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

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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