A journey towards 21st century health and care in the United Kingdom
David Calder of KTN asks “Where is the UK starting from in a journey towards 21st century health and care?”
My new role at KTN is all about the delivery system for ‘health and care’: how can KTN help businesses access that market and innovate for better outcomes and a sustainable health and care system for us all? It’s a massive topic and one that many people in both the public and private sector battle with almost constantly. Here’s my summary of where we are as we start to roll out the new KTN model.
My background is engineering. I have worked in manufacturing and product development. That experience taught me about quality and responsiveness – the need to ‘put the customer first’. That’s a key message because the present health and care system is not really able to respond to the needs of its customers. Instead it often acts to preserve the status-quo, to maintain its existing systems and offers many apparently compelling reasons for doing so. More of that later!
Where is the UK health and care system starting from in a journey towards 21st century health and care?
The UK’s health and care services (and those across the developed world) are facing a series of unprecedented challenges. The system we have now was designed to diagnose and treat acute health problems in large buildings called ‘hospitals’. That’s where most of the NHS’s budget still ends up. However the service is now under huge pressure to treat completely different types of ‘disease’ in vastly greater numbers than it used to. Enter the non-communicable long-term condition. We are an ageing population – technology has the ability to keep us alive but unfortunately not necessarily healthy.
These types of disease are only realistically manageable if the services and support needed to manage them are provided more (or all) of the time that is, not in ‘point’ interventions. Hospitals cannot do that cost effectively or even to a satisfactory standard from their brick and mortar infrastructure. In fact we really need to transfer the prime responsibility of managing these conditions to the individuals concerned. The phrases ‘self-care’ or ‘self-management’ should not be considered a threat to the quality of outcomes. Adopting those principles is the only way the system can respond effectively.
We are living for years with these conditions, often cycling in and out of hospitals with entirely avoidable exacerbations – simply because we are basically ignored by the system most of the time.
To make things even more difficult, many of us will end up with more than one of these conditions. That means separate specialisms – each attempting to treat the bit of the body they are used to looking at – but not the whole person. In fact, only the individual concerned has any hope of coordinating the complexity of the care they need – but the system does not at present support him or her to do that.
Factor-in the dis-jointed hand-over between health and care services (a differentiation many people don’t realise exists until they experience it themselves) – and you have a system that is increasingly backed-up and so very inefficient. This situation is not improving.
What can technology offer to help?
A key enabler to meet this challenge is information – which starts as data. The Digital Health revolution has the potential to enable us to share so much valuable information that services can be re-designed around empowered, resilient citizens, aware of their conditions, able to avoid exacerbations, obtain lower level support at much reduced cost from connected ‘circles of care’. All of this can be done without troubling a hospital most of the time. Even better, such activated, engaged and empowered people might increase their levels of wellbeing in a proactive manner. The system needs to be reconfigured so it supports all of us, including those of us that may find it more difficult to do so, to engage with our own health and care. This sounds like and is a revolution in culture and the dynamics between citizen and the state.
Revolution sounds exciting but you have to start somewhere and indeed many people have already got things moving. There is a myriad of great ideas that tech businesses and indeed, motivated clinicians have come up with. Many are aimed at improving the delivery of health and care services within the present system.
Typically then, these ideas will be care-pathway disrupters – changing how the system does things. That’s one of the main problems facing deployment of digital tech in the health and care setting. It threatens existing organisational arrangements.
The existing approaches in many organisations (and there are hundreds) that deliver health and care, make it impossible to assimilate or share data, they can’t automate its analysis. They also cannot hope to ‘plug in’ to consumer driven data generated by individuals as they go about their daily lives. The amount of data which could add value to this situation, could it be accessed is growing rapidly. The current system locks information away either due to its structure (non-interoperability) or organisational boundaries (the dreaded ‘information governance’).
So what about the other challenges to Innovation in Health and Care?
One really tricky subject when we talk about integrating tech into health and care is the question of evidence.
Of course the need for evidence, particularly concerning safety when devices or therapies are allowed to support or alter physiological processes or a person’s bio-chemistry cannot be circumvented.
However in health and care, the question of evidence has a tendency to slow or stop new approaches even when they have nothing to do with those ‘clinical’ concerns.
More often than not the gold standard for clinical evidence – the Randomised Control Trial – comes up, often quite inappropriately, where digital technology applied to patient experience (or care pathways) is concerned. It simply is not the right way to evaluate these sorts of solutions. But is what many people are used to dealing with. Trying to generate a control group for a digital pathway change is far too difficult and the whole process takes far to long and costs far too much.
Another challenge to digital within the health and care setting ‘information governance’. That, and the associated data-protection regulations, is another hurdle that is often made out to be higher than it really is. Despite numerous initiatives to clarify the landscape around this subject it does remain confusing and therefore ends up in the box marked ‘RISKY’ by some decision makers and legal advisors within the health and care system.
If nothing else it’s another source of delay – in and of itself a key barrier to deployment of digital solutions to the system.
What else adds to delay? Public sector procurement systems do! From and SME perspective this is very often the final nail in the coffin.
Businesses really cannot wait for IG, evidence and procurement to work its way through. They will simply go bust in many cases while this leviathan churns slowly through its process.
Pulling all this together I would suggest that what is missing is leadership at the right levels in the system where it can challenge how things are done now. Many observers are increasingly surprised and disappointed at the rate of change, despite many policy initiatives being in the right place, saying the right things. There is a cultural inertia preventing scale-up of very promising initiatives popping up all over the UK, for the reasons mentioned. And scale is another thing essential to the business model for digital technology…
And this stuff really does work – examples (with evidence) include 25% reduction in use of emergency services due to large scale deployment of Philips Motiva telehealth Services from Liverpool CCG. Then there is the fully developed eRedbook app for young mothers, developed by another SME, SiteKit. This takes the baby book all new mothers receive into the 21st century and makes it far more powerful and valuable. This innovation is about to be rolled out in parts of London. eRedbook is also an example of a personal health record or PHR.
Then we have the ‘pain-sense’ app developed by ADI – which also acts as a PHR and enables people with chronic pain to manage a reduction in their reliance on opiates. That one is deployed on a population level license in North Yorkshire, but no-where else!
Finally we have the ‘The modality GP Partnership’ in Birmingham which offers an entirely digital interaction to patients and has reduced A&E attendances locally. The service that enables that digital front-end to work so well was built with the support of Digital Life Sciences another SME that KTN and Innovate have supported over the years. The system offers choice to patients: wait for an appointment of access an online GP. 70% take the online option and 70% of those interactions address the patient’s need. Now citizens have a satisfactory solution they don’t trouble more expensive parts of the system… Freeing capacity for those that are in greater need.
So what can be done and what is KTN doing to try and help?
The short answer: KTN and many others involved in this space are currently looking elsewhere, beyond the statutory services for opportunities for innovation to grow. We have examples in Health 2.0, Ageing 2.0 – both global networks of innovators plus numerous UK accelerators and incubators that are all focussed on a ‘direct to consumer’ offer – having essentially given up on ‘the system’ – for now.
Of course there are on-going attempts to bring about change from within and indeed generate ‘evidence’ since the system is still addicted to it. The NHS Test Beds and the parallel Internet of Things projects are the latest ones. We are watching with anticipation to see what emerges from those.
At KTN we are presently lining up ‘speed networking’ linking pharma / private insurers and consumer electronics corporate partners to innovative SME’s. We aim to provide space for open innovation but see the emphasis being on a consumer offer. These events are over-subscribed so there is still tremendous interest in ‘digital health’.
The statutory system will change, we all know it has to happen, but these fast-moving businesses cannot afford to wait. Digital moves too fast!
KTN cannot realistically bring about change at scale within health and social care, so we continue to network ‘innovative nodes’ within the system. Liverpool, Newcastle and Birmingham with Oxford, Manchester and the South West to follow. These ‘place based’ innovation hotspots share an economic / business led aspect to the work they are doing. KTN is therefore working mostly where the door is open to that type of thinking.
To conclude, we should note that the challenges I have covered are well understood within our health and social care organisations (the system) and that the most senior leaders thereof are committed to bringing about transformative change. You can read more in the NHS England Five Year Forward View, and witness the activity of the National Information Board by way of an example from the English system. The autumn release of a significant report into this subject – the Accelerated Access Review, published by the Office of Life Sciences has the potential to help us turn the corner on the technology revolution poised to help secure the future of our health and care system.
Watch this space!