SAVE THE DATE:
In partnership with
28–29 June 2017 | ExCeL London Commissioning Newspaper Issue 17
LS A T I SP O H RAL PRAC
AFTER BREXIT: WHAT LIES AHEAD FOR HEALTH AND SOCIAL CARE?
ER BETT CARE F U
VANGUARDS: PROGRESS TO DATE
INTEGRATED PERSONAL COMMISSIONING IS HERE TO STAY, EXPERTS AGREE
LESSONS FROM A US REVOLUTION IN INNOVATIVE PATIENT-CENTRED CARE PAGE 13
SAVE THE DATE
Health+Care returns next year on 28-29 June 2017 to London ExCel With one MAJOR addition, the Digital Healthcare event has launched to run alongside it. We’re reviewing how education bursaries are distributed for free tickets to attend next year, so be sure to get your name on the waiting list here early to avoid disappointment.
S E I T I R SPECIAL
C O M M U NIT
THE FUTURE LOOKS BRIGHT HEALTH+CARE EXPERTS AGREE
DO WE NEED A FIVE YEAR FORWARD VIEW PLAN B?
E N GE
CC Gs A L U A TH C
Health+Care Trends for the Fourth Year Running – A Big Thank You to Everyone Who Used #Healthpluscare
28–29 June 2017 | ExCeL London
28–29 June 2017 | ExCeL London
HEALTH+CARE: In Summary
Health and social care workers respond to the clarion call of Health+Care 2016
he 2016 Health + Care conference and exhibition has once again staked its claim as the leading event for the health and social care community. Taking place at London Excel on June 29-30, Health + Care offered a rare opportunity for thousands of providers, commissioners and supplies to come together to formulate a proactive response to the challenges facing integrated health and social care services today. The secret of the success of Health + Care, which is now in its xxx year, lies in its unique one-stop-shop offer: where else under one roof can health and social care colleagues hear on one day from three former secretaries of health, as well as a plethora of Department of Health leads – and on the next take the opportunity to walk through the inside of a large inflatable breast, and explore product and service innovations on offer from more than 370 specialist suppliers? Over its two days Health+Care 2016 attracted its biggest delegate audience to date. In total over 10,149 delegates across
Health+Care and The Commissioning Show from a wide range of commissioning, provider and supplier organisations were attracted by the event’s unrivalled discussion forum, which covered a range of issues from big strategic debates to local system transformation. In addition to the conference’s 12 education streams, dedicated space was available to delegates seeking specialist networking events, trouble-shooting workshops, expert clinics and facilitated learning zones and masterclasses. In two firsts for Health + Care 2016, a new sustainable business theatre offered a dedicated forum for care home and home care managers, while the new sensory zone explored the role of sensory stimuli in the treatment of people with mental health problems. Plans are already well underway for next year’s event, which is set to grow even larger. This will take place on June 28-29, 2017, again at London Excel, and will combine four events in one: The Commissioning Show, The Residential Care Show, The Home Care Show and Technology First.
Technology first will become the new show launch Digital Healthcare for 2017
“The conference offered a wider perspective on the current issues and gives access to senior leaders that I could not hope to have on a day to day basis.” Delegate Hannah Morris, joint senior finance and performance manager at NHS Dorset CCG
This is our third time at Health + Care. We come for the access that it gives us to senior customers and decision makers. It’s a great opportunity to research our market and review competitors’ offerings, and to see suppliers who can help us provide solutions for our customers. There is always something going on in the NHS and this year there is real change so it is valuable to be able to speak to people to get a feel of what’s going on.” Jamie Shemmings, Senior access to medicines manager, GSK
“This show is not about staring into a black hole in the NHS budget but about learning from others’ successes, sharing solutions and working together to replicate the best of what the NHS and social care can achieve. “Whatever your interest in health and social care, Health + Care plays an important role in unlocking talent, securing efficiencies and harvesting successful outcomes for patients. Demand is already rising for our complimentary passes to the 2017 event, and with our best ever programme planned, exhibitors and visitors are advised to book early to ensure you don’t miss out.” Conference programme editor Lisa Thomlinson
28–29 June 2017 | ExCeL London
HEALTH+CARE: In Summary #d8197d
Timing is everything… Who would have dreamed that the timing of this year’s Health+Care would coincide with some of the most momentous events the country has known. As if the news that we’d voted to Brexit wasn’t enough of a talking point, the main political parties were also busy forming circular firing squads and taking pot shots at each other.
s a consequence, unusually, but not surprisingly, politicians were notably absent from the Health+Care this year. Even before the end of the show, we learned that we had a new Shadow Health Secretary Diane Abbott following
Heidi Alexander’s resignation. The title of the session in which Ms Alexander was due to appear now looks prophetic “The elephant in the room…” As chair, Dr Michael Dixon noted, “I think we’re coping very well without the big cheeses!” Whether it was in spite of, or because of our elected representatives’ absence from the show, the atmosphere throughout both days was upbeat, positive and resolute. The feedback from exhibitors and sponsors exceeded all previous years. Delegate numbers were up eight percent on last year. Moreover, a record number of organisations have already booked up for next year.
A complete view of the system A great part of the attraction for exhibitors and visitors alike is the depth and breadth of the show. There’s something for anyone working in, or reliant upon the many forms that constitute care.
s a microcosm of the entre industry, the shower amply reflected the imperative to move care out of hospitals and into communities. It provided a place to find out more about new
care models, and how sharing the burden of care is being addressed by local authorities as well as the traditional healthcare providers. If you are involved with any of the many different components that make up the health and care systems, Health+Care had it covered. Whether you work in the system or someone who uses it, from home care to care homes, primary to end of life care, all were represented at the show.
It wasn’t all hard work.
ANKER’S VIEW: CHANGING While most people were attending Health+Care SPECTIVES IN SOCIAL CARE to work, to learn or to share, let’s not forget He identified the risks as expenditure on
that you can continue to deliver care.”
the build celebrations for those who awards costs, pensions, and apprenticeships, And he added: “As we getwon closer to 2020, as well as the growing frailty of residents, will [the Care Act] actually come in, will it not? at and the Healthcare Awards greater compliance charges as a result Transformation There are some real challenges if it does of the recent fee increase by the Care Quality come in in the way it has been set out, hosted byIn addition, NHSstaffing Clinical Commissioners and Commission. costs especially with local authority advocacy.” associated with the national living wage, the However, he concluded that despite the Health+Care. Entrants seven categories use of agency staff, and training were across challenging market the demographics were highlighted, and the movement into the encouraging: “Care home operators have hadsector toofdemonstrate US real estate investment trustscollaboration, the positive got really good reason to look onleadership, (REITs). side. We’ve got to look and see how things innovation and transferability of their Paul Birley said: “This year the national are going to develop and make initiatives. the best of living wage hasn’t quite had the impact on it.” ad of public sector and They also to show how our client base ashad perhaps was predicted in “We definitelytheir see winnersplans in the market could Barclays, outlined the the early days. But we have got another three place. These are those that deliver quality pportunities to the sector influence or four years ofSTPs. this going on. I think the key care, value their staff, are in a great location, conference, in a session
ket challenges to re build costs, , uncertainty authority fee expansion of US and the Care ve demographics ators should be
er’s view: al care.
will be to see what happens in year two and three, to see whether the local authorities do keep the fee increases going to make certain
and they’ve got quality management that deliver a consistent message of quality across their organisation.”
Paul Birley, head of public sector and healthcare, Barclays
Congratulations to the winners who are: • Ipswich and East Suffolk CCG for their Integrated Diabetes Service
RUITMENT AND RETENTION IN CARE Surrey Downs CCG for their Delivering Clinical MES: • “REAL BOTTOM-LINE STUFF” Commissioning Leadership programme much money is leaking out of the sector.
the right instinct and values you are much
Recruitment and retention … is real bottom- less likely to have staff absences.” • Kernow CCG for their line stuff.” ‘I-Care POPPIES ambassadors’ are Medicines existing He was addressing an audience at the workers who have been trained to go into optimisation programme Health+Care conference on Recruitment and local schools and community venues and
hould use h as ps, values-based nd ‘I-Care to recruit and y workforce, as a relationship l job centres.
retention: get, keep and develop a quality
explain what roles are on offer in their care
Department for Work and Pensions.
providers to do away with recruitment costs
good way to replace staff moving on.”
I’d recommend you building a relationship
Barry Lee-Potter explained: “They based workforce, with Dean CCG Wood, from for the homes. • Oxfordshire their outcomes National Employer and Partnership Team, can do the myth busting. ‘I-Care has enabled some which is part offor Job Centre Plus (JCP), at the ambassadors’ contract adult mental health… services
Barry Lee-Potter said apprenticeships lead to entirely.” • Barnsley CCG for theirDeanRightCare telephoneWood told delegates: “The care er, director of marketing more motivated teams, and are cost-effective and low risk, and he added: “The research sector is a priority. Whether you work for a Barry Lee-Potter, director of cations at Skills for Care, based coordination centre marketing and communications at [Skills for Care] has done shows it’s also a very national organisation or a local organisation,
hat provides support on ntion to adult social care ngland, said: “Various hat there will be an ion to one million jobs [in , and if you imagine that, he sector, turnover rates then each hire costs on You can imagine how
Skills for Care
• Blackburn Darwen CCG for Quality and Values-based with recruitment involves with Job Centre Plustheir because we do have “looking at the instincts of the people who people that are interested in creating a jobseekers attended information sessions Outcomes Enhanced Services Transformation are coming forward for work. This gives you career in care.” about the sector, with that being in a care a very high percentage of the right kind of
He outlined the impact of a recent
home setting or in job centres or community
people. Every pound that you invest infor a campaign JCP. “More than 900 people of locations. • NHS Stockport CCG theirbyEnhance End LifeAlmost 1250 jobseekers undertook values-based approach delivers £1.23 return started work nationally in the sector as a a period of work experience or were involved on thatSupport investment. If you programme have people with result of the campaign last year; 1000 in some activity in a care setting.” Care
SAVE THE DATE 28-29 JUNE 2017 Complimentary passes will be available in January 2017, but to gaurantee your free pass to Health+Care next, join the waiting list: www.healthpluscare.co.uk/2017waitinglist
oliticians may have been conspicuously absent from Health+Care this year but we were thrilled with the many non-politicians – exhibitors, delegates and speakers - who attended in greater numbers than at any previous Health+Care. We thought it would be interesting to share some of the things we overheard at various points in a very full programme over the two days of the show. As we haven’t heard from him for quite a while and were delighted to see him at the show, Lord Lansley gets quoted more than most.
“We must continue to support clinical and Lord Lansley scientific research business post Brexit or risk losing it.” Lord Lansley
28–29 June 2017 | ExCeL London
What lies ahead for health and social care?
What will be the impact of Brexit, three key opinion leaders were asked in a debate at Health + Care.
ndrew Lansley, former Health Secretary and member of the House of Lords, said one of the key priorities was to determine what new system of migration should be introduced because European workers were needed to fill jobs in health and social care. The acquired rights of the 130,000 NHS staff and care workers from the European Union who are already working in the NHS and care sector also needed to be protected. Also at the top of the list was a requirement to protect the UK’s science and clinical research activity that had benefited from participating in EU-wide research and to prevent institutions like the prestigious European Bioinformatics Institute in Cambridge relocating to Europe. There was a need to discuss what to do about the involvement of the UK in the European system for medicines approval and ensure the continuation of consistent health technology assessments across Europe and work which set greater transparency in the pricing of pharmaceuticals. It would be important not to lose the current cooperation between the UK and the EU on public health measures such as combating infectious
inted to recent that 73 per cent of d at a subsequent er of those had quate to good. So r too late to turn t it takes real
er services it’s all the outstanding ery clear – it runs ead in the services Sarah Pickup and mmissioners nsibility to ensure
diseases and antimicrobial resistance. Finally there would be a need to rewrite European competition policy. “In practical terms there is a job to be done and we should start now because during the next three months we have to develop so a plan so we have political direction and a very clear list of what it is we need in order to protect the interests of the health and care sector,” said Mr Lansley. Sarah Pickup Deputy Chief Executive, Local Government Association, said: “We will be asking for a seat at the negotiating table when Brexit is discussed because we want to have a say in things that affect infrastructure and social fund finances which support communities. There will also be things we will be seeking assurances about such as research and workforce issues.” Adam Roberts, Head of Economics, The Health Foundation, added: “Pressures within the health system are rising between 3-4% a year. If Brexit leads to lower economic growth it will result in less funding for the public sector as a whole. But if we can achieve greater growth going forward working with the EU and the rest of the world then we will be able to continue to fund a sustainable health and social care service.”
SAFEGUARDING THE NHS POST BREXIT #0072bc
“People whose job it is to safeguard the future of the health service have a job to do,”
ord Lansley CBE told the Health + Care conference and exhibition in a specially convened debate on the Brexit vote. He said that the most important task now facing politicians in light of the ‘leave’ vote was to ensure that protection for the NHS was written into the UK’s EU withdrawal treaty. Several targets are important, said the former health secretary and architect of NHS reform: • Clinical research on a European level • European medicines assessment
• Maintenance of acquired work rights for EU citizens • Europe-wide support for public health • Competition policy and procurement rules. He assured delegates that both sides of the referendum lobby supported the need to protect the NHS, and that the UK could write into the new treaty provisions to enable cooperative research and access to health services. “The UK is as good as any other in delivering services and Europe will not see the advantage in closing out the UK’s health and social care offer. There is an incentive and desire to continue partnerships.” he said. But, he said, a points system for immigrant workers may not address the future workforce needs of sectors such as the care sector. “That conversation needs to start now.” During the debate, which also included
Sarah Pickup, deputy chief executive at the Local Government Association, and Adam Roberts, head of economics at the Health Foundation, delegates were told that in many ways it is business as usual. “Last week’s priorities are still this week’s priorities,” said economist Adam Roberts. According to Ms Pickup, for local government the priority is to secure as seat around the discussion table. “Local government is well placed to take a lead on some aspects of the legislative powers that are handed back from Europe. We don’t want all the power going to Whitehall,” she said, calling for assurances on finances and ongoing engagement with communities. Looking ahead to the autumn spending review, Mr Roberts noted that the long term sustainability of the NHS depends on robust long-term economic growth. Lord Lansley responded: “Both sides of the referendum argument have said that the NHS needs to be better supported, and if every politician believes that the NHS is a priority, this must feature in the autumn spending review.” But, he warned delegates not to expect a £350m weekly cash injection into the NHS in lieu of the UK’s EU membership contributions. He said that the assumption that this would revert to the NHS was never “remotely correct”. He said: “The amount due back to the UK from the EU is closer to £120m per week maximum and this is promised to a wide variety of supplicants, which have promptly started putting in their chit.”
“More people would admit to watching porn than admitting they voted for Brexit.” Adam Roberts
Roy Lilley, health policy analyst, writer, broadcaster and commentator on the National Health Service and social issues.
A LIMITED AMOUNT OF COMPLIMENTARY CONFERENCE PASSES WILL BE RELEASED IN JANUARY. GUARANTEE YOUR FREE PLACE AT THE 2017 CONFERENCE BY PUTTING YOUR NAME ON THE WAITING LIST HERE
28–29 June 2017 | ExCeL London
THE FUTURE LOOKS BRIGHT #d8197d
Health+Care experts agree At the end of a busy and very successful show Dr Mike Dixon, Chair, College of Medicine, asked a panel of experts what they thought the future holds for health and care. The consensus was that the there will be testing times ahead but with innovation and the talent and dedication of staff the future still looks bright.
edia guru and broadcaster Roy Lilley, said:
“What I get from this conference is that there is a huge amount of talent and optimism in the NHS. This is the time for us to work together, circle the wagons, be more innovative and accept that the time has come to do things differently. We need to get on with the Five Year Forward View now. We need to focus on what’s important, protect the front line, fund it properly, make it fun to work there and if we work together we will see ourselves through what I think we all agree will be a very difficult time ahead.” Professor Sir Mike Richards, Chief Inspector of Hospitals, Care Quality Commission, said: “We are just coming to the end of our first round of hospital inspections and what has come through is the caring and compassion of our staff and
the dignity and the respect that they show to patients. We have got some fantastic talent. As the financial squeeze gets tighter we must look for innovation but at the same time we mustn’t forget the basics because we will still need hospitals and specialist services but by working together we will be able to come through this period.” Dr James Kingsland, President of the National Association of Primary Care, observed: “The future is bright and what keeps me going is the enthusiasm and appetite for change of the people I meet at this type of conference. What is getting me really enthused is the Primary Care Home programme being developed by the NAPC. It is going to have half a million population coverage in England and we are aiming to have five million coverage by the autumn.” Julie Wood, Chief Executive of NHS Clinical Commissioners, said: “What I’ve been hearing over the two days is that integration of health and care is critical for our future and we must make sure we deliver that. Clinical commissioning is here to stay but CCGs must evolve. Payment systems need to support integration and transformation and we need better and more joined up place based regulation.” Sir Sam Everington, GP, National Advisor New Models of Care and Chair, Tower Hamlets CCG, set out a wish list: a majority of clinicians on every trust board; 1000 professors of general practice and 1000 professors of nursing; end the war with junior doctors; cut NHS regulators by 75% and invest in quality improvement; make Skype consultations the norm for every clinician, introduce social prescribing in every primary care setting; appoint a Chief Medical Officer in the Department of Education to look after the health of children; finance medical schools on the places they deliver for the workforce and end payment by activity immediately. Dave Sweeney, Director of Transformation and Deputy Chief Officer, NHS Halton CCG and Halton Borough Council, said:
DO WE NEED A FIVE YEAR FORWARD VIEW PLAN B? With the clock ticking loudly are we on a trajectory for success with the Five Year Forward View or do we need a plan B, a panel of experts was asked at Health+Care
“What I have seen from two days at Health + Care is that we have huge amounts of technology and artificial intelligence but we need people to make it work. Secondly for me it is time for social movement - for example we have put out a call to action out that no child in Halton will go to secondary school weighing over the national obesity levels. This is a big opportunity to start rallying our communities for the good of all.”
ndrew Haldenby, Director of Reform, said: “The Five-Year Forward View is trying to do the right thing but we have seen the limits of its ambition and that’s why we need Plan B to go a bit further. We can see big change in primary care in organisations such as the Lakeside Healthcare and Modality super practices but there isn’t in any way the same degree of change in acute or social care so we should focus our attention there.” Sir Sam Everington, GP, National Advisor New Models of Care and Chair, Tower Hamlets CCG, said: “We need Plan B to happen now. Let’s get rid of choose and book, e-refer patients to hospital and reduce outpatients by 20%. Let’s have social prescribing in every general practice, let’s recruit more professors of general practice and let’s put consultants completely in charge of hospitals.” Professor Paul Corrigan former Health Policy Advisor to former Prime Minister Tony Blair said we currently have a system of healthcare that is very good in dealing with episodic healthcare but is not equipped to deal with the increasing demand from older people with multiple long term conditions. “The problem is we have got a healthcare system that intellectually recognises the need to change but we have got a leadership that is hampering that change because it is putting most of its money into stabilising the old model of care, which can’t be stabilised. Our leaders are not putting sufficient thought and time to move with speed and pace into what should be reform plan A. What this means is that Plan B, which should be ready by 2020, needs to be here now to deal with the current crisis in healthcare.”
28–29 June 2017 | ExCeL London
WHAT THE COMMENTATORS HEARD AND SAW #0072bc
Mind over matter
ental, health has always been something of a Cinderella area – this despite the demand for mental health services soaring. While there has been some progress, for example, the publication of the Five Year Forward View for Mental Health and some transformational treatments, there are still gaps, the panel agreed. Dr Geraldine Strathdee, former clinical director for health, NHS England Dr Caroline Dollery clinical director for the strategic clinical network for the east of England for mental health, dementia, neurology and learning disabilities/ autism and chair Mid-Essex CCG, Phoebe Robinson, deputy head of mental health and senior programme lead, mental health, medical directorate, NHS England and Tim Kendall, national clinical director for mental
Geraldine Strathdee health in England agreed that substantial change won’t be achieved without STPs putting mental health on an equal platform with physical health. The session highlighted the lack of focus on the important area of mental health:
Dr Caroline Dollery Tim cited the correlation between long term illness and increased likelihood of mental health problems while Caroline argued that STPs don’t yet have enough data or detail about the effects of mental health on performance, quality and finance.
Tim Kendall Lastly, all speakers called for an open conversation and more publicity about the issues. Positive outcomes, they said, must be promoted in a language that can be understood by all audiences.
“Integrated care is a dimension of quality not a set of interventions – it means I tell my story once.” Chris Naylor, Senior Fellow, King’s Fund
“We need to concentrate on giving people a life – not a series of services.” Prof Martin Green OBE, Care England
“There may be those quite understandably I the NHS who are expectantly waiting for £350m a week to turn up. Frankly it was never remotely correct.”
key feature of the show was about health and social care integration – the ambition, the need - and the reality of separate organisations working together. In East and North Hertfordshire, health and social care teams have been working together for years, long before the notion of integration became universal. Paul Fenton, Vanguard Programme Manager and Kulbir Lalli, Head of Integrated Accommodation Commissioning, imparted the results they’re getting from their HomeFirst programme. In order to keep older and vulnerablepeopleoutofhospitalandgive those care homes a better experience, they’ve joined up commissioning and providers, redesigned workforce and harnessed technology – notably using data sets from several agencies to get a rich understanding of the people at risk and using the results to intervene before someone’s condition requires hospitalisation. It really is true integration.
United we fall
he collapse of the £726m UnitingCare contract in December last year was “the biggest waste of money and loss of potential I have witnessed in my 38 years of public service”. So said Julie Spence, chair of Cambridgeshire and Peterborough FT in the first public appearance from a provider involved in the now infamous contract which was halted just 8 months after it got off the ground. Hers was only one perspective she acknowledged. July’s National Audit Office Julie Spence report may bear her out. Meanwhile the work to build better integrated community services that was started by UnitingCare continues. Ms Spence revealed that during Health+Care week, all acute, mental health and community providers in Cambridgeshire and Peterborough signed up to create an accountable care organisation.
“The UnitingCare contract was the biggest waste of money and loss of potential I have witnessed in my 38 years of public service”. Julie Spence OBE, Chair Cambridgeshire and Peterborough NHS Foundation Trust
28–29 June 2017 | ExCeL London
Dispensing health #0072bc
irst results about the impact of primary care pharmacists are now emerging from the 17 GP practices in the West Wakefield multi specialty provider vanguard. In just six weeks from May 1 2015, primary care pharmacists saved 976 GP hours. What GP’s did with those hours remains to be seen but it could well have included going home on time for the first time in years.
“We won’t be regulating apps” David Behan, CQC
ver in the West Midlands, home of the only mental health vanguard, the first green shoots are showing. The focus is on crisis care and recovery. Simon Gilby, Coventry and Warwickshire Partnership FT, reports that centralised bed management should this year see a single number to check for bed availability. A small step for communications technology perhaps. A massive one for avoiding those costly - in every sense - out of area mental health placements.
Digitising social care
Boring but important
• Delegate numbers up eight percent on last year
ust in case you’ve been living in a cave for the last few years – or had forgotten, Margaret Wilcox (vice president, ADASS), Adam Roberts (head of economics, the Health Foundation), Simon Worthington (finance director and deputy chief executive, Bolton NHS Foundation Trust), and Tom Jackson (chief finance officer/deputy chief officer, NHS Liverpool) reminded us of the dire state of the health and social care systems. While Adam’s financial analysis was bleak, the view was that hospitals and A&E are overwhelmed partly because of what primary care and social care aren’t doing - but have the potential to do. The overwhelming consensus was that the NHS isn’t strong enough to survive with a collapsed social care system. The need for health and social care integration has never been greater as we can no longer afford to live with the consequences of separate systems. Sound familiar?
very now and then, you see something that makes you think “why haven’t we been doing that before?” – and EveryLIFE technologies PASSsystem is a case in point. The PASSsystem provides a single view of care records from enquiry, assessment, medication and task changes and reviews – meaning less time printing and disseminating, less time duplicating notes and less time on administration. EveryLIFE technologies and Lloyds Pharmacy chose Health+Care to announce a solution that digitally tethers the administration of medication in domiciliary care with the pharmacy that dispenses it. PillPass is an extension of PASSsystem that creates a single Medical Administration Record (MAR) that can be updated in real time as drugs are given to residents. Lloyds Pharmacy is linked into the same MAR and does not have to create or manage its own version. It’s a classic example of how technology harnessed properly, can make the health and social care sectors safer, more transparent and more effective.
“I don’t believe £22 billion saving is possible in this parliament.”
• Satisfaction levels at 98% • 91% of exhibitors who have booked for next year.
“South Yorkshire and Bassetlaw STP will adopt a system control total from April 2017, covering potential deficit trusts.” Sir Andrew Cash, Chief Executive of Sheffield Teaching Hospitals NHS Foundation
“We absolutely need more mavericks in primary care.” Dr Jonathan Serjeant, clinical director at Brighton & Hove Integrated Services Lord Carter of Coles
he insights delivered by Lord Carter’s productivity review continue to mount. He’s been round the country and seen the best and the worst to build his model hospital. Or, as Lord Carter put it: “At one end we have people doing wonderful work and we have complete idiots at the other end - and people in the middle who could do better.” Would that be a, um, normal distribution then?
“At one end we have people doing wonderful work and we have complete idiots at the other end - and people in the middle who could do better.” Lord Carter of Coles
Home sweet home
eflecting the show’s theme, Dr Steve Kell from Beacon Medical Group, explained how Primary Care Home uses multidisciplinary teams to best effect – both for the provider teams and for patients. The transformational facet of Primary Care Home is that they don’t believe in a one-size-fits-all approach to delivering the best care – only that all care is team-based. It’s not a question of finding more GPs, it’s about taking a populationlevel approach to health. Social prescribing, closer collaboration with community pharmacy and with the voluntary sector are just some of the tactics Primary Care Home is trying to achieve better outcomes and greater efficiency.
“I prefer the term disruptor – innovators are, by necessity, disruptive.” Stephen Dorrell, Chair, NHS Confederation (in response to Dr Serjeant’s statement)
“The fact that we’ve got more regulation is our fault for letting things slip, so now we’ve got it I’d like to see it as supportive, productive, proportionate and placed-based.” Dr Phil Moore, Deputy Chair (Clinical) Kingston CCG
“The system is obsessed with itself, we can only claim success when the system becomes invisible.” Prof Martin Green OBE, Care England
www.healthpluscare.co.uk 28â€“29 June 2017 | ExCeL London
2016 In Pictures
www.healthpluscare.co.uk 28â€“29 June 2017 | ExCeL London
28–29 June 2017 | ExCeL London
INTEGRATED PERSONAL COMMISSIONING IS HERE TO STAY, EXPERTS AGREE #0072bc
Is integrated personal commissioning a side show or a main event, three key opinion leaders were asked at Health + Care.
am Bennett, Head of Integrated Personal Commissioning, NHS England, said: “The programme enables people to play a more active role in their health and well-being and to take more control and have more choice over their care and has huge transformatory potential. We see it as an essential counterbalance in future to the whole population commissioning model with it working within or alongside new models of care. It should ensure that people with some of the most complex needs that
need the most personalised approach can access that through a supporting and enabling framework. “So while it doesn’t replace the need other forms of structural integration and budgetary integration at a macro level it is going to be an important part of the future commissioning landscape and I would argue that it will in future provide a more nuanced framework for health and social care integration.” Alex Fox, Chief Executive of Shared Lives Plus, said: “What is crucial to understand about integrated personal commissioning is that it is more than a culture shift, it’s also very much about a power shift through personalisation and social care. It isn’t just about new mechanisms it’s around an idea
that care should have different kinds of outcomes and there should be different kinds of relationships between health and social care services and crucially the people who use those services.” Marisa Rose, Integrated Care Programme Director, Islington Council and Islington Clinical Commissioning Group, said: “Integrated personal commissioning is really complimentary to the new models of care in terms of giving a counterbalance to whole population approaches by enabling us to get money down to individuals across health and care. It’s also about having a different conversation with them around personalised choice and opportunity.”
GOOD LEADERSHIP IS THE KEY TO HIGH QUALITY GENERAL PRACTICE Practices that achieve an “outstanding” rating from Care Quality Commission (CQC) inspectors have amazing leadership, Professor Steve Field, Chief Inspector of General Practice, told Health + Care. Professor Steve Field
ata from the first 2,500 inspections show that quite a few of these top GP practices are led by women and a number are social enterprises. Dispensing surgeries tend to be rated highly and those with APMS contracts tend to do better than those receiving GMS funding. The CQC has also found a correlation between funding and good care. “Leaders in outstanding practices tend to increase the practice income from sources such as Public Health England, charities and
local government, because they are more entrepreneurial and go to other funding bodies,” said Professor Field. Geography is also a factor – practices in Devon and Cornwall are likely to be rated as good or outstanding but there are proportionately far more inadequate practices in London and parts of Essex, Reading and Birmingham than elsewhere in the country. In many of the inadequate practices problems arise because of a lack of leadership, sometimes caused by partnership problems, the practices not being aware of standards they are required to meet or have lacked support over the years. A good practice is characterised by high scores from patient surveys with patients
recommending the practice, saying the GPs show concern care and concern and involve them in decisions. Practices with more GPs tend to achieve higher ratings and although smaller practices are more likely to be rated as inadequate there are still some fantastic single-handed practices, said Professor Field. To date the CQC has rated 4.4% of practices as inadequate, posing a risk to 871,000 patients. However most of the practices (87%) that have had to be reinspected have improved. “The data shows that the bulk of general practice in England is good or outstanding and that the CQC is having a positive effect on the very poor quality of care in some areas,” concluded Professor Field.
KNOW YOUR NUMBERS AND COMMISSION FOR VALUE IN ATRIAL FIBRILLATION
When it comes to medicines optimisation in atrial fibrillation (AF) it is important to know from your records how many patients are missing, how many have outcomes that are not to target and how many are reported as an exception. Dr Duncan Jenkins, specialist in pharmaceutical public health, Dudley CCG and office of public health, said: “If you don’t know your numbers demand them.”
• Issues affecting medicines optimisation in AF include: • New Oral Anti Coagulants (NOACs) vs warfarin • Interpretation and implementation of NICE guidance at local level • Prescriber confidence and competence • Patient selection • Practical issue such as dosing and side effects • Achieving a coordinated approach. According to Dr Jenkins, medicines
SAVE THE DATE 28-29 June 2017 www.healthpluscare.co.uk/2017waitinglist 28–29 June 2017 | ExCeL London
optimisation is not just a one to one interaction but also a tool for use at population level. He said that one solution is to draw up a ‘5Ps value model’ comprising goals that allow the organisation to meet quality premium targets, improve patient care and comply with NICE guidance. The 5Ps relate to product, patient, pathway, programme and population. Dr Jenkins also promoted Daiichi Sankyo AF reports that can help inform decision-making.
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28–29 June 2017 | ExCeL London
RIDE THE WAVE OF INTEGRATION – YOU MIGHT EVEN ENJOY IT!
There are now 50 vanguards across the country, all working to addressing the gap in the Five-Year Forward view in relation to health and well-being, the variation in care, quality, finance and sustainability, Jacob West, National Lead for Primary and Acute Care Systems and Acute Care Collaborations, told delegates.
Do you see integration as an unstoppable wave that feels overwhelming? Or, are you riding the wave – and enjoying it along the way?
Progress to date
“The golden thread running through all the vanguards is a focus on integrated care and population health,” he said. “It has to be about local ownership which is clinically led and engages patients and service users. If you don’t get that right then really everything else is of little concern. It’s about the how you change and it really runs so everything we do.” Early examples of progress include: • North and East Herts Care Home vanguard has reduced hospital admissions by 7.2% in Lower Lea Valley and reduced A&E attendance in North Hertfordshire by 14%. • Southern Hampshire Better Local Care has set up a Same Day Access Service which is resulting in greater GP availability, better working conditions for practice staff, longer appointment for patients with complex conditions and reduced waiting time for routine appointments. • Mid Nottinghamshire Better Together is providing preventive care to patients deemed at high risk of future admission through multispecialty teams, proactive interventions and a reduction of around 1500 hospital admissions.
T Jacob West is making the most of new technology: 70% of patients say the new system has improved their access to care. Mr West said success for the three year programme would be defined by two things - firstly that the vanguards succeed on their own terms, they will also fail but they will learn rapidly from their mistakes. Secondly that the new models of care can be adopted across the country. The goal is that half the country by 2021 will have access to the new care models in different forms. “The test of the vanguard’s success will be when these care models become the new norm, when staff really want to work in them and patients start to demand access to them,” he said.
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• Modality through an expansion of online services and service redesign
hose were the questions posed by Jennifer Mellani, head of health and social care, Essex legal services at Essex county council, and Sheila Norris, director for commissioning integration, Essex county council, in a presentation designed to give practical tips and hints to help organisations unblock governance barriers to integrated care. Speaking in the Health + Care forum for NHS right care – commissioning for value, Ms Mellani said that organisations considering integration should see governance “not as an end in itself” but as an aid that helps you “to do things differently.” Among the drivers to integration were the forecasted rising demand for social care, improved user experience of health and social care, and legislative requirements. In Essex there is a vision to promote prevention and early intervention, and create resilient communities that can self care and reduce their need for acute care, she said. To achieve this vision requires the following: • Open dialogue with authorities and learn from others • Understand and respect governance processes
• Find the common goal and design joined up strategies, for example, use the health and wellbeing boards as the forum for sharing data and implementation • Set common outcomes focused on the needs of the community and designed in partnership • Involve specialists at the beginning of the process and consider flexible implementation, while not losing sight of the overall strategic goals • Build awareness of the importance of integration and make integration a
Jennifer Mellani standard Board discussion item • Build trust between partners • Commit to real time learning and evaluation. The presentation also profiled the West Essex experience where an accountable care partnership model was set up as an interim model to deliver integrated care while an accountable care partnership for health and social care was developed. Features of the interim model include: • A strategic commissioning partnership (SCP) board, set up as a working group and made up of all commissioners with strategic oversight of partnership projects • No formalities or legal entities involved. The SCP commissions an accountable care partnership to provide the services, in an outcomes based model Features of the definitive model include: • Single model of contracting with a single legal entity, the accountable care organisation (ACO), with responsibility for whole system delivery for a registered body of people under a delegated capitated budget or expenditure target • ACO can subcontract provision under collaboration agreements or memos of understanding. Subcontractors can enter into alliances or collaborations to share risk and reward.
GET AHEAD BY EMBRACING CHANGE AND NEW WAYS OF WORKING, SAYS NATIONAL CARE FORUM CHIEF Change is constant in the social care market and austerity is set to continue, so commissioners and providers of care home services need to innovate, be flexible and find new ways of working.
his was the advice Sharon Blackburn, Policy and Communications Director, National Care Forum, gave to delegates in a talk on how to make sense of the Care Act. She said the current provider market was fragile and there were continuing concerns about quality. “So commissioning, market shaping and understanding what’s needed locally is really important. Personal budgets and direct
payments are going to be the new forms of commissioning which will need to be used to influence local markets and the sustainability and pace of change.” She said commissioners and providers needed to make sure they were having the right conversations, making the right decisions and were including the voice of people and carers. There were new opportunities to benefit from pooled budgets, to use the workforce differently and get out of professional silos to look at the perspective of the person using the service and ask what’s best for them? Integration was no longer an option but a necessity and should involve not just health
and social care but also housing. It involved looking outside the traditional care services and thinking about new models of care and people as citizens rather than customers. “This is about leadership at all levels of an organisation and particularly the frontline manager. Every one of your staff that you work with is a leader which gives you the ability to affect some change. It’s important to find out what your staff can do, what their strengths are then to use them not only for the benefit of the service that you are offering but also for the benefit people using the service. “There are lots of stormy times ahead but use the opportunities to get out there and learn to dance in the rain,” said Ms Blackburn.
28–29 June 2017 | ExCeL London
HEALTH+CARE DEBATE EXAMINES SOCIAL CARE “ON THE BRINK” A panel of four key experts in health and social care was challenged to get a ‘quart out of a pint pot’ in a keynote theatre debate at the Health + Care conference and exhibition.
oining debate chair, the College of Medicine’ Dr Michael Dixon, were Margaret Willcox, vice president of The Association of Directors of Adult Social Services (ADASS), Adam Roberts, head of economics at the Health Foundation, Simon Worthington, finance director and deputy chief executive, Bolton NHS Foundation Trust, and Tom Jackson, chief finance officer and deputy chief executive, NHS Liverpool CCG. In the debate the panel was challenged to suggest how the NHS could survive with social care described as “on the brink of
collapse’. Taking up the baton of financial efficiency, Mr Worthington said a priority was to put some financial discipline back into the system. He said: “People have the idea that achieving financial targets is not possible; they are concentrating only on delivering quality commissioning and not on their regard for their financial duty.” He added that NHS organisations achieved a surplus when they adopted a ‘can do’ attitude. He said: “We need people to be really engaged with saving money as well as delivering quality services.” Economist Adam Roberts agreed that Trusts need to move away from deficit acceptance. He said EU contributions freed up post Brexit would not come “any time soon”. “The NHS’ long term situation will depend on what deals we strike and how this allows the economy to grow. In the
meantime, we need to get a grip on finances. England is not alone internationally with these pressures.” Liverpool CCG’s Mr Jackson added that the Sustainability and Transformation Plan only gives CCGs a very short time to get their plans in place and working. Chairing the debate in front of packed keynote theatre on the opening day of Health + Care, Dr Dixon pointed out that the
effect of failures in primary care and social services were felt in the NHS in the form of “full up A&E departments and hospital beds”. On behalf of ADASS members, Ms Willcox admitted that social services were under pressure from factors including a 30 per cent budget cut and growing workforce concerns. She said: “We need to add at least one million workers over the next few years but it is just not that attractive a career option”. The spectre of post-Brexit immigration controls post-Brexit was likely to exacerbate the problem, she said. But social services had managed to make savings so far, and most people were satisfied with the care they receive, she believed. A solution could be to redirect acute care resources. “We need to see it as the local Pound that we have to spend between us as part of one budget.” Audience members pointed out that previous transfer of services to local authority control had resulted in a loss of expertise and morale, and that moving away from a predominantly medical model could be problematic. #0072bc
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PROVIDERS REVEAL HOW TO REDUCE REFERRAL TIME How much clinician time is spent acquiring the knowledge necessary to navigate patients through referral pathways?
his was the question posed by Dr William Lumb, GP and chief clinical information officer at NHS Cumbria, in the provider theatre session entitled: dynamic resource matching and impact on delayed transfer of care – air traffic control for patients. Dr Lumb told the audience that robust health system architecture was needed to signpost patients to the right care offer - when there are so many options to choose from. Using Strata Health’s Pathways referral management system, child safeguarding referrals could be reduced in time from two hours to 15 minutes, he said. Another advantage is that errors could be greatly reduced, so that declination rates can be interrogated to reveal pressure points in the referral process. He said clinicians needed context-, age- and geolocationspecific information in real time, as well as integration with acute andcommunitypatientrecordstofacilitatepatientmanagement. “A navigation piece ‘in a wrap’”, he said to summarise.
28–29 June 2017 | ExCeL London
HEALTH+CARE UPDATE ON THE BETTER CARE FUND #d8197d
In a presentation at the Health + Care conference, delegates were updated on the Better Care Fund by Anthony Kealy, national programme director of the Better Care Fund, and Dr Tim Moorehead, chair of NHS Sheffield CCG.
ealth and social care delegates learned that by the end of July, there will be real progress towards the 2020 deadline for plan implementation. Outlining the key BCF achievements, Mr Kealy highlighted: • £5.98bn pooled – 11 per cent more than in 2015-16 and 53 per cent above the minimum of £3.9bn • in 49 HWBs - the funding pool has been increased by more than 5 per cent • 21 HWBs are planning for a financial risk share linked to non-elective attendance • sizable amounts of money going towards out of hospital services: In HWBs 43 per cent of funds are allocated to social care
and 36 per cent to community care. He also looked at life after the BCF and said that areas graduating from the BCF will adopt new models of commissioning/ provision of integrated services using the Sustainability and Transformation Plans as an overall framework and dashboards to measure their progress, said Mr Kealy. But, in a question to delegates, Dr Moorhead asked whether the Better Care Fund has the credibility it deserves. In Sheffield, providers are under extreme pressure and severe financial viability problems and there is a £9.3m recurrent funding problem in social care. He said: “There is no magic solution, and a lot of conversations to be had.” And, noting the Brexit effect on workforce, he said. “If social care is not working, it will fall on the healthcare service, which is much more expensive and it isn’t right.” In Sheffield the BCF programme implementation has four strands: • Ongoing care – comprising shared
assessments and joint approach to ongoing health and social care • People Keeping Well – an interventionist approach using risk stratification to provide support opportunities • Independent living solutions - retendering a completely different approach to providing equipment • Activity support and recovery. While there are some excellent outcomes, the following problems remain: • admissions to hospitals continue to rise way beyond the level of evidenced need • too many people wait in an inappropriate care setting while staff solve problems caused by the system • too many people end up in long term care after an acute admission • money is still in the wrong place. Causing the problems are a lack of understanding of each other’s ‘worlds’ and different planning cycles, financing and
Tim Moorhead commissioning maturity cycles, said Dr Moorhead, who advised: “It’s about being much better about coordination of services around people, giving fewer opportunities for people to fall through the gaps between services, and replacing disjointed services in silos with one integrated offer.”
This is our third or fourth year, and this year we have two stands, one specifically for women’s health. Coming to Health + Care gives us a showcase for our different skills and capabilities and not just our drugs. This immerses us in the commissioning landscape which is very complex with more important influencers than ever before. This is a way to engage with a broader range of stakeholders than we would get at a clinical or pharmacy conference. In this broader commissioning environment Health+Care gives us access to key people.” Kuldip Sembhi, Area healthcare lead, MSD
LESSONS FROM A US REVOLUTION IN INNOVATIVE PATIENT-CENTRED CARE Employing risk stratification processes and care management tools across health systems can revolutionise health care Amir Dan Rubin, Executive Vice President of Optum and Chief Executive of Optum 360 told Health + Care.
former chief executive of Stanford Health Care, Mr Dan Rubin explained how using these tools in the US they had been able to reduce in patient bed days by 50% and significantly improve the patient experience. In the US 50% of healthcare spending is accounted for by 5% of the population accounts and 35% is spent on a further 20% of the population. So by risk stratifying
the population they were able to more effectively provide support services and target proactive, meaningful interventions for specific health populations such as those with complex or chronic needs and those who are well. They identified those patients with the highest likelihood of inpatient admission in the next six months for congestive heart failure, COPD or diabetes then provided outreach services to those patients. This resulted in a reduction of 30% in emergency department visits, a 30% reduction in inpatient admissions and a 4% reduction in mean blood glucose levels of people with diabetes. Other reforms included more closely co-ordinating care for people with complex
conditions, providing immediate access to urgent care walk in centres and arranging services and specialists around the patient and their family members. For well patients they worked to bring together medical and social services, offered them access to senior centres, day centres, exercise programmes, movie nights and offered free transport to the centres and for medical visits. In addition they improved workflow by improving the organisation of their clinics to make them run more smoothly. This resulted in more patient visits per day, increased revenue and improvements in both the patient and clinician’s experience. “At Stanford Healthcare we managed to grow significantly yet also improve the
Amir Dan Rubin patient experience so I do think there is a case for new models where we can improve the population’s health, improve care and improve value,” said Mr Dan Rubin.
28–29 June 2017 | ExCeL London
MAKING THE MOST OF DEVOLVED COMMISSIONING #0072bc
Devolved commissioning is an opportunity to move away from generic offers, undifferentiated services and unregulated providers to a system of multiple contracting models, options and services designed around clinical need, Denis Gizzi, NHS Oldham CCG managing director, told delegates in a Health + Care facilitated learning session.
defined and executed, and if professional groups are not held to account. In the view of Mr Gizzi, three factors are important in commissioning success: • Demand controls – doing the right thing all the time
Considerations will include: • System dynamics and incentives
n a talk entitled NHS Forward View - a CCG strategic view on changes, relationships and opportunities, Mr Gizzi said: “Primary care is the fulcrum of everything – get it right, then great. Get it wrong and it is the end of primary care as we know it.” He said that commissioners need to be able to develop local models that utilise a blend of micro (single practice), meso (partnerships) and macro (federations) providers. He warned that it will end in failure if the strategy is not carefully
• System controls – doing things most cost effectively all the time • Market entry controls – shaping the right things all the time.
• Governance and organisation • Culture and capability • Ability to optimise resources. But, he says, within primary care commissioning there is “still a feeling that we don’t need to [reconfigure services]. But like a tsunami, you don’t realise how big it is until it is upon you and it’s too late.” Among the obstacles are factors such as: • Disaggregated system makes joining up difficult
• Self-interest/change averse professionals get in the way • Powerful organisations and self interest • Consensus culture prevents action – small wins are hard fought • Single initiatives make it difficult to build an integrated journey • Ability of cross sector leaders to resolve system constraints • Lack of change management and transformation capability • Culture of no-losers mitigates bold decision making • Lack of inclination to stop doing things that offer low value • Mind-set of in-year finance and return in year • Wrong estates in the wrong place and difficult to divest
• Lack of appreciation at the impact created by tolerated variation.
HARNESSING TECHNOLOGY TO ADDRESS LONG-TERM CONDITIONS IN GREATER MANCHESTER For Dr Shaaz Mahboob and colleague Dr Junaid Bajwa, reducing the incidence and delaying the progress of long-term conditions (LTCs) is crucial step for the NHS. In their presentation at this year’s Health+Care event, the two medics pointed to 2020 and explained that the cost of supporting these conditions would, at this rate, be no longer sustainable.
urrently, LTCs account for almost 70% of overall NHS spending, 50% of total GP appointments and 70% of inpatient bed days – representing a huge strain on the country’s health service. Through an NHS test bed, based in Heywood, Middleton and Rochdale (HMR) CCG territory, programme directors Mahboob and Bajwa are working with numerous technology partners, including Alphabet’s Verily Life Sciences, and a network of health professionals to establish
local services aimed at solving problems typically associated with LTCs. According to the team, working beyond general practice with wider digital and healthcare assets could provide patients with actionable insight which could completely transform LTC care. The HMR test bed aims to support professional engagement, care integration and remote monitoring around a pro-active self-management system, optimising the quality of service for patients. Using
existing capabilities, including informatics programmes from MSD, and data science tools such as Verily, the researchers hope to improve recognition and facilitate early intervention to slow the progression of LTCs. The first data extraction for the HMR test bed is expected over the coming weeks. From this October, the programme will be fully integrated with MSD analytics tools and could have Verily functionality by the start of 2017. The full solution could be in place by March next year, added Bajwa.
“Scaling up the approach across Greater Manchester could save up to £341 million by 2025. And we are well-placed to scale, with all partners fully-committed and our local communities have a strong track record for innovation uptake,” Dr Shaaz Mahboob Shaaz Mahoob
28–29 June 2017 | ExCeL London
HOW THE INTERNET OF THINGS IS REVOLUTIONISING HEALTH AND CARE #d8197d
The Internet of Things (IoT) holds huge potential for the future of healthcare in the UK, said Idris Jahn, IoTUK’s head of health and care, in his address at Health+Care 2016.
oTUK, a digital catapult formed last year, aims to place the UK at the forefront of IoT adoption by encouraging data-sharing
and collaboration across public, private and academic organisations. The Londonbased group helps coordinate large-scale demonstrators and supports SMEs in the development and delivery of IoT solutions. Alongside wide-ranging projects, including Smart City innovation, new energy systems and research into connected agriculture, Jahn noted that one of IoTUK’s key agendas is working alongside the NHS on its IoT test beds. Of the seven NHS test beds, two are dedicated specifically to the Internet of Things, concerning IoT applications to improve care for dementia and diabetes patients. Jahn explained that in order to truly revolutionise how we manage these conditions, the test beds are seeking to ensure confidence in the new IoT technologies through testing and analysis. A short film shown to the Health+Care audience revealed: “The NHS IoT test beds are trialling new technologies, monitoring them and conducting data analysis to discover new ways of working. They will show how IoT can bring financial benefits to the health sector, develop evidence to
DIGITAL HEALTHCARE 28–29 June 2016 | ExCeL London
DIGITAL THE FUTUREHEALTHCARE OF HEALTHCARE IS HERE. The brand new Digital health and technology event from the team behind Health+Care.
support wider adoption, and fully cement the UK’s leadership in IoT innovation.” Citing UK-wide research, Jahn explained that the majority of IoT products and services are concerned with healthcare, in a predominantly home-based setting. “The elderly population, and patients with longterm illnesses are increasingly demanding independence in managing their health and there’s a growing desire to keep this care at home,” he said. According to Jahn, this trend opens up huge opportunities for businesses looking to provide IoT-based healthcare solutions. He suggested that these products could support the improvement of communication between various carers, and medicine adherence, among other ideas. “Being a tech savvy nation, patients are demanding technology in all aspects of their lives including healthcare and fitness,” said Jahn. “We need to be borrowing experiences from other sectors…like online retail and delivery tracking for example.
Once a patient has been diagnosed with an illness we should be letting them know what lies in front of them and be helping them to understand what’s involved…” Jahn argued that as technology becomes increasingly accessible, with cloud enablement and improved capacity and connectivity, startups should be encouraged to dabble in IoT solutions. “Decreasing sensor sizes, power consumption and price, means that IoT prototypes can be cheap and almost disposable, allowing businesses to test their new ideas and conduct more experimental projects.” Jahn concluded his session emphasising the importance of data at the centre of the IoT revolution: “All these apps, devices, services and products are all about the data – As IoT expands it is critical that we bring data streams together across healthcare, avoiding information silos and allowing for better analysis of what’s really right for patients.”
DIABETES DIGITAL COACH: THE VISION FOR THE IOT NHS TEST BED As a key area of concern in the West of England and partnerships already convening to tackle its challenges, diabetes was a clear choice for consideration at the time of the NHS test bed open call.
he local Academic Health Science Network (AHSN), responsible for driving innovation and promoting mainstream adoption of new technologies in the region, recognised the demand for education and self-management from diabetic patients and carers, and sought to find out how Internet of Things-enabled technologies could play a part in achieving this goal. The pilot, titled Diabetes Digital Coach, aims to make it easier for patients to manage their condition and balance the complexities of juggling blood tests, insulin injections, diet and exercise, and other routines associated with diabetes management. Speaking at Health+Care 2016, Idris Jahn, head of health and care at project partners IoTUK, explained the process of bringing together selfmanagement app developers to create a digital platform that would fit seamlessly into patient lives. In a short film shown at the session, Elizabeth Dymond, deputy director of enterprise at the West of England AHSN, said: “People have busy lives. You have to manage the condition 24 hours a day, 7 days a week, but you’ve got to live your life, work, travel, look after your family, do all the things that we all need to do. It needs to be about making it easier for people to manage their condition in a timely way.” The programme, which is aiming to recruit around 12,000 participants, is trialling a number of existing technologies
Elizabeth Dymond including wearable devices and apps that monitor insulin levels. From these sensors the Digital Coach will gather data to feedback real-time actionable insight to the patients and associated healthcare professionals. Sandra Tweddell, co-ordinator at the Bristol Diabetes Support Network, commented: “The Digital Coach will provide technologies to enable diabetics to see exactly what is happening with their condition, so they can take action. Hopefully, ten years down the line the number of complications will reduce – that’s the big vision!” The Digital Coach platform will allow users to track their condition and have control over where their data is sent. The patients will be given the choice if they prefer to manage the data themselves, or to share it digitally with their consultants. Jahn noted that if the test bed project proves that the diabetes model works well, it could be easily extended into other longterm conditions.
28–29 June 2017 | ExCeL London
PRACTICAL IMPLEMENTATION OF BIOSIMILARS The cost-saving potential of implementing biosimilar products is of current interest, although the hidden cost of setting up and running the service also need to be considered. This was the principal theme during the Practical Implementation of Biosimilars symposium, supported by AbbVie, at the Commissioning Show June 2016. Article organised and funded by AbbVie.
iologics have revolutionised the treatment of many debilitating disorders, enabling people to resume normal daily activities. Extensive preclinical and clinical studies need to ensure that there are no clinically meaningful differences between biosimilars and their reference product.1 Leading bodies recognise the importance of providing best practice guidance on the use of biologics Key considerations for the introduction of biosimilars:1 • No automatic substitution • Brand name prescribing and batch number recording to ensure traceability and pharmacovigilance • Involving patients in decision making • Switching medically stable patients from an originator to a biosimilar should be managed at the discretion of the individual prescriber in partnership with the patient, with appropriate monitoring. Vital to “get your house in order” The experts stressed that it is important that the biologics service be in very good order and NICE compliant before implementing a biosimilar switch programme. The importance of transparent relationships with the three main stakeholders (the Clinical Commissioning Group, clinicians, and patients) was emphasised, to achieve what’s best for the patient as well as the health economy.
Dr Zoe Cole
Hosted by Sue Saville
Consultant Rheumatologist, Salisbury District Hospital
Medical Journalist and Broadcaster
Specialist Biologics Pharmacist, Southampton University Hospital
Definitions Importance of reinvesting into clinical services The experts highlighted that cost savings from introducing biosimilars can be reinvested directly into the clinical area, to improve patient services and increase gain share. Whilst there are potentially very large cost savings in prescribing biosimilars, there needs to be investment in the services in terms of not only patient and staff education, but also in areas such as prescribing systems updates, processes, administrative tasks, helplines, additional staff and clinician time, to ensure that there is clear decision making, safety-and-accountability. Multiple-switching between biosimilars – key considerations The expert panel provided the following additional guidance on the expanding biosimilar market: • Switching between biosimilars of one originator biologic is currently not recommended • Biosimilars are only compared to the originator not amongst themselves. Therefore potential differences may occur between biosimilars of the same originator biologic • There is a need for patient education to ensure smooth transition to the new device, and awareness of the importance of post-marketing surveillance. In summary, it was agreed that the biosimilar market brings an opportunity to drive down costs of biologic medicines in the UK and hopefully increase accessibility
A biologic is a compound derived from a living organism, and include less complex biologics, such as insulin, through to the very large molecules, such as monoclonal antibodies1,2 A biosimilar is a biologic medicine that is developed to be similar to an existing biologic medicine (the ‘reference medicine’). When approved, its variability and any differences between it and its reference medicine will have been shown not to affect safety or effectiveness.3 to many patients; however, the importance of getting the processes correct now was emphasised, as the landscape of biologics and biosimilars is going to be much more complex in the coming months. Consequently, there is a need to ensure brand-name prescribing, adequate patient education, patient involvement and consent, appropriate pharmacovigilance systems (e.g. processes for recording batch number per patient), and always having clinical approval for switching.1 References
1. NHS England. What is a Biosimilar? Sep 2015 2. Biotechnology Innovation Organization 3. European Medicines Agency. Questions and answers on biosimilar medicines, Sep 2012. July 2016 AXBIO161085l
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SUMMARY CARE RECORD AND THE ‘PAPERLESS 2020’ AGENDA #0072bc
The Summary Care Record (SCR) has set the trend for the importance of electronic communication and the sharing of information in healthcare, said programme manager Fintan Grant, speaking at Health+Care 2016.
riginally derived from GP records, the SCR aims to provide a wealth of clinical information across care settings. The Record already covers over 96% of the UK population, with a digital SCR file accessed every eight seconds. With robust governance policies, the platform allows for a cost-effective method for accelerating data sharing and realising efficiency benefits, while protecting patient confidentiality, said Grant. The SCR is a core part of the NHS’ Paperless 2020 agenda and lies within Domain D, which is concerned with joining up the different islands of care. According to Grant, Paperless 2020 has been a huge impetus behind the project, and is encouraging SCR adoption across a variety of clinical care providers. “The SCR has been transformative in reducing prescribing errors, and is empowering health professionals with key information that allows them to coordinate appropriate care pathways,” Grant added. Angela Tompkins, lead nurse at North Tyneside General Hospital, joined the discussion to explain how her Trust is implementing the SCR to aid integrated care. She described how the programme was initially introduced as a pilot, but is now an integral tool for service provision. “The SCR is simply matching what patients should expect from healthcare. Medicine and allergy lists allow for up-to-date, effective planning of pre-operative care, and smoothing of admissions and discharge processes. We have seen a huge impact on the length of stay for the average patient,” she said. Grant explained that the SCR is still a work in progress, presenting operative challenges which need addressing: “The Record is difficult to access on the move. It can also be quite limited in the range of information it offers; medication, allergies and adverse reactions. However, we hope to expand this to cover information on past problems, immunisation history, patient preferences, and anticipatory care needs.” He continued: “The SCR management team is also starting to look across expanding into different information sources, beyond general practice.”
28–29 June 2017 | ExCeL London
Stewart Wright, Account Manager, Telehealth Solutions
DIGITAL HEALTHCARE WILL LAUNCH ALONGSIDE HEALTH 2017 T #d8197d
Bláthnaid Ní Mhurchú, National Home Area Manager, Myhomecare
David Shapland, Corporate Communications, HSCIC
’m really interested in this Digital Healthcare launch as we’ve just adopted an online software platform in order to cut the cost of homecare for families. The system is able to provide monitoring and 24/7 care. It’s working very well – we have placed activity sensors in the home and these are able to feed data back to our support centre. We’re trying to encourage more families to get on board and get involved in homecare.
e’ve exhibited with CloserStill for many years, and enjoy a great relationship which we really value. We always have a really good experience at the show. This year we’re pleased that we could accommodate the launch of the new Digital Healthcare event – and we’re really looking forward to being a part of it next year. H+C in general is one of the events that has pioneered the approach of creating lots of different, distinct areas of content under one big umbrella, which many others in the marketplace are copying now. You originally set the benchmark for this model of bringing the whole sector together. What
you have now is a testament to what you have built up over the previous years. It’s an important event on the calendar because of when it’s positioned at the right time of the year, and attracts a really broad cross-section of our target audiences. This is one of the busiest events of the year in terms of footfall across the two days. It’s great that CloserStill is expanding the digital aspect, as information technology and digital transformation is absolutely critical to where the healthcare sector goes next and what it needs to do. It’s a key strand of the event and it’ll be really interesting to see how it develops.
his is one of the biggest events of its kind in the UK. It attracts a lot of potential customers for us, and many of our competitors are here so it’s very important that we have a presence. Health+Care is a perfect show to target NHS professionals and CCGs. Other shows are quite niche and have a limited offering of suppliers so there’s not a huge amount of choice for delegates. Here it’s nice to have such a wide-range of vendors which attracts the greater footfall. I really like the variety and number of people here. The breakout speaking slots next to the stands are also great as it pushes more delegates past the stands. Aesthetically H+C is really good too – It’s professionally laid-out and it’s easy to find everything. We’d certainly be keen to come back next year, particularly with the new digital angle.
SUPPORTING PEOPLE AND IMPROVING PRACTICE THROUGH CO-PRODUCTION Research shows that deaths at six months after a stroke can be reduced by two-thirds if the person receives support on at least two occasions, the Health+Care local authority theatre audience heard in a presentation on collaborative, integrated personcentred care.
DIGITAL HEALTHCARE SHOW 28–29 June 2016 | ExCeL London
THE FUTURE OF HEALTHCARE IS HERE. The brand new Digital health and technology event from the team behind Health+Care.
atherine Wilton, director of Coalition for Collaborative Care (C4CC), said that the death rate falls from 60 to 20 per cent if a person receives support on at least two occasions. Collaborative, integrated personcentred care is based on the ‘three Cs’, she told the audience: • Co-production with people who use services • Building strong community-based supports through community development and developing peer support and support for self-management • Better conversations between health professionals and the people they support, through integrated, personcentred care and support planning.
Ms Wilton said C4CC had been set up to “find a better way to ensure that people have the right support, knowledge, skills, power – and of course confidence – to manage their own long term conditions and live the lives they want.” Its ambition is to bring together people, including people with long-term conditions, and organisations from across the health, social care and voluntary sectors to drive change in practice by: • Providing direct support for pioneering programmes • Connecting people and initiatives • Spreading good practice. Of the 8,760 hours per year lived by
a person with a long term condition only around two to three hours per year will be spent with a healthcare professional - so for the vast majority of the time, a person will be looking after themselves. “People with a long term condition know all about their condition/s and know what services work and what they want,” said Ms Wilton. Noting the greater satisfaction levels when services that are designed with – rather than for – people, she said:
“Social prescribing using community assets is good for patients, good for professionals and it achieves good outcomes.” C4CC co-chair and co-production group member Fiona Carey said: “Co-production is doable - so just do it!
28–29 June 2017 | ExCeL London
HOW TECS IS AT THE HEART OF BETTER HEALTH AND CARE IN SUNDERLAND #0072bc
Technology Enabled Care Services (TECS) underpins healthcare strategy for Sunderland CCG, and has been a central model following its introduction in the city two years ago. The framework aims to enhance care in the area through digital initiatives, improving services for patients with long-term conditions, supporting general practice collaboration and exploring selfcare opportunities.
verseeing a population of 290,000, across five locality areas, Sunderland’s CCG is working on implementing TECS to support staff across the healthcare system
and find solutions to suit them and their patients. “It’s about having the time to listen and design a tailored solution instead of implementing something that perhaps isn’t relevant,” explained Rachael Forbister, telehealth lead and project manager at Sunderland CCG. Avoiding a ‘one system fits all approach’, Forbister listed the numerous solutions deployed in the community since the introduction of TECS, including Florence, Care Messenger, and Code4Health. Speaking alongside senior commissioning manager, Penny Davison, Forbister detailed a specific TECS case study which is currently being trialled in care homes. The pilot, which includes 14 care
establishments and around 450 patients, looks at how primary and secondary care providers can better support patients in Sunderland-based care homes. Digital tablets and equipment have been introduced to help carers conduct clinical observations, which allows them to monitor patients, identify trends and aid in triaging to the most appropriate clinician. “It’s about taking models from a hospital setting into the community,” said Forbister. Carers have been trained to track National Early Warning Scores, Nutrient Scores and Abbey Pain Scores, which they then upload into a cloud-based system. This data can then be shared with community nursing teams, and other
DIGITAL HEALTHCARE IS THE FUTURE
Charlotte Vince, Event Coordinator, Optum
e come here specifically to get in contact with decision makers and CCG members, who are close to the NHS. We’ve seen a diverse and consistent traffic and lots of interest in the stand; particularly with our new touchscreens showcasing our solutions. We’ve seen social workers and nurses too, which is great as it gives us a different perspective towards what they are seeing as employees and what they’re looking for in terms of making their job easier and keeping them motivated. H+C gives us an opportunity to discuss with the actual end-users, who then go onto speak to the budget holders. If we weren’t at this event, people would be
asking questions. This is definitely one of the biggest shows that attracts the most delegates. We provide commissioning to CCGs so we get to speak to the people who we actually work with. It’s a huge networking opportunity too, catching up with customers who we haven’t seen for a while. Both our speaker sessions have been extremely popular. The dedicated Digital Healthcare area will be great for us as a technology provider. Digital is obviously our main push so we love to see that emphasis encouraged at exhibitions.
Daphne Slater, Healthcare Project Manager, Independent
+C is an excellent event for getting updates on the industry, and this launch of the Digital Healthcare event is really important and an exciting development. There are many clinical people who are concerned with improving outcomes but they have no time to go out and search for digital solutions. Here, you are able to bring
this opportunity to us. I’m glad that the technology section is becoming its own next year, as all the sessions today were packed. Digital health is the way forward, particularly for integrated care which was traditionally paper-based – now everything must be digitalised.
Hannah Montgomery, Marketing Controller, everyLIFE
e’ve had great traffic on the stand, literally rushed off our feet. Our champagne reception drew a great crowd and our speaking sessions have been oversubscribed. We’ve been particularly pleased with our stand positioning too. H+C is the industryleading event for integrated health, so it’s important to be seen here. We get to see lots of professionals across both the residential and domiciliary sectors, and what’s great is that these are people coming out of their own free-will. Digital Healthcare is in interesting addition, but I’d be concerned that all the suppliers would be the same – there might not be enough variation.
healthcare professionals should they need to access the information to inform clinical decisions. Forbister and Davison outlined various early successes of the project, such as a reduction in calls to 111 and 999, fewer A&E visits and emergency admissions, as well as a marked improvement in early detection and the safety and quality of information on handover. Based on these outcomes, the pilot is will be rolled out across the entire city from next month. Noting the challenges however, the team hopes to overcome issues around interoperability, particularly with support for EMIS and other similar integrated care systems.
Andrew Thomas, Head of Marketing, EMIS
e’ve seen plenty of footfall already this morning. We always do and that’s why we have kept coming back for the last four years. We tend to generate at least 100 good quality leads over the two days every year. Based on evaluation of previous years, we couldn’t miss this event! This is our key target audience, and H+C always draws a big crowd whether they’re from GP practices, CCGs, or community and health commissioning organisations. We’ve met a lot of professionals from practice level, as well as a lot of key CCG representatives who we’re keen to talk to. The volume and specific nature of H+C is what’s so unique – you reach the vast majority of commissioners. The programme improves every year too – it brings in massive crowds of the right people to learn about the right topics. Digital is such a huge part of the NHS’ drive in terms of efficiency and the new models of care to deliver better quality patient experiences, so it’s great to see digital at the forefront of what H+C is doing.
Ray Hill, Head of Information Systems, Health Education England
think the introduction of a Digital Healthcare event will be a nice addition as the tech offering at the show is currently quite bitty, so it’ll be great to bring these aspects closer together and give it a theme. It is
beneficial to have such a broad range of subjects and H+C is unique with its direction towards integration. It’s a nice reminder of how tech plays a role in the wider health and care ecosystem.
28–29 June 2017 | ExCeL London
WHAT ARE ACUTE HOSPITALS FOR? #d8197d
“We must work out what acute hospitals are for and where is the appropriate place in the care pathway for the patient. Why do we jam up hospitals with people that they can’t treat?” This question was posed to delegates attending the second day of the Health + Care conference by Lord Carter of Coles, author of the 2016 report, Operational productivity and performance in English NHS acute hospitals: Unwarranted variations.
ord Carter told a packed conference theatre that the NHS still had to prove to the Treasury that it could be run efficiently. “Then we have to discuss what a proper healthcare system looks like going forward,” he said. Two key drivers of efficiency in patient ‘throughput’ are to ‘work up’ patients before they are admitted for elective procedures, and for the hospital to be ready when they get there. He said: “Unwarranted variations, delayed discharge and reconfiguration are key areas that we can do something about. We need to make all resources work as well as they can. Quality is the top priority but we must pursue value with the same
THE WHY, WHAT AND HOW OF DEVELOPING AN ACUTE PROVIDER FEDERATION “Our track record shows that we can work together. But to make progress faster we need robust decisionmaking and an increased commitment to the delivery of collective solutions,” Sir Andrew Cash, chief executive, Sheffield Teaching Hospitals NHS Foundation Trusts, told providers during the Health+ Care conference. Additional prerequisites for success include: • More structured approach to collaboration
• Clear financial framework to support service redesign www.healthpluscare.com • Fewer but bigger dial changing projects
ANTIMICROBIAL COPPER CAN BREAK THE CHAIN OF INFECTION IN CARE HOMES • Expanded pace and scope but with managed expectations.
Sir Andrew Cash In the presentation designed to share the lessons learned from a local acute provider Lord Carter of Coles He said:Sir “Copper offers an opportunity to federation, Andrew said organisational pathways for specialist care, resulting in put another layer in place to complement The installation of had been existing protocols. Pretty much realised, every microbe including: antimicrobial copper touchbenefits equity of access, he said, but to achieve the that is of concern to human health has been surfaces in care homes would process standardisation, shared back office intent and vigor.” tested - copper is effective against all of benefit infrastructural changes had been significantly reduce bacterial them. We are beginning to understand how and information, expertise utilised Lord Carter told transfer the audience that functions and contamination, necessary. These include: microbes move around the environment. across thecopper network andis the leading to less include infections and Putting in that chain a waydevelopment of tools to achieve efficiencies • Governance of board level decisionimproved patient outcomes, reducing the reservoir and movement of of a workforce strategy. This strategy had benchmarking, moneyand flow - to facilitate microbes around the environment.” making: projects a absolutely minimum could payback fitting kills these by germs and Consortium (YHEC). Using a new build 20- copperagreed Antimicrobial copper is a mixture and of more service resilience reduced lessdigitisation than one year.increased destroys their DNA, antimicrobial resistance bed ICU use with a rate of health care treatment step down –costs andinthe per cent vote would be supported by than 500 copper containing metals and associated infections of 75 15% as an example, can’t be transferred between microbes.” and of patient records, procurement and rotas. of locum alloys, or all ofagency which are staff regulated by thehad US increased a rates no-going back “We’ve approach. seen improved patient outcomes copper reduced infection by 20% and ark Tur, technical consultant at the Environmental Protection Agency. professional development andKey training. had a payback period of less than 3 months, in the studies that have been done in the Development He said: “We still work in silos.Copper Time is spentAssociation, environmental surfaces that can be upgraded with 216 bed days saved • In-depth clinical mapping toin less identify States and in Chile. Payback than one per year at a cost told the Health+Care Conference For patients and clinicians there were in a facility include bed rails, light switches, handling paperwork that should justas flow per bed day of £147.21. The spreadsheet year – certainly in the hospital that’s the that using the copper a supplement to emerging themes for clinical model over-bed or tray tables, chairs, nurse call model developed by YHEC can be adapted case. We don’t have experience yet of care standard hygiene practices was a simple, clinical protocols, compliance electronically. People need guidance as to unified buttons, door handles, and grab rails. home environments. We’d like to know now to local data. cost-effective intervention. He outlined development. Mark Tur also presented a cost-benefit with addition, copper initiates a cascade of what you think about contamination in your a quality standards, and agreed Inpatient what good looks like.” results from a US clinical trial showing
greater than 83% reduction in average bioburden on copper objects.
SPECIALISED SEATING PROVEN TO IMPROVE RESIDENTS’ HEALTH AND WELL-BEING
analysis of the copper alloy intervention from the University of York’s Health Economics
Researchers found an 88.3% reduction in pressure ulcers, a 95% increase in oxygen saturation levels, and a 92% decrease in high-risk cushion use. Caregivers reported a significant decrease in the numbers of patients falling and sliding from their chairs. Martina Tierney, clinical director of Seating Matters, said the findings will lead to better resource allocation, improved posture for patients, and improvements in physiological functioning. Current NICE guidelines recommend that patients are adjusted every two hours. In addition, in the health care sector, one quarter of all injuries are handling injuries, at a cost of £400 million a year. She pointed out: “If you can get residents into the right chair, there is less of a need to change their position every 2 hours.” Martina Tierney told delegates that many of them had clients sitting in homes who were doing the equivalent of a long haul flight every day. “There has been a lot of focus on cushions, but there has never been a study on a complete chair and its interaction with patients in terms of pressure and posture. We know we can impact people’s lives and change the way people are cared for in homes.”
“This is our third year at Health + Care. In diabetes there are huge changes in the commissioning New research presented at the environment and we Health+Care conference on the effectiveness of specialist seating for nursing home need to make sure that residents suggests that it can lead to improvements in levels oxygen saturation, withcustomers a we keep engaged, understandofreduction what our in pressure ulcers and in the time patients need need and want in their environments. is an to spend in bed, and This a decrease in handling injuries staff. opportunity to have high levelamong conversations about strategic matters, such as theTsupport we can offer, for example, providing commissioners with the information they need to make a local case for service redesign.” Wendy Kane, Value and access manager, Sanofi
he study, to be published in the next few months in the British Journal of Occupational Therapy, focused on the impact of the chairs on health and wellbeing, repositioning needs, risk of pressure ulcer, and functional ability. The trial was performed by the University of Ulster in collaboration with Seating Matters, a company that provides specialist seating. Patients in three nursing homes were randomised to a control or intervention group for a 12-week period. Intervention patients were provided with individualised seating while those in the control group were seated in standard chairs.
Martina Tierney, clinical director, Seating Matters
events that makes it unlikely bacteria will develop resistance. Mark Tur said: “Because
health care environment.”
Learning Archive Delegates have complete access to speaker presentations from the 2016 conference plus the entire CloserStill Media Healthcare catalogue of events
CLICK HERE TO ACCESS THE LEARNING ARCHIVE
28–29 June 2017 | ExCeL London
THANKS TO OUR MUST SEE EXHIBITORS AT HEALTH+CARE #0072bc
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New medication management
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