HEALTHCARE DELIVERY
finding ways to organise services around the demands of a population with more complex and chronic health and social needs, to responding to the challenging financial context for the NHS and local government. The document is supported by a self- assessment toolkit designed to support local health and care leaders through health and wellbeing boards to critically assess their ambitions, capabilities and capacities to integrate services to improve the health and wellbeing of local citizens and communities. Integration is an important step towards transforming services for adult social care to ensure they are sustainable for the future and that they offer truly person-centred care. The report states that redesigning services around the needs of an individual provides the best opportunity to improve that person’s health and wellbeing including closing health inequalities and helping to bring financial sustainability. This consensus was developed from evidence emerging from where integrated
The NHS Confederation is hearing repeated concerns about the future sustainability of the NHS from within the service.
approaches have been implemented – including trailblazers such as integrated care pioneers and vanguard sites, as well as national programmes including the Better Care Fund. Evidence indicates that integration results in improved clinical outcomes and a better patient experience. There is also evidence that person-centred services can change the pattern of demand and can offer service efficiencies. The report highlights the need for system transformation to achieve greater integration and calls on national leaders to address a number of fundamental questions. Although different places will develop an integrated system tailored to meet local needs and
aspirations, there are common issues that need to be addressed and these are also explored within the document.
Key proposals
The NHS Confederation recently outlined four key proposals for how the Government can support the NHS to achieve sustainability in a time of immense financial challenge. The NHS Confederation stated that it is hearing repeated concerns about the future sustainability of the NHS from within the service, commenting that to deliver the Five Year Forward View (5YFV), its members needed to be afforded the “right conditions to transform the service to
The role of technology in delivering sustainability
Simon Stevens has introduced a fast track funding programme which will help patients receive treatment innovation more quickly. He explained that the NHS will now provide an explicit national reimbursement route for new medtech innovations to help accelerate uptake of devices and apps for patients with diabetes, heart conditions, asthma, sleep disorders, and other chronic health conditions, as well as for other areas such as infertility and pregnancy; obesity reduction and weight management; and common mental health disorders. It is hoped that this new funding route will help cut the issues experienced by clinicians and innovators in getting uptake and spread of innovation across the NHS. A new innovation and technology tariff category will remove the need for multiple local price negotiations, and instead will guarantee automatic reimbursement when an approved innovation is used, while at the same time allowing NHS England to negotiate national ‘bulk buy’ price discounts on behalf of hospitals, GPs and patients. Simon Stevens has also announced a new round of recruitment to the NHS Innovation Accelerator (NIA) programme which supports developers with tried-and- tested innovations to spread them further and faster across the health service. This follows a successful first year, which saw a rapid roll out of innovations to 68 NHS hospitals, benefitting over three million patients.
Such innovations have the potential to have a significant impact, as Simon Stevens explained at the NHS
Confederation Conference: “In the intensive care setting 20,000 patients per year get ventilator-assisted pneumonia, which has a
30% mortality rate. There is a small inflatable tube that can be put in patients’ throats which practically eliminates the risk of pneumonia-related death. It is being using in Birmingham where it is saving £700 per patient, but not right across the NHS. We need this kind of innovation diffused much more quickly and more widely.” Another example of how modern technology in healthcare can be used to support sustainability is
telehealth.The East Midlands Academic Health Science Network (AHSN) has introduced Flo, a simple NHS-owned healthcare solution, which uses cost-effective SMS to support patients to manage their own care. In Nottinghamshire, over 3,000 patients have now used the telehealth service which uses text messages as a quick and cost- effective way to communicate with patients with long-term conditions – reminding those with diabetes to check their blood sugar levels and enabling them to send results back to their doctors by text, receiving support if levels are a cause for concern, for example. With over 15 million people in the UK now living with a long-term condition, many patients with a chronic health issue have to attend unnecessary appointments for routinely scheduled check-ups even though their condition is stable. They may also have found that, when their condition was problematic, support was not offered early enough to prevent serious exacerbations. This has led to poor patient experience, as well as being an inefficient way for health services to run. Early research from East Midland AHSN suggests that Flo is an effective tool, enabling people to better manage their own long-term conditions. This is associated with an increase in patient
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satisfaction, and a decrease in the number of unnecessary clinical appointments. Specific successes include a 40% decrease in expected hospital admissions when the service used to help patients monitor their oxygen saturation levels.
The use of Flo with heart failure patients reduced the need for nurse home visits by around one-third and people with Asperger’s syndrome reported improved quality of life, improved independence and less need for care when using Flo.
Innovations already supported by the NIA prog ramme
MyCOPD: An app which allows patients with chronic obstructive pulmonary disease (COPD) to self-manage their condition on their phone or tablet. It offers expert advice and education on how to use medication properly and how to perform special exercises designed to improve lung function.
AliveCor: A mobile heart monitor that instantly captures electrocardiogram (ECG) recordings, allowing the user to detect, monitor and manage heart arrhythmias. It also helps detect incidents of atrial fibrillation.
PneuX: A cuffed ventilation tube and inflating device which is used to electronically monitor patients, breathing in intensive care to prevent bacteria leaking into the lungs which can result in ventilator-associated pneumonia (VAP).
MARCH 2017
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