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Transforming Healthcare HEALTHAWARENESS.CO.UK
Empowering patients is the prescription for sustainable healthcare
Industry Coalition Group
on how community-based care could ease pressure on the system P4-5
Julie Wood, CEO, NHSCC
on transforming the NHS to be fit for the future P7
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Dr Michael Dixon on the challenges of creating sustainable healthcare P6
Extended article with the Industry Coalition Group members
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Transforming healthcare: a partnership venture
Health and healthcare-transforming innovations offer exciting opportunities yet some NHS staff can view innovations as a risk and a cost pressure. So how do we progress? ‘Innovation’ remains a popular buzzword, liberally sprinkled across pages of national strategy, with digital technology touted as key to transforming healthcare. However, time- and resource-constrained NHS staff often feel bombarded by people trying to sell them ‘solutions’ to problems that aren’t their priority, and in language that does not resonate. The NHS Innovation Accelerator (NIA) is a tangible example of how carefully selected innovations are being put into practice for patient and NHS benefit, from the IT platform empowering patients to make decisions about their end-of-life care, to a personalised model, which integrates a trained police officer into mental health teams to support those struggling with complex disorders. Follow us
Other successful products include the digital service, which enables patients to confirm and change their hospital bookings (thereby cutting waiting lists); a free epilepsy risk-management app, supporting people to manage their condition; the device that’s preventing ventilator-associated pneumonia - a leading cause of death in Intensive Care Units; and a fun-to-use app for kids, tackling the epidemic of tooth decay in children. All 26 evidencebased innovations supported by the NIA are demonstrating a very real impact; transforming the health and care landscape as we know it. Since the NIA launched in July 2015, over 900 additional NHS Providers and Commissioners are now using NIA innovations, 61 new jobs have been created, 22 awards won,
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Dr Amanda Begley Co-Founder, NHS Innovation Accelerator (NIA) Director of Innovation and Implementation, UCLPartners
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and 13 innovations are now selling internationally. Conservative estimates highlighted within an independent evaluation, suggest that savings to the UK’s health and social care system generated by NIA innovations amount to over £12million per year. Transforming health and healthcare necessitates a collaboration that combines the experience and expertise of patients, carers, NHS staff, researchers and entrepreneurs. Importantly, it requires a willingness to learn together, share knowledge about innovation use, and to take managed risks for a common purpose. Only then can we truly create the culture and conditions necessary for innovation to spread widely; ensuring a sustainable NHS and transforming health and healthcare for generations to come.
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Why we must embrace digital platforms to connect patients with health information Perhaps one of the biggest challenges facing the NHS is making sure that technology meets the needs of everyone in the system – clinicians, practitioners and patients alike. All too often, 21st century people are left feeling frustrated by the seemingly 20th century technology that we use in the NHS.
A lot of information still swirls around on paper; making it quite difficult to achieve connectivity between primary and secondary care. Getting everybody off paper and onto connected digital platforms that ‘talk to each other’ is a huge priority. Equally important, is the need for patient and clinician empowerment. There is an imbalance of responsibility, which sidelines patients’ potential for self-monitoring and can lead to NHS staff burn out. Patients can support their care system if they have the information and digital tools they need to take more responsibility for their own health and care choices, while enabling health and care professionals to work more productively.
Patient technology is optimised for user experience The impact of any app or digital service centres on its usability and usefulness. To achieve this, the developer identifies a problem to solve, and designs the solution to meet the need of the user. User experience is key. Digital platforms for the health service are often designed to meet NHS staff needs: does it allow me to collect information in the way I need to? Does it allow me to organise my staff to see more patients? Although these are important internally, they take little account of the people who are being moved through the system. Conversley, digital interventions in health allow opportunities to shape the user experience for the person on the receiving-end of
care. Solutions are springing up that allow people to take more ownership and control of their health, and feel empowered as a partner in their care. They are the expert on how it feels to live with their condition.
Online content and tools must be useful and easy to access Considering the popularity of the NHS website (over 50 million visitors a month), it is clear that people interact with the healthcare system via digital platforms. We must, therefore, ensure that online clinical and service information is current and that online tools are accessible, helpful and able to support people to engage with their health away from bricks and mortar services. It must be acknowledged that, rarely, are these tools a complete replacement for traditional bricks and mortar services, but rather, they act as an adjunct by allowing people to engage with their health in a different way. The information that is really critical for people is the information that is about them. It seems like it should be such a simple thing to arrange for key information about a person to follow that person around the health service. Sadly, this is not the case and there are multiple system suppliers and organisational boundaries to overcome.
Utilising GP records to create more personalised online experiences NHS Digital is actively working with partners across health and care to resolve this fundamental requirement for interoperability. Until this has been solved, we are working with localities, providers and developers on the leading edge of this work to learn how they have made things work and what more we could do. Through the NHS.UK programme, we are upgrading NHS Choices to give patients a more personalised and relevant healthcare experience online. This includes improving
Mona Johnson Self-care and Prevention Domain Senior Clinical Lead, NHS Digital
“We must ensure that online tools are accessible, helpful and able to support people to engage with their health” digital access to GP records, which we are piloting in five locations. We are also building on the work of NHS England’s Patient Online project to enable more ‘transactions’, such as booking appointments and requesting prescriptions online.
Developing apps that are part of the healthcare package The beauty of the digital space is that it is fast-paced and vibrant. There is a willingness to fail – it is OK to “fail fast” because through that failure you learn and iterate your product, pivot, or abandon. The idea of failure or getting it ‘wrong’ in any way is a big sticking point for large NHS organisations. Quite rightly so, as many thousands of people rely on the service in one way or another every day. In order to deliver things safely, the NHS moves slowly. However, there is the opportunity to create a framework of standards within which developers may create solutions. Our role is to articulate the standards,
assure products against these and enable the market to engage safely in that work. This is the case in the apps space. Apps certainly offer advantages to patients – they can allow them to record activities and can track the effects of interventions. By harnessing these tools and working in partnership with patients, the NHS can identify and assure those apps that deliver the greatest benefits to people – to understand what ‘good’ looks like. Doing this may help to safely reduce the nervousness many clinical staff feel in this space, where they feel exposed when recommending apps. In fact, it will help apps to become part of the entire package of care wrapped around people with long-term conditions. The opportunities are immense and the possibilities really are endless.
Harnessing technology We hear a lot about artificial intelligence (AI), but harnessing the technology may not need to be quite so cutting-edge. For example, simply presenting people with easy-to-digest information indicating which of their local pharmacies are open or how long the waiting times are at their closest A&E, can really have a positive impact as it will influence the choices people make on where they access health or care. This can be done very simply by exposing application programme interfaces (APIs). These APIs are the “locks” on the doors into clinical systems. By exposing APIs in a controlled fashion, developers are able to understand how to make keys that fit these locks, which will ultimately be of great benefit to patients. The health technology space is an exciting place to be. It is an enabler – to help people make good choices about how they look after themselves, and to help the services that they engage with continue to be sustainable in the future.
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The changing face of healthcare and how it empowers patients Moving healthcare out of hospitals and into the home is bolstering patient empowerment and breaking down barriers between individuals and healthcare professionals. By Tony Greenway
T
he health and care system is changing. Gradually, the focus is shifting away from hospital-based care and onto community-based care. This means increased home healthcare visits from GPs and nurses, but also therapists, social care services and pastoral care services where necessary. The idea? To take a more rounded view of healthcare, empower the patient, put their requirements first and break down barriers between NHS users and healthcare professionals. This new way of delivering healthcare recognises that everyone, at some time in their lives, will be a patient, and deserves — and needs — the healthcare that is right for them.
Individualised care means patients feel more incontrol
Mike Bell Chairman, Croydon Health Services NHS Trust
Jane Milligan Chief Officer THCCG and Executive Lead for north east London STP
It’s also designed to benefit individuals by giving them more control over the way they receive healthcare. By being more proactive, everyone can be treated in the location that suits them best, whether they require
chemotherapy or physiotherapy. It’s a win-win situation. The system wins because the pressure on it is relieved. The patient wins because they have a more flexible healthcare experience.
Need answers to the biggest healthcare challenges? Healthcare at Home working in partnership with the Industry Coalition Group
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This emphasis on community-based care has been recommended by the Industry Coalition Group (ICG), which represents organisations across the health sector. The first step in its implementation is for health professionals to fundamentally reassess the way they view patients. “We need to see people in the wider context of their families and communities and recognise them as individuals with their own needs and aspirations,” says Mike Bell, Chairman of Croydon Health Services NHS Trust and Chair of the ICG. The ICG also sees the value of a people-centred care system which
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gives individuals more say in the way their own healthcare is delivered. “When people go into a hospital or healthcare setting, they tend to quickly become a passive recipient of care,” says JJane Milligan Chief Officer THCCG and Executive Lead for north east London STP. “That’s because there’s an entrenched idea that ‘the doctor knows best’. We have to make it easier for people to navigate the system more effectively so that they can access better information and support and feel more in control of what is happening to them.” Technology can be a game changer in this regard, giving people access to their own records and results. Better education would also help
individuals take more responsibility for managing their own health.
How community-based care could ease pressure on the system
Natalie Douglas Chief Executive Officer, Healthcare at Home
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A redesigned health and care system wouldn’t only benefit patients insists Natalie Douglas, ICG member and CEO of Healthcare at Home: it could also have a dramatic effect on NHS staff. “That’s because delivering community-based care — such as administering complex drugs or monitoring those with more specialised conditions — can be a more satisfying and flexible experience for healthcare professionals,” she says. “Naturally, not every person can be cared for in
the community, and some nurses might prefer the cut-and-thrust pressure of a hospital ward. Yet if there was more of a focus on supported clinical homecare it would take some of the stress out of the system.” The report brings together a mix of current examples which were instigated in the Five-Year Forward View and new ideas which will collectively form this new principal care system, says Milligan. “But, of course, there is immense financial effect on the health system — and when money is tight it makes it harder to keep transformation on track. The aim of the ICG is to keep the conversation going.”
Find out more by reading the report at: insight.hah.co.uk/2000days
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Community-level support needed to sustain the NHS
To create a financially sustainable healthcare system we need to change the hospital-focussed nature of the NHS and empower people to be more responsible for their own wellbeing. By Tony Greenway
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ithout a seismic change in thinking, the National Health Service could become unaffordable warns Dr Michael Dixon, Chairman of the College of Medicine. “You can’t keep piling pressure on the system and expect it to keep delivering,” he points out. “If it does collapse, good healthcare will only become available to the rich.” Consequently, no one should downplay the challenge of creating a health system that is financially sustainable. “Costs are going up because we have a fast-ageing population,” says Dixon. “Plus we’re seeing more long-term disease than ever before
- such as diabetes, stress, obesity and cancer - the treatment of which requires more and more resources.”
How can you help our NHS? This is why our whole society needs to make a fundamental mindset shift regarding healthcare, says Dixon. “Individuals and communities have to ask ‘what can we do for the NHS?’ as much as ‘what can the NHS do for us?’ We must enable and motivate every person to become a resource by being more responsible for their own health. We need to achieve a health-creating society where cheap but healthy food is available and where we are all encouraged to engage in exercise and positive social relationships.”
Dr Michael Dixon Chairman, College of Medicine
Addressing economic inequalities and helping those alienated by society is key to this, insists Dixon. This can be achieved with ‘social prescription’, which addresses the needs, beliefs, hopes and health challenges of each individual. This may involve non-clinical interventions such as self-help groups, art clubs, volunteering and exercise classes which “reconnect people to their own health and welfare... and their communities.” Changing the hospital-focussed nature of the health service also means more community collaboration and partnerships. “As a GP I need the help of my local authority, local businesses, retailers, farmers and schools,” says Dixon, who is
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Julie Wood Chief Executive, NHS Clinical Commissioners
Transforming the NHS to be fit for the future
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also NHS England’s National Clinical Lead for Social Prescription. “We’re dealing with problems that can’t be solved by one agency alone. Yet there is hope in this area because social prescription collaborations are beginning to occur between the CCGs (Clinical Commissioning Groups) and local authorities, for instance.”
Patients can use tech in supported self-care Online consultations are a costeffective opportunity for the future, says Dixon, and an example of how technology can help to create a sustainable healthcare system. He also envisages patients monitoring their conditions more closely in the
future with the help of their mobile phones. Yet the push for sustainable healthcare can’t simply be government-led, maintains Dixon - otherwise its aims could be misconstrued and ultimately devalued. “This whole movement is an organic one created mostly by frontline patients, doctors and clinicians,” he says. “It needs to remain organic and locally led with support at all levels in the health system.”
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It is a simple truth that the NHS needs to transform to be fit for the future and, as our recent analysis Steering towards strategic commissioning has shown, clinical commissioners are playing a key role in doing just that. Since their inception, they’ve been working hard with partners to find ways to improve healthcare including: ■■ Focussing on the prevention of ill health rather than waiting until people need a cure ■■ Increasing care outside of hospitals and closer to patients’ homes ■■ Working with local authorities to ensure better community integration of health and social care There are challenges facing the drive to transform the NHS for the better – among these the finances. The NHS provides highquality, cost-effective care, but its ability to continue doing so will be restricted if we can’t prioritise the areas that get the best outcomes for patients, while also getting best value for limited budgets. Work to support this includes our joint consultation with NHS England on 18 treatments that cost £141m a year. We recommend these should no longer be routinely prescribed in primary care because they are: ■■ Of relatively low clinical effectiveness ■■ Clinically effective but more cost-effective items are available ■■ Clinically effective but, due to their nature, low priority for NHS funding. The list was initially developed in partnership with our member’s pharmacy and clinical leads and further refined through work with NHS England. While this will make a difference, it’s only part of what’s needed; the NHS is being asked to deliver an awful lot. Clinical commissioners are certainly up for the challenge of creating a transformed, sustainable and high-quality system, working with partners across health and care, but this will involve tough decisions and an honest conversation with the public and politicians about what can realistically be delivered with the finite funds available.
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healthawareness.co.uk Read more insights from leading experts within the NHS and industry on how to achieve a sustainable healthcare system.
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