Peoples’ Service from Halton in Cheshire.

overall winner

- fit as a fiddle

Fit as a Fiddle (FF) was established in 2007 with funding from Big Lottery’s Wellbeing Programme, a £165m grant programme encouraging healthy lifestyles and wellbeing. Fit as a Fiddle was designed by older people for older people. Its intention is to champion healthy eating, physical activity and mental wellbeing. It encompasses two national projects and 24 regional projects delivered throughout England by over 200 organisations (99 of which are local Age UK’s). Over 300,000 people and 4,500 volunteers have now benefited from the project. There is no charge to individuals except for refreshments.

patient-centred approach

From the outset, in designing the programme, organisations intending to deliver elements of Fit as a Fiddle were encouraged to take account of what older people felt would be important. Focus groups were formed before the project began and have run throughout the life of the programmes. As a consequence, the organisations associated have become more responsive to the needs of older people and this, in turn, has helped them gain more control over their lives. Anyone who has taken part is encouraged to become a volunteer who can support and

Promoting physical activity and wellbeing is a key aim, but this doesn’t necessarily have to be “exercise”

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The FF portfolio ranges from walking, dancing or bowling groups, to gardening and allotment projects engage others in the programme. Leaflets and other resources aimed at improving health literacy have been designed in collaboration with the people who will use them. Promoting physical activity and wellbeing is a key aim, but this doesn’t necessarily have to be “exercise”. The FF portfolio ranges from walking and dancing groups, to gardening and allotment projects, virtual sports via Nintendo Wii, all the way to Tai Chi and yoga. Some programmes also include activities to promote mental alertness and wellbeing: relaxation, confidence building, stress management, reminiscence sessions, buddying groups, book clubs and scrabble sessions. One scheme trains people to become “wellbeing ambassadors”, who promote wellbeing and can signpost their peers to local activities.

tailor-made projects

In the North West, the Eastern Lives project focuses on working with older people and faith communities. It has organised sessions on “Managing Diabetes during Ramadan” and “Fasting and Feasting during Ramadan and how to remain active”. The sessions were held in local mosques and reached people who would not normally use the services delivered by mainstream healthcare providers. In an East Midlands group, a man was found to have Type 2 diabetes. With FF support he changed his eating and exercise habits and subsequently those of his extended family changed too. This is the sort of community knock-on effect that FF projects often see. The same project also produced the example of an FF member for whom appropriate support was found when his partner died. He has become a volunteer bereavement counsellor. A detailed case study undertaken by Age Concern Kingston Tackling Obesity project identified that 99% of the 97 people taking part in the project reported that “group support had been an important factor in helping me complete the programme”. These are just three examples illustrating how peer to peer work has become an important element in the success of FF programmes.

economic value

An Interim Evaluation Report prepared by Keele University reviewed the emerging evidence on the value for money provided by the Fit as a Fiddle portfolio. The cost per participant to date ranges from £37.84 to £480.70 for individual projects within regional portfolios. Overall, the figure stands at just below £100 per participant. A number of projects have used the Social Return on Investment methodology (SROI) and projected potential savings to NHS of between £3.50 and £7 for every £1 spent on Fit as a Fiddle. The SROI undertaken on the Tackling Obesity project delivered by Age Concern Kingston took into account the following: the true market level of activities delivered against the reductions to the health service as a result of the project. Following detailed interviews and completion of surveys by 166 participants on the impact of the programme, it was able to calculate a reduction on demand for GPs with a saving of 2,230 based on a figure of £28 per visit. The largest reduction was on the NHS services for treatment of fall-related incidents at a saving of £29,100. This took into account the fall avoided, the number of A & E and hospital admissions avoided, which also impacted on individuals long-term care. An additional saving of £1,530 savings made as a result of improved weight management and the impact on the avoidance of Type 2 diabetes and coronary heart disease. As a consequence, the SROI identified a saving of £3.50 for every £1 spent. The following SROI calculation conducted by the Fit as a Fiddle project in Sunderland

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reported: “From the health conditions listed, it is obvious that Fit as a Fiddle in Sunderland has had an enormous positive and preventative impact on improving and sustaining older people’s health. “Although this is difficult to measure in monetary terms, Age UK Sunderland strongly believes that through the campaign there is a significant reduction of falls and, overall, an increase in the quality of life for older people. To quantify this, with the use of financial proxies, Age UK Sunderland has calculated the social return on investment of the campaign. This illustrates that £7.02 of social value has been created for ever £1.00 invested into the campaign”. A final report will be prepared at the end of the project in September 2012.

sharing best practice

At the start of the national FF programme, many of the projects were working in isolation, but by year four, 65% of 124 delivery organisations were working in partnership with new partners (according to an Ecorys Partner Survey). 98% of projects surveyed strongly agreed or agreed that “partnership working on Fit as a Fiddle” was effective. Fit as a Fiddle established a variety of networks to share good practice and learning from national and regional partners. Age UK has worked with nine national organisations to develop training for volunteers, and produce easy-to-use resources for practitioners. National partners include the Mental Health Foundation, Sporting Equals, Blood Pressure Association, Exercise and Movement

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A significant growth of strength and balance exercises continued after FF ended

community evaluators to run focus groups to explore the impact that FF has made on participants quality of life.

sustainability

FF tries to ensure the long-term sustainability of its projects nationally and regionally by: »» Training volunteers to act as buddies and walk leaders and to establish their own fund-raising committees to keep activities going when central funding dries up. In Berkshire, for example, 99 of 133 activity networks have already become self sustaining since funding ended. »» Charging reduced fees for people to continue with activities. Encouraging local authorities and private providers to offer their facilities at a lower rate. »» Sharing best practice across the UK, through practitioner guides and DVDs. »» Developing service delivery models, which can be commissioned by Public Health, Adult Social Care and Clinical Commissioning groups.

what users have been saying

Dance Partnership, Independent Age, Community Networks, British Heart Foundation ( National Centres) and the National Association of providers for Physical Activity NAPA.

The survey highlighted improvement in healthy eating habits during the same period. In the Kingston study, the following was identified: »» 73% of participants lost between 1-5kg »» 63% reduced their weight size by 1-5cms »» 55% reduced body mass index by 1-3 points.

evidence-based developments

The national survey highlighted a significant growth of strength and balance exercises after FF has ended, with a 71% increase on the national value of 477 people completing the survey across all three time periods. Responses from the open-ended beneficiary self-evaluation question “What was the best thing about the project” showed the most frequent report response to be the impact the project had on mental health and wellbeing (40%) followed by social isolation (39%).

FF members took part in a longitudinal survey of the amount and type of exercise they were taking, their eating habits and their general state of wellbeing. The surveys were completed at the start, end and three months after the project had finished. The Warwick Edinburgh Mental Well Being Scale showed an increase of 3.2 points from the start of FF to three months after the project ended. This is a significant gain in wellbeing, since even a small annual increase in the scale’s mean score (greater than 0.4) indicates significantly improving wellbeing in a group.

The team is currently in the process of identifying a realistic economic value of FF to commissioners. As well as this kind of quantitative evaluation, FF trained members to become

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“I haven’t been to my doctors since I’ve been here. Before, I would have gone five or six times a year.” “When you get old ,you don’t think you can do things, so you don’t try. It has given me confidence. I now know I can do anything” “I don’t fall over so much. I feel much more confident that I am not going to fall. It’s really tremendous what it has done for my balance” “Because we get so encouraged and praised, by each other, you don’t feel like a senior citizen no more. That’s what it has done for me”

For more information, contact: Park Place, 12 Lawn Lane Vauxhall, SW8 1UD E-mail: info@collegeofmedicine. org.uk Tel: 0844 873 7388 www.collegeofmedicine.org.uk

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Face to face with the future of healthcare With the Health and Social Care bill now passed into law, the changes that will introduce a primary healthcare-led NHS are underway. Delegates at the Commissioning Show will find out everything they need to now about the changes Now everybody involved with the new clinical commissioning agenda – GPs, managers, healthcare leaders, local authority stakeholders and hospital providers – is hungry for information, practical ideas and inspiration.

roundtable discussions and panel debates and network and share ideas with fellow practitioners who can offer practical ideas and a wealth of experience from inspiring case studies.

Thousands of delegates will be able to find all this and more at the Commissioning Show, one of the UK’s largest GP events being held on 27 and 28 June at London’s Olympia.

In this article, some of our key speakers explain why you should not miss this event.

ccgs of the future

At this two-day conference, delegates will be able to listen to key talks in five different speakers’ streams by some of healthcare’s most influential figures and policy makers. There will also be opportunities to engage in

Progress towards implementing the health service reforms is so rapid, now that the legislation has received Royal Assent that CCGs are having to run very hard to keep up with all the changes.

Professor Steve Field, chairman of the NHS Future Forum and chairman of the National Health Inclusion Board, who is a keynote speaker in the CCGs of the Future stream, says: “Now there is political certainty that it’s going to happen, the health service is changing almost daily.” He says he can’t predict yet what he will be talking about at the Commissioning Show because he says the atmosphere between now and June will have changed. ‘What I can guarantee, though, is that what I will be saying will be bang up to date, very relevant. ‘People are in the middle of forming and storming CCGs and the issues they are going to be dealing with in eight or 12 weeks time are going to be very different to those they are grappling with now. CCGs have been working with draft guidance, but they haven’t yet seen a lot of the detail about how their groups should be structured. All of these policy papers on these issues can now be released and talked about. ‘Everybody involved in commissioning should come to this conference because they will be able to find out the most up-to-date information and be able to network with colleagues and this will really help them develop their local commissioning. Professor Steve Field, chairman of the NHS Future Forum and chairman of the National Health Inclusion Board

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Dr Rebecca Rosen of the King’s Fund and the Nuffield Trust

“People will come because they will want to hear about commissioning, where the politics is going and there will be loads of things they will want to talk about,” he concludes.

further speakers

Delegates who attend this speaker stream will also be able to gain inspiration from Dr Hugh Reeve, Chair of Cumbria CCG and GP Partner, Nutwood Surgery, Grange-overSands, Cumbria. Cumbria is recognised as being at the forefront of many of the current NHS changes. This pioneering CCG has been created from six locality commissioning groups and is seeking to devolve responsibility as much as possible to local level while gaining the advantages of being part of a large group. This CCG is well on the way towards gaining authorisation in 2013, and in this talk delegates will hear some of the key lessons already learned and be offered practical tips on making progress. The learning points will include: being clear about where you are heading; how to keep members on board CCGs; the importance of focusing on clinical quality and not just balancing the books; and building partnerships with specialists, the third sector and patients. Dr Jamie Macpherson, partner at Coventry’s Springfield Medical Practice will talk about managing potential conflicts of interest in a radically reshaped local economy, while lawyers Browne Jacobson will look at practical examples and offer advice on how to manage conflicts when they arise. Cynthia Bower, chief executive of the Care Quality Commission will give a talk on how primary care providers should be preparing for CQC registration in 2013. Liz Stafford, national clinical liaison lead for Rowlands Pharmacy, Cathryn James, clinical pathways advisor for Yorkshire Ambulance Service and James Kingsland of the National Clinical Commissioning Network will explain how to develop multi-disciplinary working within commissioning.

Bob Senior, director of medical services at RSM Tennon accountants and Valerie Martin-Long from PKF Accounting, will be advising CCGs on how they can identify ways of making savings and efficiencies.

they are passed from pillar to post by different providers, says Dr Rosen. ‘Commissioners need to be clear about their aims and be able to create a clear narrative about service transformation which provides better care for patients,” she says.

subjects

The delegates will learn about the economic and efficient procurement of support services; contract management and monitoring of healthcare services; developing a robust governance structure from the outset and managing patient care pathways to minimise secondary care costs.

integrated care

The ingredients of an effective integrated care system are shared values, strong relationships between professional groups, pooled information and good IT systems. This is the conclusion of research conducted by Dr Rebecca Rosen with colleagues at the King’s Fund and the Nuffield Trust. A GP in South East London and a senior research fellow at the Nuffield Trust, Dr Rosen will be giving delegates an insight into the principles of integrated care. The objective of developing an integrated care system should be to improve quality and the experience of patients and their carers. These are the people who get frustrated when

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“A spin-off from this approach will be more cost-effective care from an integrated system that eradicates the duplication and waste that occurs when different providers are not working well together. “You then need good professional leaders in both health and social care in order to develop a shared goal about what service transformation is about.” In her talk, Dr Rosen will set out the key elements needed to achieve an integrated care system. These are: robust governance; a supportive set of financial and payment arrangements; IT systems that can share clinical information and share what the integrated service is doing; agreed clinical standards and pathways for health and safety. Dr Rosen, who is also vice chair of Greenwich Health, the clinical commissioning group for the London Borough of Greenwich, says: “If you talk about systems and mergers you put people off. In Greenwich I talk about glue – it’s about gluing together the services that are already in place and building the relationships and trust that you need between different teams to get people working together.”

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Speakers will provide case studies and the chance for debate

Dr Rosen continues: “People understand that and are completely supportive. It’s all about trying to get people to think differently about how they work and thinking beyond practice boundaries. There are lots of people in community services that can support GPs caring for patients with difficult problems and it’s about getting people to be more aware of that and more willing to use them.” Dr Rosen says all commissioning GPs, “jobbing” GPs, plus people from community and hospital trusts should all come to the Commissioning Show to find out more about integrated care. They will gain an understanding of the principles of integrated care and will also be able to learn from successful case studies, she concludes.

further speakers

Goran Henriks, chief of learning and innovation for Jonkoping County in Sweden, will talk about how, in his healthcare system, they dramatically improved health care delivery, access and patient satisfaction. He will explain the importance of organisational culture as a driver for change and integration. Sweden is known for having one of the best health systems in the world and Jonkoping, one of 21 county systems, is recognised as the best in the country.

Other case studies will be showcased from Taunton and Stockport, where clinicians and managers are leading the way in making integration a reality. In another session, Dr Sam Barrell, chair of Baywide Clinical Commissioning Group and Clinical Director of Commissioning and Transition at Torbay Care Trust, and Claire Jones, associate director of nursing, Croydon Health Services, will compare and contrast the experiences of Torbay and Croydon, which have both have been working on the integration agenda for several years.

productivity through technology

The long-awaited information strategy is due to be published in the next few weeks, with a promise by the government that it will bring about an “information revolution”. Delegates at the Commissioning Show will be able to find out first hand whether this information revolution really will be delivered. Ailsa Claire, Transition Director Patients and Intelligence for the NHS Commissioning Board Authority, which will be implementing the strategy, will be giving a talk explaining the far-reaching implications of the strategy. Claire says they have been doing a lot of work attempting to understand how data might assist the NHS to do things differently, including changing its relationship with the public. “The directorate that we’re trying to set up is about enabling people to make the best decisions they possibly can, whether they are a commissioner, a patient or anyone else in the system. We have been working to gain an insight into how patients want to engage and relate to care services and how the care services can support them to make their own decisions,” she explains.

Delegates at the Commissioning Show will hear from a range of speakers

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Facilitated sessions will take small groups through a learning task, often based on a real-life project

The Commissioning for Intelligence Programme, which Ms Claire has been leading, has been conducting research into different channels of communication and how informatics can support the business model of clinical commissioning groups (CCGs). “We have been looking at what data standards and quality we need to put in to the strategy to enable information to flow through the system,” she says. “We are working to help CCGs to directly relate to the health of the population they are working with. The information strategy will focus on enabling people to make the best decisions and it will place IT as an enabler.” Claire says her talk will be directly aimed at clinical commissioners and it will explain what the impact of the information strategy is likely to be.

support mechanism for the NHS and not for it to become something imposed on the NHS,’ she promises.

To inform the new strategy, her department has been examining how CCGs get intelligence and information.

further speakers

Claire says CCG leaders they have talked to have told them that they want a very different flow of information and processes from the ones previously provided by primary care trusts (PCTs). “The real problem has been that the primary source of information for PCTs was contract information and what the CCGs want is patient based information which exists but is difficult to get at, so that is what we have got to try and get for them,” she says. “Some of the information will be facilitated by the new role of the Information Centre which will be a given a specific new responsibility for data linkage for health and social care. “It will therefore become a safe haven where patient data will be made unidentifiable and available for CCGs,” she says. “Data will improve. In the past, it has been very separate for the NHS and the business model has often had to adapt to informatics instead of the other way around. We now have an opportunity to turn that around and make the provision of data and information a

Also in this stream, clinical commissioners will be able to find out more about how GPs can significantly change the way they manage patients with chronic conditions in a talk by Stephen Johnson, head of long term conditions at the Department of Health. Ian Blunt, senior research analyst at the Nuffield Trust will talk about how predictive modelling for chronic conditions can reduce risk and admissions. For those interested in ways that the internet could be used to transform healthcare, Paul Hodgkin, chief executive of Patient Opinion will explain how patient attitudes can be captured to shape dynamic services.

Facilitated learning The Facilitated Learning Zone will be one of the liveliest areas of the show. Combining hands-on sessions with round tables and lively panel debates, it will be the place for delegates to get their views heard, questions answered and to come away with practical skills and tools tackle daily challenges. Facilitated sessions will take small groups through a learning task, often based on a real life project in a format that allows plenty

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of questions and interaction. The objective is for every participant to leave with some new knowledge they can use to improve services from the moment they get back to their locality. Formal sessions include a guide to understanding the media lead by experienced journalists and the Primary Care Commission, touching on reputation management and dealing with (possibly hostile) enquiries. Leading figures from the National Commissioning Board Authority will be guiding participants through some of the major milestones that CCGs can expect on the way to authorisation.

time for debate

There will be no holds barred in CCGs: The Big Debate, when a leading editor puts all the pressing questions to a panel of senior policy makers. The debate will then be opened up to the floor ensuring this session will be the place to hear the very latest views on the progress of primary lead care. In between the expert led learning sessions will be less formal round tables organised by delegates. Anyone can use this space to propose their own sessions using the Commissioning Connect online networking system, inviting colleagues, experts or other delegates with experience to share.

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AGM – a full body of knowledge The Acute and General Medicine event offers a new approach to medical training that’s emphatically cost- and time-efficient for doctors Hospital doctors are among the most important decision-makers in hospital medicine. But they are also, notoriously, among the hardest to reach – particularly those involved in acute and general medicine.

makers and suppliers together in cutting edge medical events, Acute and General Medicine 2012 is a new, comprehensive event specifically constructed around the new realities of hospital medicine and secondary care.

And now, with hospital doctors faced with unprecedented demands on their time, it is even harder to get face-to-face with the decision makers who are at the sharp end of secondary care.

You don’t need us to tell you that the inexorable rise in patient expectations coupled with the downward pressure on budgets and an aging population all combine to create unprecedented demands on hospitals. And just when medics need support to help them meet the new challenges, training budgets and study leave are being severely squeezed.

But now it is easier to reach these important decision makers, at the Acute and General Medicine (AGM) event, 21—22 November 2012 at London’s Olympia. Brought to you by a team that has had dramatic success in bringing clinical decision-

That’s where AGM comes in: a new approach to medical training that’s emphatically costand time-efficient for doctors.

not the traditional conference

AGM is not a typical, over-priced, didactic conference, in which weary delegates get locked into endless lectures. Our programme allows doctors to follow their learning needs across the medical specialties with pacey, interactive seminars, uniquely offering knowledge and skills training in acute and general medicine. An “all you can eat” modular format, allows delegates to customise their own programme ensuring they have time for networking as well as learning. Neither is AGM a typical exhibition with endless rows of “me too” products and second-rate content. AGM is a new type of event, part compelling conference, part essential CPD training, part intimate networking event, with a strictly limited number of sponsors and exhibitors to ensure highquality interactions between delegates and commercial participants.

capturing the moment

Hospitals are under budgetary pressure. Doctors are under time pressure. The entire secondary care sector is under pressure to deliver better outcomes at lower cost. All of this means that both the budget to fund training, and the time available to clinicians to do it, are at a premium.

Delegates can customise their own programme, ensuring they have time for networking

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A limited number of exhibitors ensures high-quality interactions between delegates and commercial participants

That’s why AGM offers two days of the highest quality training, with 11 points of CPD accredited by the Royal College of Physicians, delivered by leading experts across the medical specialties for practically nothing. There are free places for some specialties and delegates who book early pay less than £100, that’s dramatically less than every other serious clinical training conference, where prices for delegates can often be as much as £500. It’s a ground-breaking new model that guarantees an unusually large physician audience offering both cost and time efficiency to hardpressed doctors.

keen to train

An in-depth survey with close to 200 consultants revealed a community of senior physicians keen for acute and general internal medicine training. »» 88% of physicians said gaining CPD accreditation in general internal medicine is “important” »» 43% of those physicians said it’s “difficult” to keep up-to-date in acute and general medicine »» 94% told us they would attend a low cost, two-day event in acute and general medicine offering 10+ CPD points We’ve joined together with a number of leading organisations and companies, including the British Society for Rheumatology, the Society of Acute Medicine and the Association of British Clinical Diabetologists, to create a compelling event for medics and those that support them. The AGM 2012 programme has been designed to appeal to all senior grades of physician, from core medical trainees to consultants — making it one of the few events they can jointly attend to learn and be inspired together. Medics can gain up to 11 CPD points accredited by the Royal college of Physicians. The programme will offer 80 insightful seminars on both acute and general medicine covering the major medical specialties, including:

»» »» »» »» »» »» »»

Cardiology Diabetes and endocrinology Gastroenterology Nephrology, Neurology, Rheumatology, Respiratory medicine

Don’t miss AGM 2012

The acute medicine talks will provide delegates with up-to-the-minute guidance and protocols. The general medicine seminars will cover the latest advances, evidence and practice in general medicine.

21—22 November 2012 London Olympia “AGM 2012 is set to break the mould. No event combines acute and general medicine training; no event offers knowl-

Delegates can book online at: www.agmconference.co.uk

edge and skills training under one roof; no one has designed a comprehensive package of post-event learning for its

an event for all the team

delegates and no event is offering all this

AGM will be located alongside Hospital Directions, a practical, hands-on learning event, responding to changes in the way the NHS commissions and delivers services.

for practically nothing.”

The event will offer senior secondary care managers best practice advice and real world solutions through seminars and workshop sessions. In addition, there is a tightly focused exhibition space featuring some of the most innovative suppliers to the sector.

Mike Broad, editor, Hospital Dr and AGM programme director

“AGM 2012 will be a great event for anyone who is involved in the acute medical ‘take’, and will provide useful general medicine CPD for all physicians.” Dr Chris Roseveare President of the Society for Acute Medicine

Delegates can book online at: www.agmconference.co.uk

For more information, visit: www.hospitaldirections.co.uk

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www.havenhealthproperties.co.uk

Our research.Your business. The perfect MATCH MATCH aims to transform the medical devices sector by researching, testing and making methods available to cut the time and cost from concept to continuous improvement in the market, in support of device users, the medical device industry, regulators and reimbursement agencies, and healthcare providers such as the NHS. MATCH is a collaboration of four universities (Birmingham, Brunel, Nottingham & Ulster), jointly researching, training and engaging towards this end.

MATCH Courses Sold to the NHS: making business decisions for new medical devices The medical sector is different from other sectors in at least two ways. Firstly, because statistics of illness are kept, giving a clear indication of the size of potential markets for technologies that address a given illness. Second, healthcare providers are increasingly seeking to understand the value-for-money proposition that the technology they purchase represents. The course focuses on accessible methods to identify the commercial potential of medical devices. The methods and analysis presented will be suitable in the following situations. ● Application at the conceptual stage when a

company must decide whether to pursue an idea. ● Application to the stage when the product is

about to be placed on the market. ● Accounting for uncertainty can help to decide

when to invest further in a product.

Not all forms of risk are covered by this theory, but it does link the uncertainty a business carries forward to the strength of the statistics from clinical and other trials that the product may have undergone.

Understanding Device Users: from traditional methods to social media User involvement in medical device development is vital to help ensure the quality and safety of devices. This workshop will provide insights into the barriers to this as well as an overview of strategies to overcoming these, an accessible overview of tried and tested approaches to user involvement in the context of relevant human factors regulations and standards and guidance about determining the number of users needed for device evaluation. Increasingly social media provides a way of accessing user views that may be relevant at all stages of the device development process. An introduction to this area will be followed by a demonstration of MATCH resources in this area: ● MATCH Campaign tool; and ● MATCH Tweetcatcher.

For medical device companies in search of user requirements the advent of social media offers opportunities to reach individuals and specialist communities, and to gather business intelligence on the competition.

Who should attend: ● Industry and investors seeking informed product development

decisions based on health technology assessment. ● R&D Managers wishing to integrate health economic

considerations into New Product Development Systems. ● Marketing Managers seeking to differentiate products based

on cost-effectiveness. ● Sales Managers seeking to articulate the value proposition of

innovative products.

Dates and Venues: Business Decisions for New Medical Devices The Headroom Approach 16th April Birmingham Austin Court 11th May London Hilton Paddington 8th June Nottingham Crowne Plaza 6th July London Hilton Paddington 20th Sept Birmingham Austin Court 26th Oct London Hilton Paddington

Registration and Sponsorship Standard price £499.00 + VAT Early bird non-member price £300.00 + VAT (The early bird discount will be closing on the 7th of each month the course is running)

MATCH Affiliates price £200.00 + VAT

Understanding Device Users: from traditional methods to social media 22nd March Nottingham Crowne Plaza 26th April London Hilton Paddington 24th May Nottingham Crowne Plaza 21st June London Hilton Paddington 27th Sept London Hilton Paddington 25th Oct Nottingham Crowne Plaza

For information on MATCH courses please contact Elizabeth Deadman at match@brunel.ac.uk 01895 266050 or check the MATCH website: www.match.ac.uk/courses.php

Health Protection Agency The expert public health organisation in the UK

• Microbiological and molecular diagnostic tests from 8 Clinical, 6 Food Water & Environmental and 2 National Reference laboratories • Advice and support, particularly for the investigation of outbreaks and incidents • Infectious disease surveillance and coordination, including advice on risks posed and responses to international health alerts. • Emergency preparedness including training and exercising the healthcare community • Provision of authoritative scientific/medical information in responding to public health emergencies. • Delivery of local services through a network of Health Protection Units To find our more please visit us on stand AA32 @ The Commissioning Show 2012 Olympia

Dr Phil Luton Business & Marketing Manager Health Protection Agency Porton Down Salisbury SP4 0JG Phone: +44(0) 1980 612725 Fax: +44 (0) 1980 612241 www.hpa.org.uk/business