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Addressing the growing disparity in health in the UK
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1
Making Clifton People Healthier
Improving health outcomes for disadvantaged people
Nottingham today UK tomorrow
2
Patients Panel
• Invited to join the Clifton Medical Practice patient’s panel after I wrote a letter of complaint following problems trying to book an appointment.– I found the practice too staff and process focussed
and it didn't value the customer. – I found the waiting room full of ill and disabled people
when compared to a West Bridgford practice.• I joined the patient’s panel• I started making suggestions for improvement
and asking the practice about their targets and objectives and progress towards these goals.
3
My Observation
• I moved from NG2 to NG11 & statistically lost 7.2 years of life expectancy!
• What is the practice doing to catch up with Bridgford’s health outcomes?
• What about morbidity how does NG11 compare to NG2?
• What are you doing about this imbalance in health?
4
The Clifton Culture!
Cannot do anything about it because its:
Response
5
Response Continued
• It is not our job, it’s a public health issue• You will never change this situation its just
how it is here.• People will continue to wreck their health
and wellbeing not through ignorance but through neglect.
• Smoking, Drinking, Over/Junk Eating and No Exercise – it is the Clifton Way to chronic ill health and an early death.
6
The Statistics
Data from the Indices of deprivation 2007
Ng11
NG2
7
Nottingham Insights Stats
• Key facts• Life expectancy in Nottingham is significantly lower than the
England average, with three years less for men and one and half years less for women (Nottingham: 75 men; 80 women. England: 78 men; 81.8 female)
• Nottingham’s life expectancy for men is ranked 8th worst in England and 31st for women
• 15 of the City’s 20 wards have significantly lower life expectancy for men than the England average.
• In some wards (St Ann’s and Bulwell) people are living on average 10 years less than those in more affluent wards (Wollaton West).
• The largest contributors to Nottingham’s gap in life expectancy compared to England are cardiovascular disease, cancer and respiratory disease – 50% of the gap is due to smoking
8
My View
• I was amazed that there was no fire in their bellies for the challenge.
• There was little zeal to bring about change • Was I being naive, they may have tried in the
past to bring about change and had their spirits broken in the process?
• I asked my wife Patricia who had taught in Clifton schools for many years, She confirmed there is a problem but only with a minority.
• What was to be done?
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Training & Education
• Far from the madding crowd….inspired an idea – Director Joseph Losey. Stars: Julie Christie, Terence Stamp, Alan Bates,
Margaret Leighton.
• The Lesson: – Keep presenting targeted health information. – Repeat & reinforce the message– Until the message has been absorbed and the
behaviour changed
• But do it in the most subtle and nicest possible way.
10
The Answer
• Use a machine within a systematic process to educate patients.
• Pros:– No additional work for Medical staff– Use NHS Choices; A Curated, Professionally
Produced series of Health Educational Programs. – Choices uses subtle and entertaining health
messaging to get their message across.– Reinforce the message with Games, Apps, Tweets
and Nudges to reinforce the message and bolster adherence.
11
Captivating a Captive Audience
• Replace current LED displays in NHS waiting rooms with large format TVs
• TV plays NHS Choices videos – Plus displays scrolling practice information at base of screen.– And advert like prompts to signal patients to attend the
doctor/nurse • Target the video play list to the needs of the currently
waiting patients via profiling (see later). Relevancy • Measure the change in patients behaviours vis-à-vis
control groups. Monitor effectiveness. • Use feedback and interaction stats to refine control
software and programme material to maximise health outcomes. Keep material fresh, focussed, entertaining and relevant.
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NHS Choices• NHS Choices 973
professionally produced videos
• In 29 Categories• But not huge online
viewing figures• 2000+ views for
medical videos to 30,000+ for healthy living / cooking videos
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Healthy Living
• Healthy eating• Sensible Drinking• Giving up drugs
14
Improving Social Interactions
• Lessons on how to control anger.
• May improve interactions between patients and medical staff.
•
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Patient Profiles
• Use NHS atlas of risk data by age and locality to drive initial play list selection.
• Refine playlists selection algorithms as better health needs profiling is embedded into the solution.
• Essentially KISS to start.
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Maximising ImpactThrough Reinforcement
• Link NHS choices apps library to patient check-in via QR codes.
• Check into the doctors waiting room and snap the displayed QR code to download an app. especially for you.
• Snap the alternate QR code to access the practice Facebook and Twitter feeds. – DM Twitter feeds and Facebook nudges from
your practice especially for you
• Don’t forget we are seeking to engage patients in managing their own health and wellbeing.
NHS Apps Tailored for you
Clifton PracticesDiabetes
Twitter Feed
17
Maximising OutcomesNear Field Communication
• NFC tags in medicines are imminent.
• Tap phone on medicine for details of side affects & dosage schedules
• Setup dosage reminders in phone calendar for display on Smartphone or SmartTV
• Nudges ensure that patients take their medicines at regular intervals and finish their course of treatment.
• Don’t forget we are seeking to engage patients in managing their own health and wellbeing.
18
Improving the Message
• NHS Choices Video Material worthy but not spellbinding. • Improving the message:
– Sponsor more Short Film Competitions with a medical or social message.
– Get kids involved via schools, film schools and universities.– All shortlisted films are added to the video content– Sponsor Health and well being games and app. competitions– All shortlisted games and apps. are added to the pool.
• Open competition engenders a Darwinian imperative to the improvement of health and wellbeing videos and related apps and games.
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Tweets and NudgesA Secure Direct Messaging digital helpmate
• Essentially a digital helpmate to keep patients on the road to better health.
• These are periodically transmitted phone or database driven messages to help patients manage their wellbeing.
• Displayed on patients Smartphone or SmartTV• In near future patients will view their own health pages to
monitor their progress towards their own health goals. • Patients can respond to tweets and nudges and these
messages will come into a practice in-tray where a human can respond.
20
Helpmate Dashboards
We can do all the interactive web technology for smart phones and tablets we need your input to help shape the solution for patient wellbeing
An example interactive dashboard from one of our applications
21
Closed Loop SolutionUsing Statistical Process Control
• Targeted Education via the TV systems
• Opt-in apps and Twitter via the click-on QR codes
• Health, Fitness and Wellbeing feedback from the phone apps to patient dashboards.
• SPC monitors common cause and special cause deviations via control charts
• SPC trends and deviations from norm trigger analysis plus corrective tweets and nudges.
• Continued deviation leads to investigation or pep talk
22
Lean Design • Is there a need for this solution will it make a difference in Clifton and
Bullwell?• If yes To do this we need to identify sources of funding• I need to sit medical professionals down with some software engineers to
draft the initial design specification and write the initial algorithms.• We need to agree syndicated content deal with NHS Choices for a “video
kiosk” solution. Done • We need to meld NHS choices video into user configurable practice
information and practice news feeds. • We don’t need to do everything on day 1 • We need to independently test the impact and health outcomes via a
moderated trial in a Clifton or similar practice.• We need to refine the design in light of outcomes plus clinicians & patient
feedback • We need to design a product that is smart, safe, secure, green and easy to
use with easy integration into existing NHS, Doctors and Clinician’s systems.
23
Developing a Product• Will it sell…is there a demand for the product, does it solve a problem?• Will doctors practices and NHS hospitals buy it and use it?• What are the incentives for GP practices? • What is the size of this market? • How will we advertise and market our product to this market? • What are our projected fixed and variable costs? • How many will we sell at which price points?• What competition is already out there?• What is our USP? What differentiates us from the competition?• What can we do to beat / outperform any competition?• What additional products or services can be developed around this
technology? ( Screen Savers, Smartphone apps & Games and Sheltered Housing systems)
• We need to develop a brand and develop a business plan to see if the opportunity stacks up.
24
Delivering the Solution• With a management team a
business plan and a proven pilot in a Clifton / Nottingham medical practice we can probably raise the finance to progress this venture.
• Start by Initially seeking community funds from organisations like Experian, Browne Jacobson, Nottinghamshire community funds
• We should also look for some sponsorship
• Which of you want to help me develop this vision and to help Clifton and Nottingham Folk live longer healthier lives?
• Task1 raising the first tranche of funding.
Clifton NeedsYou
25
About Me
• Engineer at Kodak 30+ years– Voted Kodak Limited’s most innovative employee– Lean, Six Sigma, SPC, Poka-Yoke, JIT 20+ years ago– Now being embraced by the NHS.
• One of my invention featured in the Millennium Dome’s British Genius exhibition.
• Currently run brite-sparks.com an innovative developer of web and Smartphone based software.
• See my profile on LinkedIn