Developing the Transparency and

Participation Call to Action

EXPO 20144 March 2014

Agenda

2

Time Item Lead

2.30 Welcome Chris Outram

2.35 Introducing NHS England’s strategic vision – purpose, ambition and structure

Chris Outram

2.45 Modelling of opportunity for digitally-enabled participation and transparency: summary overview

Stephen Moran, McKinsey & Co

3.05 Further questions/discussion All

3.25 Next steps and close Chris Outram

Strategic Vision: Summary

3

NHS's biggest asset is people – both its patients and staff. We need both more empowered patients who are more in control of the healthcare decisions and choices and more motivated staff delivering higher quality of care.

Key enablers in achieving this vision include:

• Information and Data – joined up, real time and analysed data and information to enable more informed choice; and

• Technology – to generate efficient service delivery, enhanced consumer convenience and patient and provider empowerment.

Transforming delivery

Active and empowered

citizens

Better outcomes and greater efficiency

Goal

Productivity improved by automation and

transparency on outcomes

Enabling the digital tools and support to take greater control of health and care

choices to help reduce demand

Transforming the way people

interact with the NHS

Supporting initiatives

and technologyexamples

• ePrescriptions, eReferrals

• Summary care records, IDCR

• HSCDS, Patient Online

• CQRS, FFT

• Remote monitoring devices

• Mobile health monitoring and management apps

• Secure connectivity at home

The Transparency and Participation journey

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Developing the Transparency and Participation Call to Action: strategic context

5

PurposeTo clearly describe strategic vision and direction for commissioners and the wider NHS, illustrating the benefits of supporting the active and empowered citizen as a key part of transforming the quality and efficiency of the NHS.

Underpinning evidence baseUsing contributions from world-class experts, work has begun to develop a clear evidence base for the economic contribution of data, technology and participation to help bridge the NHS’s quality and funding gaps. Local case-studies of innovative transparency and participation in practice will also help inform our strategic vision.

Next Steps

6

We will:

• engage with you to get your comments, views and feedback on the ambitions, scope and content of the emerging Call to Action

• continue to work with you and your teams to begin to identify what, in local communities, is occurring that could be used as case-studies of creativity and innovation of transparency and participation in practice

Modelling of opportunity for digitally-enabled

transparency and participation

EXPO 20144 March 2014

The aim of this work is to:

Provide an evidence base to inform better investment decision making in relation to the use of data, patient participation and transparency.

Support NHS England’s vision of modernising customer services through patient participation, better data and effective use of information technology.

The NHS is facing a serious funding gap

859095

100105110115120125130135

Funding£b

£44b

£28b

2021/2220/2119/2018/1917/1816/1715/1614/1513/1412/1311/122010/11

Real terms freeze through 2014/15 followed by increase with real GDP (2.4%)

Real terms freeze

Historical Funding pressures on the NHS in England (~4%)

SOURCE: Nuffield Trust: The funding pressures facing the NHS from 2010/11 to 2021/22: A decade of austerity?

1 The forecast spend assumes pressures continue to rise in line with patterns observed prior to 2010/11 and that policy-makers and managers take no action to improve efficiency and reduce costs. This estimate is based on the rising pressures on the NHS from 1) Demographics (principal population projection from ONS), 2) Health care activity (Chronic demands on acute 04/05-09/10; MH 08-10/11; primary care 95/96-08/09; prescribing 08/09-11/12) and 3) Health care costs (Pay 2% a year over GDP deflator; drugs in line with GDP). Assumes NHS funding continues to grow with inflation (GDP deflator)

Project deliverables

Estimate opportunity from data and transparency - both demand and supply

Evidence base - nationally and internationally

▪ Model assumptions

A business case to prioritise

The new digitally-enabled NHS could look very different

People may… Providers may… Commissioners may…

Talk to their doctor online

Automate routine tasks

Monitor their own health via an online portal

Share informa-tion to improve patient care

Use deep insights to incen-tivise providers

Book appoint-ments and get prescriptions online

Use information to improve their operations

Use risk stratifi-cation to direct resources efficiently

Others?

ILLUSTRATIVE EXAMPLES

Approach

Modelling approach4

3

Transparency and Participation interventions(evidence base)

5NHS impact & strategic choices

2 Demand levers

Supply levers1

Supply productivity

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Medium termQuick win Long-term

~1%

~5%

~1%

?

~10%

>2%

~2%

Allocative efficiency- Which diseases?

Stop clinical interventions low value

Prevent hospitalization (Integrated care)

Self care

Internal administrative efficiency

More productive providers -

hospitals, primary care etc

Wage freeze

SOURCE: McKinsey quantification of UK health value pools, based on 10/11 data

1. How you allocate

resources

2. Technical efficiency

3. Input costs

~5%Estates optimisation

>2%Reduce procurement costs

At risk popula-tion

Mostly healthy people

Demand management

1 Combined Predictive Model; predicts risk of an emergency admission in the next 12 months based on previous acute admissions and age

SOURCE: McKinsey

High

Low

Average risk of emergency admissions

Share of populationin each stratum

High risk

Very high risk

Moderate risk

Low risk

Very low risk

0.5%

4.5%

15%

30%

50%

Present

ACTIVATED PEOPLE

1

2

People with LTCs1b

Population segment Lever

Frail/ elderly people (no LTCs)

1a

Primary and secondary prevention

2a

Self-care for minor ailments

2b

Avoid unnecessary elective procedures

2c

The way we see patients will need to change

Populations

Predictive

Patient power

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Increasing data transparency▪ Alliance of 46 countries to promote transparency in

government, launched 2011

▪ Government-sponsored provider of quality and service information about healthcare providers

▪ 8 million unique users per month

▪ US government insurance and health reform portal, launched in 2010 for public health literacy

▪ Public information service which helps users navigate available healthcare services

▪ Used monthly by 40% of Stockholm’s residents

▪ Payor-driven site providing information on physician tariffs, reimbursement

▪ Independent infomediary comparing prices and services across healthcare and other industries

▪ Independent infomediary providing comparative information about hospitals, doctors, treatments

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ZocDoc/Teladoc enables on-demand access to doctors in minutes via phone video calls

From … To …

Call to make appointments/days or weeks to see doctors

(Zocdoc/Teladoc) on-demand access to doctors in minutes or same day/in person or via phone video call

Technology supplementinghealthcare professionals …..

Monitoring patients Say hello to intelligent pills – digital system tracks patients from the inside out

Nature

The doctor is out, but new patient monitoring and robotics technology is in

Scientific American

Metavision is a patient care IT platform which supports tablets; it has several applications including ICU

SOURCE: Metavision website http://www.imd-soft.com/

IT patient care platform, including an ICU specific application

Link to all tablets and mobile devices

The Maccabi Healthcare System in Israel is Highly Digitalised

▪ Maccabi Central Electronic Medical Record

▪ Every transaction computerized

▪ E-Laboratory

▪ E-Prescription

▪ E- Consultation

▪ Telemedicine

▪ Alerts and Reminders

▪ Registries

▪ Patient Website

Kaiser Permanente's mobile health portfolio aspires to improve health and relationships between patients and their doctors

Location finderMessagingAppointment scheduling

Electronic medical record

Test result viewer

SOURCE: Kaiser Permanente

Patient information…

Online patient communities Helping patients find trials

DNA testing for more than 100 diseasesInteractive access with peers and physicians

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Singapore “Fish n’ Steps” used a gaming approach to achieve an increase in physical activity

SOURCE: Lin et al., Fish'n'Steps; Loke et al., Developing Virtual Patients; McKinsey

Online health information

Increase in physical activity (steps) under "Fish 'n' Steps" programDaily steps per person

Presented as game

Competitive elements

6,760

8,034

After programBefore program

+19%

Kick Buts, an Agile Health solution, uses a simple, evidence-based text messaging program to support patients in quitting smoking

SOURCE: Agile Health company website, PR Newswire: http://www.prnewswire.com/news-releases/agile-health-adds-smokeless-tobacco-cessation-support-to-kick-buts-program-221153541.html

A 2011 controlled study with 6,000 participants showed significant impact smoking quit rates at 6 months: 10.7% Intervention vs. 4.9% for Control

Kick Buts is an interactive, text-messaging smoking cessation program that works through mobile phones and supports patients via clinically validated text messages

Kick Buts is a SMS based approach…

… with significant impact

Discussion

"What do you feel are the biggest opportunities through use of digitally-enabled participation and transparency and what examples of impact have you seen?"

Project concludes in next 6 weeksProject concludes in next 6 weeks