Expo 2018

@mswindells

Technology and the transformation of the NHS

5th September 2018

Matthew Swindells

Deputy Chief Executive

2

IT Strategy

NHS - today and tomorrow

Reinventing Care

3

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

NHS.UK E-Prescribing E-Capacity management Single source of truth Life sciences and

research platform

Apps Library Global Digital Exemplars

and Fast Followers

E-Scheduling Frictionless Performance

Management

Genomics and Precision

Medicine

Developers’ Ecosystem Digital Academy and

Workforce Education

Regional interoperability

hubs

Population Health

Dashboard

Machine Learning and

AI

WiFi and Home Page GPSoC refresh Urgent and Emergency

Care

Analytics Capability Bioinformatics Institute

NHS Online Extended Summary

Care Record

Elective Care SUS for Transactions

Decision Support Mental Health

Integrated Care Plans Women and Children

Chronic/co-morbid

disease

Social Care

Foundational Infrastructure Projects

Patient Identity

Information Governance and Transparency

Interoperability and Enterprise Architecture

Personal Health Record and APIs for Apps

APIs / Standards

4

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

5

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

GDE and FFs

STP Investment

• 16 acute GDEs, 17

acute fast followers,

• 7 mental health GDEs

• Digital Academy

established with first 100

students

• £311m committed for

GDEs

• £412.5m available for

STPs

• £75m for e-Prescribing

6

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

nhs.uk

apps

• www.nhs.uk has 1.6m

daily visits

• Over 70 apps on NHS

Apps Library

• ½ million visits to

Apps Library

• 50k app downloads

• WiFi in 79% of GP

practices

• 14m accessing GP

online

• 98% access to NHS

111 Online

• GP referrals 100%

through e-Referrals

System

7

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

• Local Health &

Care Record

Exemplar

programme

launched in 5

areas, covering

40% of the country

• £37.5m committed

for 18/19 – 19/20

8

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

Single source of truth

• Prototype

dashboard

• Performance data

single source

• National data opt-

out and GDPR

across the NHS

9

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

Digital Innovation Hubs

Research

• AI Code of

Conduct being

developed with

industry

• Test Beds

programmes in

place

• 100,000

Genomes project App Ecosystem

10

Our plan for IT

Better Health, Better Care, Lower Cost

Empower People Enable Clinicians Integrate the Health

and Care System

Better Management

Information

Build the Future

LHCRs

Evidence into practice

11

The challenge now and next

Current performance: operational standards

12

• A&E performance (Jul-18) at 89.3%

• Cancer 62 day performance at

79.2%

Current performance: operational standards

13

• RTT performance at 87.8%

• 3,517 patients waiting over 52 weeks,

a 28% increase from March 2018

(when there were 2,755)

• 4.11m on the waiting list, compared

with 3.84m in March 2018 (7%

increase)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Apr-12

Aug-12

Dec-12

Apr-13

Aug-13

Dec-13

Apr-14

Aug-14

Dec-14

Apr-15

Aug-15

Dec-15

Apr-16

Aug-16

Dec-16

Apr-17

Aug-17

Dec-17

Apr-18

Total number of 52+ week waiters

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

Apr-12

Aug-12

Dec-12

Apr-13

Aug-13

Dec-13

Apr-14

Aug-14

Dec-14

Apr-15

Aug-15

Dec-15

Apr-16

Aug-16

Dec-16

Apr-17

Aug-17

Dec-17

Apr-18

RTT performance against incomplete standard

Standard

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

Apr-12

Aug-12

Dec-12

Apr-13

Aug-13

Dec-13

Apr-14

Aug-14

Dec-14

Apr-15

Aug-15

Dec-15

Apr-16

Aug-16

Dec-16

Apr-17

Aug-17

Dec-17

Apr-18

Total waiting list size (million)

Where is this heading

• Around 1.5% to 2% additional capacity required each year to deal with increasing demand. This would mean another 1,500 – 2,000 beds required per year - equivalent of opening 30 new DGHs over the next 10 years

• Cancer needs more testing / more detection …

• Trying to move forward with the current model of care:

• Can’t afford it

• Can’t staff it

• Wrong anyway

• Profound system shift

• Improve prevention

• Avoid referral and admission

• Discharge earlier

• Manage in primary and community care

• Requires a system response to meet these challenges, delivered by STPs and ICSs, working with integrated regional teams

14

15

Pharmacy Online self

triageNHS 111 GP A&E

Urgent

Treatment

Centre

Hospital

bed

Home,

nursing or

residential

care

27% of patients seen by their GP could have their needs met

elsewhere

Self care

Up to 50% of patients attending A&E could potentially have their needs met elsewhere

66% of people

want to die at

home but only

24% do

All parts of the system are overloaded, but is it with the right

people in the right place?

10.3% of

people are

carers for

elderly or

sick

30% of patients in

hospital would be

better cared for

somewhere else

System-wide response is required

16

STPs ICSs

- aligning incentives / focussing our finest minds

17

Level Pop. Size Purpose

Each level performs specific functions under the following common headings

1. Leadership, engagement and workforce

2. Care redesign

3. Accountability and performance management

Neighbourhood ~50k

• Strengthen primary care

• Network practices

• Proactive & integrated

models for defined population

Place ~250-500k

• Typically borough/council level

• Integrate hospital, council &

primary care teams / services

• Hold GP networks to account

System 1+m

• System strategy & planning

• Hold places to account

• Implement strategic change

• Manage performance and £

Region 5-10m

• Agree system ‘mandate’

• Hold systems to account

• System development

• Intervention and improvement

4. Strategy and planning

5. Managing collective resources

The future of a digital NHS

18

• Closing the loop on translational research to create faster adoption of new

innovations for patients

• Wrapping care around acute recovery

• Wrapping care around chronic conditions to support people’s wellness

• Intervening where there is the most opportunity

• Personalising medicine to the individual

• Creating the conditions for profound disruption of old models to create a

better future

The next generation of research

19

Data research

Testing and live

Address slow innovation adoption

From time new knowledge discovered until ½ of physicians act on that knowledge = 17 years

Everett Rogers, Diffusion of Innovations, 1995

Balas, Boren. Managing Clinical Knowledge for Health Care

Improvement. Yearbook of Medical Informatics 2000

% o

f popula

tion

Time

Adoption Half-life = 17y

Knowledge Half-life = 10y

“Finish medical school and residency knowing everything…read and retain 2 articles every single night…at the end of 1 year you’re only 1,225 years

behind.”

W Stead. JAMIA 2005;12:113-20

Alper BS, Hand JA, Elliott SG, et al.J Med Lib Assoc 2004;92:429-37

Hungarian doctor named Ignaz Semmelweis in 1846.

Presented his paper to the Vienna Medical Society in 1847

2004 NHS Cleanyour hands programme

MRSA and Cdiff halfed in 4 years

Predictors of Success Adjusted OR

Automatic provision of decision support as part

of workflow

112.1

Provision of decision support at the time and

location of decision making

15.4

Provision of recommendation rather than just an

assessment

7.1

Computer-based generation of decision support 6.3

Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision

support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr

2;330(7494):765. PMID: 15767266

75% of decision support interventions succeed when the information is

automatically generated

▪ Clinical decision support associated with:

• 21% mortality reduction for pneumonia

• 16% reduction in patient complicationsSource: HCIT evaluation of 167,233 patients at 41 hospitals

Electronic Process Cost Savings Per Patient

Decision support $538

Order entry $132

Test results $110

Notes and records –$2

Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information

technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009 Jan

26;169(2):108-14. PMID: 19171805

Technology-enabled decision support works

Suzie is recovering from cardiac surgery

LHCR

PHR

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 23

LHCR

EMREMR

Maria

PATIENT

Lisa

SCHOOL Office

Brenda

CARE COORDINATOR

Dr. Fortades

PAEDIATRICIAN

Cristina & Julio

MOTHER AND FATHER

Automatic alerts or text messages are

sent to parents and the school to notify

of the poor air quality

Maria suffers from severe asthma

UTC or GP surgery

Maria uses a spirometer at school

Maria’s parents use an app to check

her readings

The care manager or GP or 111 might

be alerted if Maria is at risk

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 24

EMREMR

Maria

PATIENT

Lisa

SCHOOL Office

Brenda

CARE COORDINATOR

Dr. Fortades

PAEDIATRICIAN

Cristina & Julio

MOTHER AND FATHER

LHCR

Maria suffers from severe asthma

UTC or GP surgery

Maria’s parents might check she has

her inhaler or speak to 111 for advice

Maria’s health has been managed

without disrupting her schooling

Population health management spectrum

Value

Opportunity

Cloud based support for precision medicine – Workflow Integration with

EHR

KnowledgeBase

VCF

Report

Bio-markers

Genomics Lab and Services

EHR

ReportBio-

markersVCF

Phenotype(EHR)

Pedigree

FHIR FHIR FHIR

WroPedigreeSMART App

CPOE + Phenotyping

SMART App

Interpretationand review

SMART App

Workflow

NGS PipelineInterpretation

Engine

RawReads

Phenotype Pedigree

SMART (HTTP)

HL7 V2

3rd generation2nd generation1st generation

The evolution of digitisation

Local health and care records

BI and change

management

Population healthInnovation and

apps

Research

Evidence

into decision

support

Monitoring and

patient advice

Friction-free

administration

and reporting

28

Back office disruption

Paperless venues

of care

Digital Disruption

Creating a health system that’s there for you all the time

Real time, multi-source

data Linked and normalized

Complex programma

bility

Actions into the

workflow