Dr. M G MurphyClinical Director NWIS

Caldicott Guardian for Wales General practitioner

Martin.murphy@wales.nhs.ukTwitter @martinmurphy001

Blog sowhatfollows.wordpress.com

Transforming Care in WalesOpportunities

RSA

Structured data •Demographic•Pathology•Radiology •Medication•IHR

WCP – CORE

Unstructured data•WCRS•Shared care record

GP System GP System

CommunityMental health

Social caresystem

CommunityMental health

Social caresystem

Innovation SpaceWork flowPathways

ExistingHospital Existing

Hospital

Etc.

WCCG

WORKING INSIDEOUR WELSH PSBASECURENETWORK

IDENTIFING STAFFUNIQUELY

WITH NADEX

CONTROLACCESS TO WHO SEES WHAT

PROACTIVELY AUDIT EVERY

ACCESS TO EVERY RECORD

MHOLMHOL

Structured data •Demographic•Pathology•Radiology •Medication•IHR

CORE RECORD

Patients Documents•WCRS•Shared care record

GP System GP System

CommunityMental health

Social caresystem

CommunityMental health

Social caresystem

Innovation SpaceWork flowPathways

ExistingHospital Existing

Hospital Etc.

WCCG

WORKING INSIDEOUR WELSH PSBASECURENETWORK

IDENTIFING STAFFUNIQUELY

WITH NADEX

CONTROLACCESS TO WHO SEES WHAT

PROACTIVELY AUDIT EVERY

ACCESS TO EVERY RECORD

MHOLMHOL

National Diabeticsystem

National Diabeticsystem

National Ophthalmology

system

National Ophthalmology

system

Current position• Modern SOA Architecture • Private PSBA, data centers, Active Directory• Core services provided provided slowly rolling

out • Created room for innovation – to use Best of

Breed apps

All our activity is internally focused – obsessed with communicating with each other

So What ? sowhatfollows.wordpress.com

ZZZZZZZZZZ….ZZZZZZZZZZ….

A short history of the NHS

• 1947 – but the care process is 150 years old• The consultation – based on face to face contact• The patient travels to see the doctor / service• Institutional and building focus to provision• System was designed for episodic & infectious

problems • Separate health, social and mental health

services

But We are facing a perfect storm •Declining resources •Aging population with increasing care needs – social, mental , physical •Hospital emergency care has clogged up already with the frail elderly •Great difficulty in caring for people in their own home as numbers and frailty increases•People die in the wrong place – in hospital

NHSDirectWebSite

NHSDW239k

Paid calls

Mental health services

Police

Ambulance325k calls

500k journeys

Outpatients

Community pharmacy70% population use in a year

GP OOH

497k

Social worker

District nurse midwife14% pop. see DN per year

Admissions 343k

A & E714k

(4% FU rate)

DentistDentist

3.2M Welsh Citizens800kLTC

GP Practices5.5M contact s

unscheduled (16M total)

84% surgery10% phone

4% visits

15M new illness episodes(family, friends, voluntary help web etc)

70% population70% populationsee a dentist see a dentist In a year In a year

10m

641k

403k

273k

- 99

9

338k

338k

427

227k189kk

3k

3k

20k

55% journeysstarted in eachcategory are stopped

10k

20k (3k)

24k

78k (1k )

17k

31k

143k

2k

38k

32k

53k9k

6k

1k Died

343k

48k

66k

10k

126k

10k

18k emergency transfer

392

Nursing Home 19k

12k

7k

7k p

ath

1

11

15+ 15

7+

7+

498

Number of call centres , telephones calls

Transition in care services 20th Centaury Care •Medical Hospital disease model

•Episodic reactive (fail and fix)

•Goal is Prevention of death

•All Care is provided by the state

21st Century care •Holistic Community health and social care model •Long term management ( predict and prevent)

•Goal is maximize quality of life & Good death

•Coproduction self care

Individual at home or usual

place of residence

Individual at home or usual

place of residence

24 hour care usually in hospital

24 hour care usually in hospital

Telephone advice or telephone

consultation

Telephone advice or telephone

consultation

Travel – 99.8% they citizen travel to the

services

Travel – 99.8% they citizen travel to the

services

Face to face consultation

with professional

Face to face consultation

with professional

The Visual Care Cycle The basic risk management process in all care services

If the individual or family feel they cannot manage the problem themselves and feel at risk they ring for help

If the professional feels they cannot manage the risk without seeing the individual they arrange a face to face assessment

If after assessment the professional feels that there is residual risk and they cannot safely be returned home they arrange that the person stays in contact with the service 24 hours a day

When the service believes the risk has diminished to an acceptable level the individual return home or to their usual place of residence Individual continues

to self care

Indi

vidu

al co

ntinu

es to

self

care

©MGMurphy

Dealing with risk • Uncertainty = anxiety = risk = cost • Its about human contact – not being alone • We deal with risk – by keeping a closer eye on the patient

i.e. by staying in contact – This is true during a single episode – But it is also true over your lifetime and the reason that 70% of

the cost of care is incurred during the last year of life – morbidity compression

– At the present time the lack of alternatives means we admit put people in hospital beds

Opportunity to use technology to stay in touch – in terms of distance and time

The Great Firewall of Wales (PSBA)

Public servicesNHS,LASocial careMental health

The PublicThe CitizenThe carerThe third sector

Can put the citizen at the Center in our networked world Paradigm shift - we use the technology they have to communicate

Third sectorThird sector Health Health

Citizen Citizen

Mental health Mental health

Social care

Social care

CarerCarer

• One global network, global services – no outside, no inside

• Mobile Always on – anytime, any place, anywhere

• Each of the 15 links can carry voice, video & data

• The security of each link can change depending on type of communication and citizens requirement for confidentiality

Health servicesHealth services Social care Social care Voluntary services

Voluntary services

MHOL•Book appointments•Order prescriptions•Message GP•Access to my GP record

MHOL•Book appointments•Order prescriptions•Message GP•Access to my GP record

Access Knowledge

Internet – Ap CymruAccredited sites •Conditions•Treatments•Performance•Directories

My global communicationsUsed for Tele Health •Video , telephone•Email, Text, IM, HTTPS •Secure social networks•Instant messaging •Communications HUB•Tele devices

Undertake Tasks

GP system GP system

Health vault ( Own store)My copies of •Care plans •Contact details carers•Tests •Schedule •Self monitoring etc

Health vault ( Own store)My copies of •Care plans •Contact details carers•Tests •Schedule •Self monitoring etc

Apps to help me manage my health and social problems

Self monitoringPoint of care

Use my record

Monitor myself

What do we need ?

1. Enable patients to use the technology they have to communicate with the service

2. Enable staff to use the technology the patient has to communicate with patients and with each other

But there is a problem with current way our Networks, PSBA, security & Data centers are configured that will get in the way of delivering this change.

4 Strategic implications for Wales

1. Separate the care record services from the communications services – they require different approaches to privacy, confidentiality & security

2. Shrink the great firewall back to securing the care record data - the way other information services are delivered

3. Provision of the record data over secured link to mobile devices any where – including hospitals, estate & most importantly all homes in Wales

4. Shift the whole of human communications onto global cloud services available to the citizens

Opportunities ?1. Open Wi-Fi – in public estate and homes2. Simple reliable cloud VC – internet TVs etc. 3. Mobile working – seamless use of the above 4. Transformation of care – unscheduled care– Long term – Long term condition management

Its the right time finally for this revolution because we now have a network that reaches into people homes & the technology has moved beyond public services ability to manage it.

Wakey Wakey ...Wakey Wakey ...

Home

“PhoneFirst”

For help

Transport

Assess FaceTo

Face

24 hourCare

Individual unwell

Individual unwell

FamilyfriendsFamilyfriends

Voluntary sector

Voluntary sector

Web Directory

Web Directory

individual Stable at

home

individual Stable at

home

111 call handler 111 call handler

999 call handler 999 call handler

Clinical assessment Mental health assessment

Social care assessment

Clinical assessment Mental health assessment

Social care assessment

Ambu

lanc

e

Ambu

lanc

e

Clin

ic O

P ap

poin

tmen

t Cl

inic

OP

appo

intm

ent

OO

H v

isit

OO

H v

isit

OO

H

appo

intm

ent

OO

H

appo

intm

ent

GP

surg

ery

GP

surg

ery

A&E

A&E

Com

mun

ity

Phar

mac

yCo

mm

unity

Ph

arm

acy

Soci

al W

orke

rSo

cial

Wor

ker

Spec

ialis

t ad

vice

e.g

. D

iabe

tic n

urse

Spec

ialis

t ad

vice

e.g

. D

iabe

tic n

urse

Signpost

Signpost

Hospital Inpatient Hospital Inpatient

24/7 homeCare package

24/7 homeCare package

NursingResidential

NursingResidential

With access to the IHR, Core H & SC recordsCare plan (ELP)& Specialist advice for staff on MH, palliative care Acute physicians e

Mon

itorin

g at

hom

e

Residual

Risk

Residual

Risk

Physical & virtualCall center

With call location& demographic linkage

DN

/CPN

DN

/CPN

USC episode

Phone(SKYPE)

Hot transfer Hot transfe

r

Advice & information

Advice & information

Opt

omat

rist

Opt

omat

rist

Priv

ate

sect

orPr

ivat

e se

ctor

EmergencyRespiteSafe haven

Rapid responseHome care Hospital at home

Hol

istic

ass

essm

ent