Presently I work for the Knowledge Transfer Network (KTN), which is the UK’s innovation network. We work alongside several stakeholders, most notably Innovate UK which is the Government funded UK Innovation Agency. My role at KTN is all about the delivery system for ‘health and care’. It’s my job to work out how KTN can best help businesses to access that market and innovate for better outcomes and a sustainable health and care system for us all.
It’s a massive topic and one that many people in both the public and private sector battle with almost constantly. The amazing diversity of the stakeholders involved in this led me to join the Institution’s Biomedical Engineering Association Board. Being a member of the board ensures that this key group is kept up to date both with the innovation landscape and the topic of delivery of technology into the NHS and social care sectors. Equally, I can translate the activities and discussion from this group into the KTN and beyond.
I have worked in both manufacturing and product development and that experience taught me about quality and responsiveness – the need to ‘put the customer first’. That’s a key message because the present health and care system is not really able to respond to the needs of its customers. Instead it often acts to preserve the status quo, to maintain its existing systems and offers many apparently compelling reasons for doing so.
The UK’s health and care services (and those across the developed world) are facing a series of unprecedented challenges. The system we have now was originally designed to diagnose and treat acute health problems in large central facilities. That’s where most of the NHS’s budget still ends up. However the service is now under huge pressure to treat completely different types of ‘disease’ in vastly greater numbers than it used to. Enter the non-communicable long-term condition. We are an ageing population and while technology has the ability to keep us alive, it does not unfortunately have the ability to keep us healthy.
These types of disease are only realistically manageable if the services and support needed to manage them are provided more (or all) of the time; that is, not in ‘point’ interventions. Hospitals cannot do that cost effectively or even to a satisfactory standard from their brick and mortar infrastructure. In fact we really need to transfer the prime responsibility of managing these conditions to the individuals concerned. The phrases ‘self-care’ or ‘self-management’ should not be considered a threat to the quality of outcomes. Adopting those principles is the only way the system can respond effectively.
We are living for years with these conditions, often cycling in and out of hospitals with entirely avoidable exacerbations – simply because we are basically ignored by the system most of the time. To make things even more difficult, many of us will end up with more than one of these conditions. That means separate specialisms – each attempting to treat the bit of the body they are used to looking at – but not the whole person. In fact, only the individual concerned has any hope of coordinating the complexity of the care they need – but the system does not at present support him or her to do that. Factor in the disjointed handover between health and care services (a differentiation many people don’t realise exists until they experience it themselves) – and you have a system that is increasingly backed-up and so very inefficient. This situation is not improving.
What can technology offer to help?
A key enabler to meet this challenge is information – which starts as data. Like many other sectors before it health and care needs to embrace the massive potential offered by digital technology. The Digital Health revolution has the potential to enable us to share so much valuable information that services can be re-designed around empowered, resilient citizens, aware of their conditions, able to avoid exacerbations, obtain lower level support at much reduced cost from connected ‘circles of care’. All of this can be done without troubling a hospital most of the time. Even better, such activated, engaged and empowered people might increase their levels of wellbeing in a proactive manner. The system needs to be reconfigured so it supports all of us, including those of us that may find it more difficult to do so, to engage with our own health and care. This sounds like and is a revolution in culture and the dynamics between citizen and the state.
Revolution sounds exciting but you have to start somewhere and indeed many people have already got things moving. There is a myriad of great ideas that tech businesses and indeed, motivated clinicians have come up with. Many are aimed at improving the delivery of health and care services within the present system. Typically then, these ideas will be care-pathway disrupters – changing how the system does things. That’s one of the main problems facing deployment of digital tech in the health and care setting; it threatens existing organisational arrangements. The existing approaches in many organisations that deliver health and care make it impossible to assimilate or share data; they can’t automate its analysis. They also cannot hope to ‘plug in’ to consumer-driven data generated by individuals as they go about their daily lives. The amount of data which could add value to this situation, could it be accessed, is growing rapidly. The current system locks information away either due to its structure (non-interoperability) or organisational boundaries (the dreaded ‘information governance’, IG).
So what about the other challenges to Innovation in Health and Care?
One really tricky subject when we talk about integrating tech into health and care is the question of evidence. Of course the need for evidence, particularly concerning safety when devices or therapies are allowed to support or alter physiological processes or a person’s bio-chemistry, cannot be circumvented. However in health and care, the question of evidence has a tendency to slow or stop new approaches even when they have nothing to do with those ‘clinical’ concerns. More often than not the gold standard for clinical evidence – the Randomised Control Trial – comes up, often quite inappropriately, where digital technology applied to patient experience (or care pathways) is concerned. It simply is not the right way to evaluate these sorts of solutions, but is what many people are used to dealing with. Trying to generate a control group for a digital pathway change is far too difficult and the whole process takes far too long and costs far too much.
Another challenge to digital within the health and care setting is ‘information governance’. That, and the associated data protection regulations, is another hurdle that is often made out to be higher than it really is. Despite numerous initiatives to clarify the landscape around this subject it does remain confusing and therefore ends up in the box marked ‘RISKY’ by some decision makers and legal advisors within the health and care system. If nothing else it’s another source of delay – in and of itself a key barrier to deployment of digital solutions to the system. What else adds to delay? Public sector procurement systems do! From an SME perspective this is very often the final nail in the coffin. Businesses really cannot wait for IG, evidence and procurement to work its way through. They will simply go bust in many cases while this leviathan churns slowly through its process.
Pulling all this together I would suggest that what is missing is leadership at the right levels in the system where it can challenge how things are done now. Many observers are increasingly surprised and disappointed at the rate of change, despite many policy initiatives being in the right place, saying the right things. There is a cultural inertia preventing scale-up of very promising initiatives popping up all over the UK, for the reasons mentioned. And scale is another thing essential to the business model for digital technology.
Examples (with evidence) include 25% reduction in use of emergency services due to large scale deployment of Philips Motiva telehealth Services from Liverpool and the fully developed eRedbook app for young mothers, developed by SiteKit. This takes the baby book all new mothers receive into the 21st century and makes it far more powerful and valuable. This innovation is about to be rolled out in parts of London. eRedbook is also an example of a personal health record or PHR.
‘The modality GP Partnership’ in Birmingham offers an entirely digital interaction to patients and has reduced A&E attendances locally. The service that enables the digital front-end to work was built with the support of Digital Life Sciences, another SME that KTN and Innovate have supported over the years. The system offers choice to patients; for example, wait for an appointment or access an online GP. 70% take the online option and 70% of those interactions address the patient’s need. The result is, citizens have a satisfactory solution and they don’t trouble more expensive parts of the system; freeing capacity for those that are in greater need.
So what can be done and what is KTN doing to try and help?
KTN and many others involved in this space are currently looking elsewhere, beyond the statutory services for opportunities for innovation to grow. We have examples in Health 2.0, Ageing 2.0 – both global networks of innovators plus numerous UK accelerators and incubators that are all focussed on a ‘direct to consumer’ offer – having essentially given up on ‘the system’ – for now. Of course there are ongoing attempts to bring about change from within and indeed generate ‘evidence’ since the system is still addicted to it. The NHS Test Beds and the parallel Internet of Things projects are the latest ones. We are watching with anticipation to see what emerges from those.
At KTN we are presently lining up ‘speed networking’ . Essentially this is a bespoke event linking consumer and professional electronic and data management corporates with digital SMEs. This follows a very successful version of that event that linked pharmaceutical industry and private health insurers (and delivery businesses) as corporate partners to innovative SMEs. We aim to provide space for open innovation but see the emphasis being on a consumer offer.
I’m certain that the statutory system will begin to embrace the digital health revolution; it really has to happen, but these fast-moving businesses cannot afford to wait. KTN cannot realistically bring about change at scale within health and social care, so we continue to network ‘innovative nodes’ within the system. These ‘place-based’ innovation hotspots share an economic/business led aspect to the work they are doing. KTN is therefore (for now) working mostly where the ‘door is open’ to that type of thinking.
To conclude; we should note that the challenges I have covered are well understood within our health and social care organisations (the system) and the most senior leaders thereof are committed to bringing about transformative change. You can read more in the NHS England Five Year Forward View and through The National Information Board.
David Calder has a background in Engineering, Manufacturing and Research and Development. A cross-sector portfolio of roles includes Knowledge Transfer in support of UK Innovation. He joined the newly formed KTN Ltd in April 2014 where he is lead for Digital Health. @DavidKTN
Catch David at Venturefest Southwest on 18 October.
The views of the writer do not necessarily represent the views of the Institution.