Putting data, digital and tech at the heart of transforming the NHS

Putting data, digital and tech at the heart of transforming the NHS
DHSC 23 November 2021

• This independent review from Laura Wade-Gery considers how to ensure a coherent approach to digital transformation in the NHS national bodies. The review argues for a shift in culture, operating model, skills, capabilities and processes to put data, digital and technology at the heart of health service transformation. The goal is to build on progress made by NHS Digital and NHSX during the past 2 years of the pandemic and ensure the national NHS (defined as NHS England and NHS Improvement (NHSEI), NHSX (X) and NHS Digital (D)) can lead the transformation of the wider healthcare system, supporting integrated care systems (ICSs) to deliver better citizen health. 
• The review identified 6 areas where the current situation could be improved. Transformation model; Funding and benefits; Leadership; Capabilities; Data and technology; and Organisational responsibilities.

Elective Care Transformation Programme

Elective Care Transformation Programme
NHS England March 2017 to date

• The Elective Care Transformation Programme is leading transformative change to make sure patients needing planned care see the right person, in the right place, first and every time, and get the best possible outcomes, delivered in the most efficient way.
• Includes best practice based on Specialty and Handbooks and case studies
• The Programme has developed the Elective Care Community of Practice online platform for commissioners, clinicians and providers to share knowledge and materials, and collaborate more effectively. For more information email: ECDC-manager@future.nhs.uk

Transforming Integration through General Practice

Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme
International Journal of Integrated Care. 2018;18(2):13.

• Shared learning from a UK based improvement programme, commissioned by Birmingham Cross-City CCG, around transferring activities from hospital to community and developing holistic primary care.

Abstract

Developing new models of care in the PACS vanguards

Developing new models of care in the PACS vanguards: a new national approach to large-scale change?
Kings Fund 19 April 2018

• The primary and acute care system (PACS) model is an attempt to bring about closer working between GPs, hospitals, community health professionals, social care and others. While not an evaluation of PACs this report offers a unique set of first-hand perspectives into the experience of those leading a major programme at the national level and those living it at the local level.

The Promise of Healthtech

The Promise of Healthtech: how digital innovators are transforming the NHS
Public, April 2018

• Technological innovation is one way in which the NHS can sustainably relieve the demographic and financial pressure it faces. This report surveys the digital health market and identifies the trends that are contributing to its growth. It also highlights major barriers to innovation in the NHS.
• Includes the HealthTech 27, a list of the most promising HealthTech companies, in nine key areas of opportunity:
• Procurement & Productivity 
• Recruitment & Training 
• Prevention 
• Winter Pressures & Supported Self Care 
• AI in Pathology & Radiology 
• Patient Safety 
• Mental Health 
• Social Care 
• Research

Sustainability and transformation in the NHS - PAC committee report and Liaison Committee

Sustainability and transformation in the NHS
House of Commons Public Accounts Committee 27 March 2018

• The latest report from the HC PAC describes an NHS "still in survival mode", using capital budget to fund short term needs rather than long term transformation. 
• The Department have been asked to report back to the Committee on a number of issues: 
• progress towards more stable long-term funding arrangements, 
• action to tackle workforce issues, a strategy for addressing long-term structural problems in trusts, 
• a review of how capital budgets are spent, outlining model guidance articulating how accountability will work under the new integrated care systems
• guidance and evidence of how the NHS, local government and the voluntary sector can work more cohesively as a whole system, including communication and engagement with patients and 
• work to promote new ways of working and examples of good practice by vanguards to all areas of the country.
• Speaking at the Liaison committee on Tuesday (listen from 17.51) the Prime Minister's comments very much reflects findings with the announcement of a new “sustainable long term plan” for the NHS based on “genuine cross party engagement” (but not a public commission).

PAC report Summary

The non-executive community in transformational change

Supporting change in your NHS : The non-executive community in transformational change
NHS Clinical Commissioners 28 November 2017

• A summary of discussions held at events that brought together CCG lay members and trust non-executive directors (NEDs) which focused on how they can contribute to the integration and transformation of their local health communities.
• The publication looks at attendees’:
• perspectives on the lay member and NED role
• insights on current system change
• views on the next steps for lay members, NEDs and health and care organisations.

Leading Large Scale Change: A Practical Guide

Leading Large Scale Change: A Practical Guide
NHS England Updated 13 September 2017

• A guide to support leaders drive change in line with the Five year Forward View and next Steps, and accompanied by a supporting skills development programme.
• The Guide includes
• Updates on the leading models that will enable you to address the challenges in achieving transformational change
• The latest thinking from national and global improvement experts and change leaders
• New tools, techniques and tips to help you effectively progress large scale change programmes
• Evidence-based insights and learning that will help leaders and change agents in health and care and across public services
• Thought-provoking content that will help you successfully take forward your STP, vanguard, new care model, accountable care system or other large scale change programme
• Signposting to a host of new online resources including videos, presentations and digital media links.

Public voice in health service transformation

Major health service transformation and the public voice: conflict, challenge or complicity?
Journal of Health Services Research & Policy 2017 p 1–8

• Report of research into the design and function of public involvement in two health service “transformation” programmes through interviews with public and professionals, as well as observation.

Abstract

From Healthcare to Homecare: the critical role of 5G in healthcare transformation

From Healthcare to Homecare: The critical role of 5G in healthcare transformation
Ericsson Consumer Insight Summary Report, May 2017

• This report explores the transformation promised by information technology, and the critical role of 5G, across three healthcare situations: preventative, routine and post-operative care.
• The report presents insights from an online survey of 4,500 advanced smartphone/mobile broadband users aged 18–69, an online survey of 900 decision makers across 6 industries – healthcare, insurance, medical technology companies, telecom operators, app developers/aggregators and government regulatory bodies, consumer focus group discussions in the US and the UK, plus in-depth interviews.
• Key findings:
• Healthcare becomes decentralised, moving from hospitals towards homes
• Patient data is centralised, turning hospitals into data centres
• Increasing dependence on wearables and remote treatments makes 5G essential to provide reliable and secure services

Swimming together or sinking alone

Swimming together or sinking alone: Health, care and the art of systems leadership
Institute of Healthcare Management (IHM) 10 January 2017

• This report, written by Richard Vize and based on interviews with senior leaders in health and local government, examines the real issues behind the Sustainability and Transformation Plan (STP) process.
• The report analyses the difficulties these new, highly pressured networks are experiencing, and identifies how healthcare managers need to think and act differently to make systems leadership a success. 
• It considers the impact of the shift from focusing on individual organisations to thinking about:
• systems and local health economies, 
• the importance of trust and shared ownership of problems and solutions, 
• establishment of an organisational development programme for STP leaders, 
• authentic leadership, 
• building relationships between the NHS and local government
• clinical staff engagement, in particular middle managers and junior staff
• patient and public engagement
• the importance of dedicated management time to support the transformation 
• creating the environment for changeprocess going forward

Five year forward view for social care

Total transformation of care and support
SCIE 2 November 2016

• This paper explores the potential for scaling up the most promising examples of social care and support services to see what their impact would be on outcomes and costs. 
• Using real data from Birmingham City Council, the report estimates potential benefits from three models
• Shared Lives which provides family-based support for older people and people with disabilities
• Age UK’s Living Well scheme which involved providing low-level support to day-to-day living and utilising asset-based resources to promote empowerment and well-being
• Kent County Council hospital discharge project which introduced social care discharge coordinators into hospitals, using a reablement approach.

Planning for transformation - keep up with the latest

Planning for transformation - current resources and information 
NHS Confederation

• A collection of the key resources and information from different bodies related to the current transformation and sustainability planning process, including Five year Forward View, Better Care Fund, Roadmaps, contracts, technical guidance and key milestones.
• Also links to useful resources developed by NHS Confederation
• See also the NHS England Sustainability and Transformation Plans page

Integrating the voluntary sector into health and care transforrmation

Untapped Potential: Bringing the voluntary sector’s strengths to health and care transformation.
New Philanthropy Capital , 13 April 2016

• This research was commissioned by the Richard Group of Charities and it examined how the voluntary sector's offer can be integrated into the health and care system of the future. 
• The project also aimed to design a framework for a shared language to help charities describe their work and its value to give commissioners and policymakers a way to identify aspects of charities' work that most clearly matches their needs.

Learning for MCP vanguards from the US

Multi-Specialty Community Providers: Learning from Patient-Centered Medical Homes
Optimy Advisors March 2016

• Sharing the learning for the NHS Multi-Specialty Community Provider (MCP) new care model using the US model called a Patient-Centred Medical Home (PCMH) and presents lessons for the NHS Vanguard programme.
• Examples of this model include Geisinger Health System, Colorado Multi Payer Medical Home Demonstration, Group Health Cooperative and Intermountain Healthcare.
• Optimity has developed an evidence-based framework which we use to support transforming health and care systems identify opportunities and risks and prioritise change actions. It is also used to monitor and evaluate transformation impact over time.(p7)

Delivering transformation

Lord Prior: Two ways to help deliver our promise of transformation
HSJ 9 December 2015

Comment by Lord Prior (minister for NHS productivity)

Extracts:
"The changes envisaged within the Five Year Forward View are more fundamental and ambitious than any changes the system has witnessed since 1948. We must have a care system that can meet the demands of our population today, very different from some 70 years ago.

We must do this within the structures we currently have. Reorganisation would be a distraction.

There are two main ways of ensuring we deliver on our promise of transformation.

One is to shift care from acute settings to out-of-hospital settings, reversing a trend we have witnessed since the early 2000s – of policy decisions driving activity and resources into acute providers, not primary and community care.

We have to improve the allocative efficiency of the system by providing the right care in the right place at the right time. This can be achieved through a mixture of prevention activities – targeting for instance, the rise of obesity and diabetes – and better commissioning of services as well as through new, innovative models of care provision, the vanguards.

The second main way of delivering transformation is to improve productivity. Trusts around the country are already working with Lord Carter to identify variation and to describe the “model hospital”. This will lead to greater standardisation of best practice, improved workflow and rostering, and decreased dependency on agency staff. In the absence of a market, we need intelligent transparency to reveal variation and drive improvement.

The transition from Monitor and Trust Development Authority to NHS Improvement under the leadership of Ed Smith and Jim Mackey is crucial to all this. It is not just about bringing together the two organisations, it’s creating a new organisation with a new purpose: to support providers to improve. "

Proposals for a Transformation Fund for the NHS

Making change possible: a Transformation Fund for the NHS
Health Foundation, Kings Fund July 2015

• Both the Health Foundation and Kings Fund support the concept of a Transformation Fund for the NHS in England. This report details the key aspects of such a fund. including six case studies of funding transformation, in the health sector and beyond, along with examples of local NHS initiatives. 
• Appendices to the report give more details of the work underpinning it.
• Appendix 1 provides full information about the case studies.
• Case study 1: Deinstitutionalisation in UK mental health services 
• Case study 2: The National Service Framework for Mental Health in England
• Case study 3: Canada’s Primary Health Care Transition Fund
• Case study 4: Denmark’s hospital transformation
• Case study 5: The London Challenge 
• Case study 6: Girls’ Education Challenge Fund
• Appendix 2 explains the methodology used to calculate the size of the Fund and gives details of the local NHS examples of change that we examined.
• Appendix 3 looks at the potential for realising value from surplus NHS estate

Top tips around public engagement in transformation

Engaging with the public: The essential guide for clinical commissioning groups
NHS Clinical Commissioners June 2015

• This report draws on case studies of three reconfiguration programmes to pull together top tips around how to engage the public in challenging decisions around healthcare transformation.
• The case studies are:
• Better Beginnings, which looked at maternity and paediatric services in East Sussex
• Healthier Together, a programme around health and social care services in Greater Manchester
• Future of Acute Hospital Services in Worcestershire

NHSE Board thinking around primary care

Primary care issues at NHS England Board meeting, 15 May 2014
NHS England Board meeting, 15 May 2014

• Quality and clinical risk committee feedback - Item 9g
• Primary Care -
• "The committee was concerned that responsibility for primary care was fragmented ... The committee felt that in order to ensure a coherent approach to commissioning primary care and developing policy in this area, and to facilitate the effective identification and mitigation of risks, it would be important to rationalise the number of groups overseeing this work, and to ensure clarity around the roles of the different directorates involved."
• "The committee felt that in order to maximise the potential of [the Primary Care Web tool] for the purposes of driving quality improvement, it should be more widely available to members of the public."
• "The committee felt that NHS England should support CCGs and Area Teams to find innovative ways to commission integrated care and that NHS England should remove as many barriers to this process as possible, recognising that this would need to be done within existing organisational structures."
• Transforming primary care support services - Item 10
• Primary Care Support (PCS) services include patient record management, admin of primary care lists, primary care contract payment and screening call and recall.
• Key principle to the transformation process: 
• safe transfer of services to a new operating model; 
• a reduction in administrative costs in line with NHS England’s overall reduction of 40%; 
• a national specification with consistent standards and approach; 
• delivery in line with our developing strategy for primary care; 
• supporting the business needs of stakeholders 
• maximising the use of technology; and, 
• consultation with the workforce and their representatives. 
• The Board will consider options to transform PCS services in its private meeting
• Three principal options are: 
• Full market testing with an open public procurement; 
• an in-house option in those areas where outsourcing is not currently in place. This option includes significant reduction in the number of staff employed as well as a reduction in the number of sites; or 
• an option to outsource all services to SSCL, a joint venture between Steria and the Cabinet office.
• Final decision expected in June.

Transforming the NHS - report of the Futures summit February 2014

Call to action: transformative ideas for the future: Report of the NHS futures summit, February 2013
NHS England, Monitor and the Trust Development Authority, March 2014

• This report summarises the ideas discussed at a Futures summit held in February 2014.
• It is intended to assist commissioners, providers and their local partners, as they look ahead. This report outlines just the sort of potentially transformative options that local health economies may wish to consider as part of their strategic plans.