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Changing the Centre of Gravity and Rebalancing Relationships Between the North and the South
TECHNOLOGY
04 Technological Innovation: Raising Awareness of Defibrillation
08 Embracing Momentum in the Strive for NHS Connectivity
12 How AI is Revolutionising Skin Cancer Detection
SUSTAINABILITY
20 Developing learning Health Systems
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24 SageTech Medicals’s Innovative Anaesthetic Gas Recycling Technology In Action
28 About Us
Hannah Wintle Multi Media Journalist
Olivia Staveley Graphic Designer
FOREWORD Hello and welcome to the first edition of the Health Industry Leaders eMagazine. Over the coming issues, we will be delving into the role of technology in healthcare and how to improve sustainability in the sector, with a focus on net zero. It is the latest branch of technology and sustainability eMagazines that we publish, with our other issues focusing on Hydrogen and Housing. Over the space of 2024, we will be launching our podcast series, and webinar series and will be growing our online content so follow us on Linkedin and Twitter to keep up to date with our developments.
In this edition, we delve into the need to embrace momentum in the strive for NHS connectivity, how AI is revolutionising skin cancer detection, and the priorities for action to develop learning health systems.
CONTENTS
Floyd March Editor f.march@peloton-events.co.uk
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TECHNOLOGY
ISSUE 1
Technological Innovation: Raising Awareness of Defibrillation
“It’s a device that coaches someone who doesn't do this every day. It's really designed not for the advanced health care provider, but for lay people who may have never done this before.”
CellAED, the world’s first personal defibrillator, has been created to improve access to AEDs More education and behavioural changes are required to encourage bystander CPR
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Effective CPR and rapid defibrillation has saved the lives of millions of people who have gone into sudden cardiac arrest in the UK. Too commonly, however, being unable to access a defibrillator in the moment it is needed has resulted in deaths that could have been prevented. In answer to this problem, a personal defibrillator has been developed in an attempt to save lives and improve the prognosis of one of the UKs biggest killers.
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In the UK, there are more than 30,000 out-ofhospital cardiac arrests (OHCA) per year, with a survival rate of fewer than one in 10, according to the British Heart Foundation. Furthermore, the latest statistics from the National Institute for Health and Care Excellence (NICE) indicate that only 30-40% of people experiencing an OHCA receive bystander CPR, and for those that do, each minute that defibrillation is delayed decreases the probability of survival by 10%. To offer the best chance of survival, defibrillators must be readily available and utilised within 3-5 minutes of collapse, which can increase survival rates by up to 50-70%. Currently, however, fewer than 2% of people have an automated external defibrillator (AED) deployed before the arrival of paramedics. Despite these bleak figures, actions are being taken to increase OHCA survival rates. Resuscitation Council UK have set out four goals to reach their vision to 2030:
BY HANNAH WINTLE
Everyone should receive appropriate cardiopulmonary resuscitation (CPR) treatment in clinical, community and care settings, underpinned by the comprehensive availability of evidence-based clinical guidelines, training and life-long learning. Survival rates for out of hospital cardiac arrest match world-leading comparators. Everyone affected by involvement in a Cardiac Arrest (CA) and the provision of cardiopulmonary resuscitation receives appropriate, personalised support. Cardiopulmonary resuscitation has become a mechanism to reduce social inequalities, not another measure of them. (Source: Resuscitation Council UK)
To meet their second goal, it is clear that defibrillators must play their important part, but research conducted by the British Heart Foundation revealed that in the most deprived areas of the UK, the nearest one could take a round trip of over a mile.
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EASILY ACCESSING A DEFIBRILLATOR COULD BE THE DIFFERENCE BETWEEN LIFE AND DEATH In an attempt to solve this problem of inaccessibility, Australian company Rapid Response Revival created the world’s first handheld, smart, personal AED – CellAED. Dr Steven Brooks is an Emergency Physician and Resuscitation Scientist at Queen’s University in Ontario, Canada, as well as the Chief Medical Officer at Rapid Response Revival.
TECHNOLOGICAL INNOVATION: RAISING AWARENESS OF DEFIBRILLATION
“The concept behind the CellAED is that it should be more available. It should be in people’s backpacks, it should be in their home next to their fire extinguisher. It should be in the glovebox or the boot of their car. It should be in everyone’s backpack or purse,” he explained.
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“CellAED essentially was invented with the mindset that these should be ubiquitous, and everybody should have access to one.” “The design of the defibrillator was changed so that it could be miniaturised, made ultraportable and designed by trying to reduce the upfront costs of ownership.”
In the event of an emergency, the CellAED is designed to be used by bystanders following its ‘Snap Peel Stick’ instructions and imagery. The device is automatically activated when it is snapped in half, and instantly begins giving audio instructions to guide the person through CPR every step of the way.
A BEHAVIOURAL CHANGE IS NEEDED TO INCREASE BYSTANDER CPR RATES While it is commonplace in the UK to learn about fire safety, develop a fire plan, and install smoke detectors, the same is not true on a household level for the risk of cardiac arrest, despite the chances of dying in a house fire being much smaller. While preparing for any emergency is rightly encouraged, not enough is known about cardiac arrest for people to recognise it as a serious risk. For defibrillation to play its important role, the people that are present in the situation when an OHCA occurs, whether in the home or out in public, must be ready to act. Therefore, to increase bystander CPR rates from 30-40%, there must be a level of education involved. Dr Brooks argued that CPR should be demystified and not treated as a sophisticated skill that requires a formal two-day training course to learn – breaking down this barrier removes the expectation that only certified people should attempt CPR. Simplifying CPR could improve confidence, and make it more likely to be administered in times of need. “I believe that we need to really focus on teaching this as a life skill, how to do CPR and how to identify and use a defibrillator, to children in school, like how we spend a lot of time teaching about fire safety.
“I think cardiac arrest needs to be a routine part of education. It may not be the only opportunity that we learn about it, but if we introduce the concept as a life skill and something everyone needs to know how to do when we’re young, that will lay a foundation that we can layer on training and refreshers as we get older.” In the UK, the British Heart Foundation campaigned to introduce first aid and CPR training to the National Curriculum, until it was confirmed by the Department of Education that this would be implemented from September 2020. For those without any CPR training whatsoever, the CellAED is designed to be user friendly due to its audio instructions and metronome to help with the timing of chest compressions. This furthers the point that carrying out CPR is possible without the need for formal training, and in an emergency, can and should be attempted by whoever is around to help the person in need.
“So it’s also a device that coaches someone who doesn’t do this every day. It’s really designed not for the advanced health care provider, but for lay people who may have never done this before.”.” As well as being available commercially in the UK, the CellAED device has also been obtainable through the NHS Supply Chain since July 2023.
When it was added, it was the only AED offered under the new category of Personal Defibrillator, which was created specifically to accommodate the CellAED device in recognition of its unique design and features. Professor Gavin Perkins, Vice President of Resuscitation Council UK also commented in September 2023: “We’re fully supportive of innovation in the area of resuscitation. This is vital to securing improved outcomes for patients. Personal defibrillation technology, as a concept, is exciting. “Robust clinical evaluation, prior to implementation, is now required in order to determine the product’s effectiveness, so that we can ensure there is enough scientific evidence to confirm that this product is safe and effective.” The CellAED is registered as a class IIb medical device with the Medicines & Healthcare products Regulatory Agency, having met all the requirements set by MHRA under the UKCA mark for supply into the UK. Now, CellAED’s hopes that wider access to defibrillators will prevent more deaths resulting from OHCA. However, there must still be a behavioural change and further education to instil confidence in the public to be able administer CPR and use a defibrillator to save a life. This innovative technology highlights an issue that CellAED believes needs addressing. In creating a device designed to be simple to deploy, easily accessible, and with the goal to save lives, they hope that personal defibrillators will one day enable more people to continue to live fulfilling lives after their sudden cardiac arrest.
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TECHNOLOGY
ISSUE 1
EMBRACING MOMENTUM IN THE STRIVE FOR NHS CONNECTIVITY The COVID-19 pandemic accelerated the digital transformation of the NHS Adequate connectivity is still essential and shouldn’t be left to plateau To fully embrace connectivity, new challenges like digital exclusion must be simultaneously addressed
Having been forced to suddenly adapt deeprooted practices while juggling unprecedented demand and pressure on its services, in the midst of wide-spread distress the pandemic offered a glimpse of what the NHS could become if equipped with adequate connectivity. Nearly four years on from the UK’s first government-sanctioned lockdown, Health Industry Leaders spoke to Mark Burton, UK Health and Social Care Lead at Virgin Media O2 Business, to understand how healthcare can embrace its digital transformation and continue to improve connectivity throughout the UK. With an ultimate responsibility to do all it can to care for and protect life from cradle to grave, the NHS is a risk-averse organisation by nature. This cautious approach has been said to delay the uptake of innovative technologies and act as a barrier to progression. In recent years, UK healthcare has undergone a huge transformation at the hands of the COVID-19 pandemic, which in spite of the strain it generated, drove change in unprecedented ways 8
including how the NHS can utilise technology to complement its services.
THE PANDEMIC FACILITATED HUGE STRIDES IN CONNECTIVITY IN THE NHS When standard interaction became an impossibility due to the UK-wide lockdown that had the public confined to their homes, the NHS was left with no other option than to offer digital services. Mark, who has over 30 years’ experience in the UK healthcare sector including on the frontline of the NHS, said: “If there’s anything that could possibly come out of COVID that was positive, it’s that it forced the arm of the health sector to make the changes that they probably wouldn’t have made had it not been for the fact that they had to. “Those that were risk-averse, those that were sceptical, realised that, actually, if we don’t become better digitally connected and engaged with people in a different way, then what’s the alternative? “They had to change the way in which they interact with their patients and the way in which we interact with the care provision.” Given the unique circumstances at play, these changes were willingly adopted by the public, who also had no choice but to embrace innovation, the alternative being contracting the COVID-19 virus if forced to meet face-to-face. A collective shift in mindset enabled a digital transformation that promised to alter the way healthcare is practised in the UK forever.
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BY HANNAH WINTLE
“I THINK IF THE HEALTH SECTOR IN THE UNITED KINGDOM WANTS TO BECOME AN INTEGRATED HEALTH CARE SYSTEM IN A TRUE SENSE, THE ONLY WAY THAT THAT CAN BE TRULY INTEGRATED IS THROUGH DIGITAL CONNECTIVITY, AND I THINK IT’S SIGNIFICANTLY OVERDUE IN THE MODERN WORLD, IN THE WAY IN WHICH WE INTERACT WITH EACH OTHER.” 9
THE BENEFITS CAN BE HUGE IF CHANGE IS CONTINUOUSLY EMBRACED Recently, Mark has observed a slip back to where the NHS was pre-COVID, as people return to what they were comfortable with before the pandemic. Acknowledging the pitfalls that can accompany new technology, Mark explained that people were generally accepting of these in the context of the situation. Remove that situation, and people are less forgiving. In order to keep the momentum going before it dissipates, excellent connectivity is essential to safeguard against these issues, and remind the public that the changes implemented during the pandemic were actually progressive. Mark said: “The health sector has got to move at pace in its digital transformation so that we keep the momentum going, we keep driving forward, and the experience from the end user perspective gets better and we can demonstrate that there’s been a continuous program of improvement with how we interact digitally.
“WE TALK ABOUT GETTING BEST VALUE FOR TAXPAYERS’ MONEY, AND THAT’S PART OF IT, BUT IT’S NOT ABOUT GETTING THE CHEAPEST HEALTH CARE. IT’S ABOUT THE BEST VALUE AND EFFICIENCY.”
“If we don’t, you’ve got that risk of people thinking it was just a sticking plaster during a bad situation, better than nothing. Now we’ve got to move on to showing people all the great things we can and could do, so it becomes progressively better for people and becomes the norm.”
EMBRACING MOMENTUM IN THE STRIVE FOR NHS CONNECTIVITY
Alongside benefits such as improved efficiency through online appointments, patients having better access to personal healthcare records, and IoT technologies and AI streamlining services, Mark also alluded to the shift the NHS could experience in moving from a reactive care organisation to a preventative care one.
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“NOT ONLY WAS THERE A SHIFT FROM SOME OF THE HEALTH CARE PROVIDERS, FROM A PATIENT PERSPECTIVE, THEY WANTED ANYTHING RATHER THAN HAVING TO GO OUT TO SEE SOMEBODY. THAT WAS AN ABSOLUTE 180 DEGREE SHIFT TO WHAT PEOPLE’S PERCEPTION WAS ABOUT HEALTH CARE PRE-COVID-19.”
“A lot of what we’re trying to achieve with connectivity is, if individuals are better connected to health, we’re then able to support them with their own proactive preventative care, because currently we have a reactive health system, just by nature. “We can’t prevent everything, but you can certainly make people’s lifestyles better, which in the future are the things that will make a really big difference to the economy of the health sector.”
DIGITAL EXCLUSION POSES A BARRIER TO THE INTENTIONS BEHIND CONNECTIVITY Remote care has the potential to remove barriers for some patients, namely those with mobility and access issues, while simultaneously building new barriers to those at risk of digital exclusion. For older people, or those experiencing financial hardship – especially against the backdrop of the cost-of-living crisis – gaining and maintaining access to online services could prove a challenge. To address this, Virgin Media O2 Business have launched their Tech Donation Programme. Through the scheme, donated smartphones and mobile data are then given to those facing digital exclusion, enabling them to access online health services.
Further to this, Mark added: “We’ve been doing a lot of work with digital inclusion at Virgin Media O2 Business, where we’re actually using our volunteer days to go out and speak to patients in clinics and get them connected to the NHS app, which is the foundation really and some of the key to digital healthcare.” Tackling digital exclusion is a fundamental step in boosting connectivity across the UK, as without the ability to fully make use of online services, the digital transformation will not succeed. While improved connectivity promises to alleviate strain on the NHS by reducing backlogs through more efficient digital consultations, moving towards preventative healthcare, and embracing innovative technologies, steps must be taken to ensure barriers are removed for all, and that changes can be delivered at pace. The time to implement these changes, Mark insists, is now, before the momentum gained through the pandemic has diminished. The NHS, and public who rely on it, was offered a glimpse of what its future might look like, and delivering on this digital transformation through implementing robust connectivity throughout its services could still bring this vision to fruition.
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ISSUE 1
TECHNOLOGY
How AI is Revolutionising Skin Cancer Detection Skin Analytics’ DERM AI can identify skin cancers and benign lesions Dermatologists have more capacity to direct their care where it is needed most The AI could point to a future of preventative skin cancer care
The rise of AI is leading to the development of more and more innovative medical solutions which are seeing positive impacts on patient outcomes and healthcare efficiency. Health Industry Leaders spoke to Neil Daly, CEO of Skin Analytics, to understand how their skin cancer detection AI is being deployed to aid NHS dermatology services. With over 17,000 cases of melanoma skin cancer a year in the UK and steadily on the rise, and just over 600 dermatology consultants, the rise in demand for consultations is increasingly leading to backlogs and wait lists. Training more dermatologists isn’t a simple solution given that it takes over a decade to qualify, so it is essential that our current cohort are being utilised efficiently and that the number of cases they have to see are reduced for the best possible outcome. A more effective solution may be in the deployment of tools such as Skin Analytics’ AI as a Medical Device (AIaMD) DERM, or Deep Ensemble for the Recognition of Malignancy. When a patient is referred from primary care to a medical photographer, the images of their lesions are securely uploaded to the cloud where the AI can evaluate them. 12
To date, DERM has identified seven out of every 10 benign lesions it has assessed, and found 97% of cancers, freeing up NHS dermatologists to direct their care to the patients most in need. In April 2020, Skin Analytics launched DERM in their first partner hospital, University Hospital Birmingham, and have expanded to a total of 13 trusts since then, including Chelsea & Westminster, and University Hospitals of Leicester. Further funding has also been secured to expand Skin Analytics’ services across an additional nine NHS hospitals in 2024. In the time Skin Analytics have been operating, over 44,000 face-to-face appointments have been avoided, freeing up valuable NHS capacity. Furthermore, at one hospital, the time it took for a consultant to see a patient for the first time went from two weeks down to three days.
DERM ALSO AIDS THOSE SUFFERING LONG TERM SKIN CONDITIONS In identifying cancers and benign lesions, DERM also creates more room for those with other skin conditions to get the long-term help they need. “Not all clinical consultations about skin are cancer. A lot of those are things like psoriasis, eczema, a whole range of skin conditions that patients have. But the demand on the healthcare system is huge,” Neil explained. “What happens is, cancer referrals have to be prioritised because cancer can kill you, psoriasis won’t. So, we focus on seeing a lot of healthy patients to find those few cancers at the expense of not being able to spend time with the patients that have known health care problems with their skin, like psoriasis or eczema, and those can be actually quite debilitating.
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BY HANNAH WINTLE
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HOW AI IS REVOLUTIONISING SKIN CANCER DETENCTION
“Dermatology is just a huge part of medicine. About one in five clinical interactions are to do with the skin.”
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USING AI CREATES POSSIBILITIES FOR FUTURE PREVENTATIVE CARE While at present DERM is used after referral from a GP, there could be scope to use it in the first instance as a check-up method, to reduce the risk of skin cancers being missed. Neil said: “What we can do in the future is really lower the bar for getting people to do a skin check. We can potentially, in the future, if we can gather enough evidence to support it, we could say to people, ‘hey, every year why don’t you come in for a skin check using the artificial intelligence’, and proactively monitor skin cancer like we do with things like breast cancer, prostate cancer, and some others.
AI
“I think that would mean that we could really make sure that the number of people who ended up dying each year drops through the floor and hopefully gets to zero, which is one of the goals that we have as a company.” This forward-thinking highlights the possibilities AI has to offer in the healthcare sector. DERM’s success so far in identifying cancers and benign lesions, and subsequently alleviating strain on dermatology in the NHS, points to further potential for greater efficiency and patient outcomes down the line. As it stands, DERM is already proving itself an important asset in the NHS trusts it is used, and is demonstrating that there is a place for AI in the UK healthcare sector not only for its present capabilities, but its ongoing development and future potential.
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“We’ve seen about 70,000 patients and found about 7000 cancers in that time, so we’ve gotten through quite a few patients now. We’ve got some really, really great results. We’ve helped to avoid about 64% of the face to face two-week wait appointments that would have happened otherwise.”
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“The first goal is using DERM to try and reduce the workload on the dermatologists in the hospitals and that will allow them to free up slots across their appointments to be able to see those patients that aren’t just the two-week urgent cancer patients, but also the patients who have chronic skin diseases.”
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ISSUE 1
Changing the Centre of Gravity and Rebalancing Relationships Between the North and the South
It is cruelly ironic that where diagnostics tests are most needed, they are rarely produced. As a result, approximately 47 percent of the global population has little to no access to diagnostics. This challenge is particularly evident in lowand middle-income countries, where only 19 percent of patients have access to appropriate diagnostics at the primary health care level. This glaring injustice has prompted a leading academic to start a movement for change. Maïwenn Kersaudy-Kerhoas, a professor in microfluidics and a lead academic at HeriotWatt University’s new Health and Care Technologies global research institute, has created the Global Frugal Diagnostics Network (GFDN). “During my travels in South America and Africa, I realised that all the innovation in diagnostics is done in the Global North, and I wondered why that was. I think we’ve inherited a system that is anachronistic and outdated, with the idea that only the Global North has the power to innovate,” said Maïwenn. 16
“As a microfluidic engineer I design point of care test components and I’ve developed rapid ways to prototype devices. What I realised is rapid also means accessible, so you don’t need a lot of capital investment to be able to prototype as I do in my lab. The type of prototypes and methods I’ve developed mean you can arrive at something quite close to the end product : moulded plastic that can be produced at high volume. I also found it was really useful for teaching students when they can produce a device in just a few minutes, and iterate their design in the same afternoon.” The realisation that tests could be developed quickly led Maïwenn to question why her techniques couldn’t be replicated in the Global South, so she started contacting researchers and academics in some of the world’s poorest countries. One of them was Dr. Robert Ssekitoleko, a lecturer and head of the Biomedical Engineering department at Makerere University in Uganda.
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BY PROFESSOR MAïWENN KERSAUDY-KERHOAS
ACROSS THE CONTINENT, COUNTRIES HAVE WEAK, MISALIGNED POLICIES FOR THE REGULATION OF MEDICAL PRODUCTS, MEANING IT CAN OFTEN TAKE YEARS FORA SINGLE HEALTH PRODUCT TO BE APPROVED FOR USE.
“Microfluidics research is quite limited in all of Africa and there are few experts in the field here. My team has been developing a urine Lateral Flow Test (LFT) for Pre-eclampsia which is a big problem in Uganda,” said Robert. A recent study found that 13% of pregnant women in Sub-Saharan Africa were affected by pre-eclampsia, higher than the global average of between 5 and 8%. “What we have been doing here at Makerere University is to try to replicate some of the things that they are doing at Heriot-Watt. For example, looking at what machines and tools we need, or have access to, and then how we can repurpose them to make them work as they do back in Scotland. But we really needed expert help. In Maïwenn, we’ve found that person. “Here in Africa, we have a huge disease burden but a limited workforce and restricted access to highly expensive, sophisticated machines. Other barriers include availability of raw materials and
the underdevelopment of the regulatory system. Of course, we are also worried about buying power. “We don’t have many medical device manufacturers here and the very few that we have bring already licensed products from overseas and set up local manufacturing. There is a reluctance to trust things made in Uganda compared to devices made in Europe because our systems and processes are not currently as robust.” More than 70 companies are either headquartered in, or have manufacturing capacity in, Africa. However, only 33, less than 50%, report having standard quality assurance certifications, highlighting the need for investment in quality management systems. Across the continent, countries have weak, misaligned policies for the regulation of medical products, meaning it can often take years for a single health product to be approved for use.
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PROFESSOR MAïWENN KERSAUDY-KERHOAS
THE MISSION OF THE GLOBAL RESEARCH INSTITUTE IN HEALTH AND CARE TECHNOLOGIES IS TO TURN CUTTINGEDGE RESEARCH INTO IMPACTFUL AND PRACTICAL SOLUTIONS
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The new African Medicines Agency treaty is a continent-wide platform for strengthening and aligning national and regional regulatory authorities. It is expected to streamline this process, but sceptics argue that more African countries must ratify and invest in the treaty so all African people can fully benefit from highquality health products. “In the meantime,” continues Robert, “the network Maïwenn is creating will provide a platform that can help people to access diagnostics and help us to develop an indigenous manufacturing capability. We can then take these tests into the community and test for Malaria or HIV locally rather than asking people to walk miles to clinics. “We are the enthusiastic engineers who want to bring about this positive change, but we need the expertise of others before we can have real impact on our healthcare system. The network could be a game-changer. Of course, not tomorrow, but in the long run.”
The GFDN had its first in-person meeting at Ashesi University, in Ghana in early December. It was attended by academics and researchers from all over the African continent, as well as representatives of charities such as Doctors Without Borders and the Kuehne foundation. “My colleague Professor Alice Street from the University of Edinburgh and I have coined the term, ‘the fourth phase of global health evolution’, basing innovation in the Global South,” says Maïwenn. “We want to see investment in the capacity of these countries to develop their own products, rather than rely on innovation that is created by people who haven’t experienced the problem and don’t have direct access to end users. It might seem obvious, but I have just returned from a conference in the US where I met some brilliant scientists and engineers, and they are still very entrenched in this idea that innovation only happens in the Global North.” The mission of the global research institute in Health and Care Technologies at Heriot-Watt
University is to turn cutting-edge research into impactful and practical solutions to make a positive impact on peoples’ lives, the NHS and health and care globally. It will work closely with industry and sector partners to deliver innovative, sustainable and use-inspired solutions to global health challenges in a spirit of co-creation. For Professor Kersaudy-Kerhoas, the GFDN is perfectly aligned with this mission. “By bringing people together - engineers, biologists, clinicians - along with people knowledgeable in supply chains, commercialisation, and regulation, we’re really changing the principle of innovation. It’s going to be a long journey, but we want to turn the tables, change the centre of gravity, and rebalance the relationships between the North and the South” concludes Maiwenn. Anyone interested in collaborating with the new Health and Care Technologies global research institute at Heriot-Watt University can contact GRID@hw.ac.uk 19
SUSTAINABILITY
ISSUE 1
DEVELOPING LEARNING HEALTH SYSTEMS Current Issues are partly due to the lack of a clear definition, vision and evidence base around LHSs, meaning it can be difficult to know where to start or how to make progress The sector should adopt a learning culture to create responsibility for LHSs at the board level, embed improvement in organisational strategy, and develop wider organisational leadership There is a lack of support for the professionalisation of the data analytics workforce, the promotion of open-source data tools for all analysts to use, and the development of digital skills across the wider health care workforce
Learning health systems is the cornerstone to improving safety, enhancing deliverability and engaging in better patient care across the health sector. The Health Foundation has provided eight clear policy recommendations for ways the health sector can implement LHS more effectively. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. Health Data Research UK (HDR UK) is the UK’s national institute for health data science. HDR UK’s mission is to bring together the UK’s health and care data to enable discoveries that improve people’s lives by uniting, improving and using data as one national institute. HDR UK’s Better Care programme aims to equip clinicians and patients in the UK with the best possible data-based information to make decisions about their care. Having patients and clinicians on equal parity in the care provided is a core aspect of improving the health of UK citizens.
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KEY POINTS TO UNDERSTANDING THE FABRIC OF LHSs A learning health system is a team, provider or group of providers that, working with a community of stakeholders, has developed the ability to learn from the routine care it delivers and improve as a result – and, crucially, to do so as part of business as usual. “Done right, LHSs are not a separate agenda, but about embedding improvement into the process of delivering healthcare,” the report added. Focusing on more key points to the fabric of an LHS, it was explained: “An LHS is a way of describing a systematic approach to iterative, data-driven improvement (regardless of whether those involved label it as an LHS). “Learning and improvement are already happening in most providers and, in many cases, LHS approaches will offer a way to pull this existing work together in a more systematic way and organise it more effectively.”
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BY FLOYD MARCH
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It is widely accepted that tackling the huge pressures that health and care services are currently under will require action on multiple fronts, notably recruiting more staff and increasing investment in services. “Amid all these pressures, we should be wary about seeing LHSs as a ‘nice to have’. A step change in the health service’s learning and improvement capability is precisely what is required if it is to find a sustainable way out of the current crisis and effectively reshape care to meet future health needs.”
STEMMING THE BLEED OF SHORTTERM THINKING IS DIFFICULT BUT NECESSARY A long-term thinking approach is one of the core essences of implementing successful LHSs, something which the health sector, particularly the NHS has come under fire for not doing in recent years.
DEVELOPING LEARNING HEALTH SYSTEMS
Budget constraints and dealing with the pandemic put a lot of outside-of-thebox, long-term vision policies on the back burner. However, the report explored the idea that: “Helping teams and providers become LHSs gives them the tools to diagnose and solve problems and to drive improvement from within – turning them into ‘engines of innovation and improvement’.
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“Over the long term, this potentially offers a powerful and more sustainable route to improving quality and efficiency than simply relying on national programmes or external consultancy.”
DATA IS KEY, BUT SOCIETAL THINKING IS ESSENTIAL While often driven by empirical data sets and technical capabilities to analyse such data, the heart of the idea of an LHS is deeply social: “Requiring networks of people, collaboration and a conducive culture is essential. Investing in getting this ‘human infrastructure’ right is just as important as the technical side. “Ultimately, LHSs can bring people together to ask questions, interpret data, reconcile differing views and make decisions that allow them to successfully effect change in a complex, adaptive system such as health care.” To bring this into fruition across the health sector, the research – informed by a literature review, interviews, a survey of more than 100 expert stakeholders and a series of practical case studies – unpicked why there is a large gap between the promise and practice of LHSs and how to ease constraints. To help facilitate LHS approaches and realise their benefits, the authors expressed that policymakers and organisational and system leaders will need to make progress on a range of related policy agendas, such as data, digital maturity and interoperability, and improvement
capability and culture. They will also need to develop a clear vision and narrative around LHSs.
and systems and spread best practices for procuring and implementing digital tools.”
This report highlights eight areas where action by policymakers (government ministers, civil servants and national leaders) and organisational and system leaders (those in leadership roles in providers and local and regional health care systems) could support the development of LHSs.
Further to this there must be an embedding of digital skills and knowledge in maturity assessments.
Naturally, a clearer narrative from the central government is highest on the priority list. As with many nascent concepts or ideals that have not been widely adopted, getting the right public messaging and legislative action from Ministers is essential. The report elucidated that policymakers should build on this report to set out a clear vision and set of principles for developing LHSs. They must also: “Build the evidence base – on both the impact of LHSs and overcoming barriers to adopting LHS approaches. Also, align related policy areas to support LHS approaches and support the sharing of expertise and learning across LHSs. Separately, not all organisations and systems are on the same level of digital maturity as each other. The report recommended that policymakers should: “Provide longer-term funding to help the least mature organisations
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To do this, the sector should: “Support the professionalisation of the data analytics workforce, promote open-source data tools for all analysts to use, and develop digital skills across the wider health care workforce.” The other four core areas of improvement included system interoperability, namely the further development of standards and support services required to meet them, and the creation of a top-down learning culture starting at the board level. Implementation and improvement capability of system readiness, front-line implementation and organisational improvement capabilities were all important considerations to also make on a policy and practice level. Utilising LHSs across the sector could improve efficiencies, and reduce costs and wait times, but also increase the level of preventative measures the NHS and patients can take to care.
In this sense, some see LHSs as the next stage in the evolution of traditional quality improvement approaches.
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EIGHT PRIORITY AREAS FOR ACTION AND RECOMMENDATIONS
While improving digital maturity and setting a clear vision are at the top of the priority list, data analysis improvements are also necessary. Obtaining great data is often wasted if the analytical tools are not up to standards.
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SUSTAINABILITY
SageTech Medical’s Innovative Anaesthetic Gas Recycling Technology In Action
Benenden Hospital has become the UK’s first private hospital to purchase SageTech Medical’s anaesthetic gas capture technology Anaesthetic gases are highly polluting but are often released as waste into the environment Capturing and recycling these gases in the production of anaesthetics could promote a circular economy SageTech Medical, a UK environmental medical device company, has sold their waste volatile gas capture technology to Benenden Hospital – the first independent private hospital to officially purchase the solution. Inhalational anaesthetic gases are vital for putting patients to sleep for operations, but they come with a cost to the environment. Approximately 95% of the anaesthetic gas used during a procedure is released into the atmosphere as waste. The waste gases are greenhouse gases and are highly polluting to the atmosphere. 24
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Jane Abbott, Director of Benenden Hospital, explained: “As part of our sustainability strategy, we’ve paid particular focus to limiting the impact our hospital has on the surrounding environment. Working with a fantastic company such as SageTech to integrate their state-ofthe-art technology underlines our commitment to carbon reduction. We’re immensely proud to be leading the way for sustainability in UK independent hospitals.“
PRIVATE SECTOR UNIQUELY PLACED TO IMPLEMENT SUSTAINABLE SOLUTIONS Benenden Hospital has become the first independent private hospital in the UK to buy SageTech Medical’s innovative medical device. The device, known as the ‘SID-Dock’ captures anaesthetic gases onto two reusable capture canisters (‘SID-Cans’), preventing them from polluting the environment. The captured agents are then recovered and recycled, ready for future reuse.
When implemented across the hospital, SageTech Medical’s volatile gas capture solution could prevent up to 370 tonnes of CO2e emissions being released into the atmosphere over the equipment’s lifetime. Focusing on how this is advancing the strategic sustainability goals Luke Rawlinson, SageTech Medical’s Head of Commercial said: “The Benenden Hospital team have been great to work with, and have taken decisive action to reduce pollution from anaesthetic gases with our capture technology.
DECARBONISING ANAESTHESIA PROCESSES ONE OF THE BIGGEST BATTLES FOR THE SECTOR The manufacture of virgin anaesthetic agents and their release as potent greenhouse gases are highly damaging to the environment and contribute significantly to the carbon footprint of healthcare. During an operation, only 5% of volatile anaesthetic agents are absorbed and metabolised by the patient, leaving 95% to be exhaled and released into the atmosphere as waste.
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This supports Benenden Hospital’s strategic goals on sustainability and we are pleased to have been selected as the partner of choice.
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Preventing the release and environmental pollution caused by these gases is a priority for Benenden Hospital, in line with their carbon reduction targets.
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SAGETECH MEDICAL’S INNOVATIVE ANAESTHETIC GAS RECYCLING TECHNOLOGY IN ACTION 26
Once exhaled into the atmosphere, waste volatile anaesthetics stay around for a long time and subsequently have high global warming potentials. These gases cause climate change by trapping heat, and they also contribute to respiratory disease from smog and air pollution. Over a 20-year period (GWP20), volatile anaesthetic gases sevoflurane, isoflurane and desflurane have an impact of 508, 1401 and 3,714 times that of carbon dioxide, respectively.
This equates to around 100,000 tonnes of carbon dioxide equivalent (CO2e) emissions each year in the UK alone. SageTech Medical has developed a safe, sustainable and easy to use circular economy solution to tackle the problem of pollution from waste volatile anaesthetic gases.
CIRCULAR ECONOMY THE BEDROCK OF HEALTHCARE DECARBONISATION The circular economy solution captures these waste anaesthetic agents and then recycles them back into reusable anaesthetic, helping to reduce hospitals’ carbon footprint and preserve precious raw materials used in virgin anaesthetic agent manufacture.
The solution works by capturing the waste anaesthetic agent breathed out by a patient during an operation by safely adsorbing it onto a specially developed filter contained inside a reusable SID-Can capture canister. Two SID-Can filters are housed inside a SID-Dock capture machine that integrates simply and safely into hospital operating theatres, without having to make changes to any existing equipment. When full, the SID-Cans are collected from the hospital and emptied at regional SID-Hub facilities before being returned to hospitals for reuse. The recovered waste anaesthetic is then recycled, ready to be used again by hospitals. The waste volatile anaesthetic can be repeatedly recycled and reused, therefore reducing the significant burden associated with virgin drug manufacture and completing the circular economy solution developed by SageTech Medical. SageTech Medical’s innovative capture technology will be deployed across the theatre complex capturing the waste anaesthetic gas sevoflurane which is the dominant anaesthetic gas in use globally and has an environmental impact of 508 times (GWP20) that of carbon dioxide.
REPLICABILITY ISSUES ONE OF THE BIGGEST BARRIERS TO OVERCOME This commitment to SageTech Medical’s market leading solution provides a replicable approach for hospitals to adopt a plug and play solution to solve the global problem of waste anaesthetic gases. Simon Brooks, Benenden Hospital’s Anaesthetics and Recovery Clinical Lead, said: “This leadingedge technology has been integrated seamlessly into our existing anaesthetic equipment. We’re very grateful to the wonderful SageTech team for providing us with such an easy-to-install, sustainable anaesthesia solution.” Currently, there is an unmet, time critical need to reduce the impact of waste volatile anaesthetic agents on the atmosphere to protect our environment for future generations. By preventing these agents from polluting the atmosphere and reducing the raw material associated with their virgin manufacture, SageTech Medical are proud to be leading the way in sustainable anaesthesia and providing hospitals and clinics with a straightforward solution to enable them to make a real difference to their carbon footprint and our planet.
Approximately 95% of the anaesthetic gas used during a procedure is released into the atmosphere as waste 27
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