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NHS in 2018Opportunities for Technology & Intelligence
Mark Dundon | 13 November 2014
NHS Brand Value
2018?
Will the NHS exist?
Will the NHS be privatised?
The NHS is a political pawn
Front line staff influence voters views
In it’s current form the NHS is not sustainable
Five Year Forward View
£30bn funding gap by 2020/21
Five Year Forward View
Get serious on three fronts:
• Take our own health seriously
• Change the way services are provided
• Ask the next government to support financially
Five Year Forward View
Action on Four Fronts:
1. Do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The Forward View backs hard-hitting action on obesity, alcohol and other major health risks.
Five Year Forward View
Action on Four Fronts:
2. Commit to giving patients more control of their own care, including the option of combining health and social care, and new support for carers and volunteers.
Five Year Forward View
Action on Four Fronts:
3. The NHS must change to meet the needs of a population that lives longer, for the millions of people with long-term conditions, and for all patients who want person centred care. It means breaking down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care. The Five-Year Forward View sets out new models of care built around the needs of patients rather than historical or professional divides.
Five Year Forward View
Action on Four Fronts:
4. Action needed to develop and deliver the new models of care, local flexibility and more investment in our workforce, technology and innovation.
Context: NHS England
• Circa £120bn annual budget
• Shrinking envelope in real terms
• Increasing and ageing population
• Increasing number of physical and mental illnesses and conditions to accommodate
• PCTs disbanded
• Commissioning transitioned in to GP led Clinical Commissioning Groups (CCGs)
• Service provisioning transitioned in to Commissioning Support Units (CSUs)
Context: NHS England - CSU
• Pathway to privatization for CSUs by 2016
• Creation of a competitive landscape within the NHS
• 100+ CSUs became 23 CCGs in April 2013
• Now down to 9 CSUs due to merger and acquisition
• Strategic alliances and mergers according to market positioning of CSUs
• CSUs at the moment responsible for Technology & BI provision in to CCGs and out to practice
• Strategy and transformation is essential!
Context: NHS England - CCG
• CCG has a geographic boundary
• Health budget for a geography split across CCG (primary and secondary, community etc) and Local Authority (mental health)
• Integrated Care across a local health economy to NHS England is a top priority to better manage combined budget envelope and cut out inefficiency (better care fund)
• Great demand for excellence in technology and intelligence to support commissioning to cut costs
• All things commissioning has essential dependencies on BI. – e.g. risk stratification – top 2% of the population
Adversity creates opportunities
What can we do?
What can we do?
We can make a HUGE difference through Technology, Intelligence, Innovation!
In many ways the NHS can never been more exciting!
Five Year Forward View
Action on Four Fronts:
1. Do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of
Britain all now depend on a radical upgrade in prevention and public health. The Forward View backs hard-hitting action on obesity, alcohol and other major health risks.
Tier 2: TOOLS/DASHBOARDSPresenting the information in a useable format
Tier 3: INTELLIGENCEInterpretation of outputs
Tier 1: DATA (DMIC/DSCRO)Datasets from local providers and national sources
I need help
Dedicated specialist analysts and virtual team
of experts
Insight and intelligence to
aid decision making
Some customers like to also look at
dashboards directly
Detailed analysis (slice
and dicing)
What is Business Intelligence?
What is Business Intelligence?
Tier 2: TOOLS/DASHBOARDSPresenting the information in a useable format
Tier 3: INTELLIGENCEInterpretation of outputs
Tier 1: DATA (DMIC/DSCRO)Datasets from local providers and national sources
Dedicated specialist analysts and virtual team
of experts
Insight and intelligence to
aid decision making
Some customers like to also look at
dashboards directly
Detailed analysis (slice
and dicing)
I have what I need!
What is Tier 3 Intelligence in NHS context?
Primary Care Research Network
BI AnalystsTier 3: Intelligence/Advanced Analytics
Academia
Mental Health
Local Authorities Clinical
Quality
Research
Health Economics
Financial Modelling
Third Sector
Community
Acute
Virtual Team
CCGS
A continuum of development
Answering the “so what?”
What is Big Data?
Big data sets?
Too big to process?
High volume high frequency?
Structured vs Unstructured?
What value-add metric is attributed to data size?
Data vs Information?
Context sensitive?
What is Big Data?
I like to keep things simple!
My Definition: “No matter the breadth or depth of data source(s), BIG data is BIG contribution to decision making. The BIG is not in the source, the BIG is in the value adding intelligent contribution.” – Mark Dundon (2013)
Typical advanced analytics scenarios
How long are patients waiting for treatment?
Are we delivering national standards of care for: patient experience, quality and outcomes?
Who are thesickest people and wheredo they live? Is demand really
going up? By how much?
What is the demand today for urgent care, and who do I need to target to keep out of hospital?
Who is at greatestrisk of disease/acuteadmission to hospital?
Where is there clinical / activity / cost / outcome variation vs local, national, international, best practice?
Is cost aligned to volume, quality and outcome?
How much do individual service- lines/ pathways cost compared to budget?
What are the current flows and pathways and are patients using the right ones?
How Healthy?
What’s happening in this system?
How much?
How Do We
Compare?
Ref: NHSE Commissioning intelligence report
Typical advanced analytics scenarios
What is the current performance against plan?
What service lines are above or below
plan - why?
What will be the impact of demographic
and disease pattern change?
What activity should we contract for to deliver the service changes / cost efficiencies needed?
How can we make QIPP savings of £XXXm?
Have we improved outcomes?
What are the benefits of the changes?
Would 'Scenario A' improve patient flows and productivity more than 'Scenario B'?
What would be the impact, in activity flows and costs, of making a proposed change to a clinical pathway?
Are My Providers Delivering
?
Are providers delivering on service-improvement, quality, patient experience and waiting-times targets?
How could
things be better?
What difference have we made?
What are our future
plans?
Ref: NHSE Commissioning intelligence report
CSU
CCG
CCG
CCG
CCG
CCG
CCGCCG
CCG
CCGCCG
CCGCCG
CCG
CCG
CCG
CCG
CCG
CCG
CCGCCG CCG
CCG
Diabetes
Cardiovascular Disease
Cancer
Value Add of a CSU
e.g. this CSU identifying 6-700
people with propensity for
diabetes – installing preventative
measures
Risk stratification analysis and
research across clinical pathways
Generate ideas around
interventions
Five Year Forward View
Action on Four Fronts:
2. Commit to giving patients more control of their own care, including the option of combining
health and social care, and new support for carers and volunteers.
Five Year Forward View
Action on Four Fronts:
3. The NHS must change to meet the needs of a population that lives longer, for the millions of people with long-term conditions, and for all patients who
want person centred care. It means breaking down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care. The Five-Year Forward View sets out new models of care built around the needs of patients rather than historical or professional divides.
Video Conferencing
Non when I arrived!Circa £2.5m of cost to CSU!
It doesn’t need to be rocket science, leverage the basics!
Agile Working
Integrate the way we work to improve patient care
Telehealth
TeleCare
TeleMedicine
• Trials between practice and patients in Yorks
Five Year Forward View
Action on Four Fronts:
4. Action needed to develop and deliver the new models of care, local flexibility and more investment in our workforce, technology and innovation.
Change is needed!
Rationalise Technology Estate
Lots of duplication across systems, contracts, process
e.g. multiple service desks, telephony and mobile contracts (£300k saving on mobile and telephony post merger)
Overhauling CSU delivery structure
Greater Customer focus
Greater Commercial focus
Greater Staff focus
40
High Level Target Operating Model
Fin
an
cia
l C
on
tro
lle
r
HR
M
an
ag
er
Re
so
urc
e
& C
ap
ac
ity
P
lan
nin
g
Bu
sin
es
s
Un
it
Su
pp
ort
Head of IT Head of BI / DMIC
Head of Account Management & Business Development
Head of PMO, Programme & Service Delivery Cust
omer
CIO / CTODeputies
• Customer is primary focus
• Head of IT and BI/DMIC concentrates on their professional verticals
• Account, New Biz, PMO & Programme horizontal delivery through to customer
• Finance, HR, Resource & Capacity, BU Support are foundation pillars