NHS | Presentation to [XXXX Company] | [Type Date]1

Healthcare Scientists-a call to action

Fiona CarragherDeputy Chief Scientific Officer

East Midlands HCS Summit9th October 2013

Challenges to the NHS

Ageing Population

Chronic Diseases

Many Co-

morbidities

Late diagnoses

Mobility & Greater

expectations of Public

Scientific Discoveries/Technology Advances

Health Inequalities

Challenges for the NHS

The NHS- Reflecting on 65yrs

• If the NHS is to survive another 65yr it must change

• www.england.nhs.uk

• Have your say

Addressing the Challenges Creating CCGs with a ‘new DNA’ with added clinical value

Developing new integrated pathways of care with quality outcomes at its core

Shifting care outside of hospital and closer to home, providing more choice

Taking a patient AND a population focus

Innovative models of provision – at the centre of new NHS thinking

From Everyone Counts – 2013/14 planning guidance from the NHS Commissioning Board

“Our National Medical Director will establish a forum that includes

national and local commissioners, providers and regulators to

identify how there might be better access to routine services

seven days a week and report in the autumn of 2013.

“As a first stage, the review will focus on improving diagnostics

and urgent and emergency care. It will include the consequences

of the non-availability of clinical services across the seven day

week and provide proposals for improvements to any

shortcomings.”

NHS Outcomes Framework

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

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CQUIN QOF

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6

Duty of quality

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

Du

ty o

f qu

ality

Du

ty o

f qu

alit

y

tariffstandard contract

CQUIN QOF

5

6

Duty of quality

Premature mortality-the challenge for HCS

• Britain has worse record for premature death than comparable countries – and the gap is rising 1

• A key issue is the late diagnosis of disease

• Government has identified the need for more and earlier diagnostic activity, particularly in primary care

1 The Lancet, 5 March 2013doi:10.1016/S0140-6736(13)60355-4

Long term conditions-the challenge for HCS

• Around 15 million (28%) people in the UK have a long term condition, and the number is increasing

• People with LTCs account for

• 50% of all GP appointments

• 70% of all bed days

• 70% of budgets

• Co-existing conditions can produce confounding diagnostic results and complicate interpretation

• Remote and other forms of monitoring needs to be developed to support self and directed management approaches

Acute and episodic care-the challenge for HCS

• Preventing admission and readmission – diagnostics supporting risk modelling

• Reducing length of stay and supporting early discharge

• Responsive emergency care with embedded diagnostics

• 24/7 provision of diagnostics with the intervention – eg interventional radiology and cardiology

• 7 day service provision especially linked to areas of higher mortality at weekends

Improving the patient experience – The challenge for HCS

• Providing services at accessible locations

• Further reducing waiting times

• Effective measures that relate to the experience of HCS services ( eg friends and family test)

• Patient Information on which to base choice and quality of provider

• Open and accessible test results and support to understand them

Ensuring safe care – The challenge for HCS

• Global Antibiotic resistance – Highlighted in the CMO report (pub. May 2013)

• Continued focus on HAI and VTE prevention

• Safety and side effect monitoring of drug therapy

• Safety of blood products and tissues

Science will be crucialresearch informing new ways of working

•Genetic profiling•Personalised medicine•Enhanced Point of Care Testing•Portable and home monitoring•Smart homes•Data fusion & bioinformatics•Virtual physiological human•Multi-modality imaging

Think about the changes in your career

Laboratory (life) Sciences• Analytical Toxicology• Anatomical pathology• Blood transfusion

science/transplantation• Clinical biochemistry including

paediatric metabolic biochemistry

• Clinical genetics/Genetic Science

• Clinical embryology & Reproductive Science

• Clinical immunology• Cytopathology including

cervical cytology• Electron microscopy• External quality assurance• Haematology• Haemostasis and thrombosis• Clinical Immunology• Histocompatibility &

immunogenetics• Histopathology• Microbiology• Molecular pathology of

acquired disease• Phlebotomy• Tissue banking

Physiological Sciences • Audiology• Autonomic neurovascular function• Cardiac physiology• Clinical perfusion science• Critical care science• Gastrointestinal physiology• Neurophysiology• Ophthalmic and vision science• Respiratory physiology• Urodynamic science• Vascular science

Physical Sciences and Biomedical Engineering• Biomechanical engineering• Clinical measurement &

Development• Clinical Pharmaceutical Science• Diagnostic radiology & MR physics• Equipment management & clinical

engineering• Medical electronics &

instrumentation• Medical engineering design• Clinical photography• Nuclear medicine• Radiation protection & monitoring• Radiotherapy physics• Reconstructive Science• Rehabilitation engineering• Renal dialysis technology• Ultrasound & non-ionising radiation

50+ scientific professions delivering over 150 different services that cost the NHS approximately £8bn. The workforce of 55,000 informs 80% of all diagnoses and is involved in the delivery of over 1 billion tests and investigations per annum. They have multiple impacts on all patient pathways through the specialist diagnostic, therapeutic and equipment services they provide.

Bioinformatics• Genomics and Clinical Bioinformatics • Health Informatics • Pathology

Healthcare Science Specialisms

Transition from paediatric to adult with long term hearing

loss

Respiratory scientists leading high quality

spirometry within the community for COPD

Monitoring anti-coagulation therapy in the primary care

Engineers supporting Augmentative and

Alternative Communication

Implementing telehealth to support patients with LTC

Biochemical screening for diabetes in Sikh community

Neurophysiology monitoring of treatment in X-ALD

Rehabilitation engineers support for wheelchairs and prosthetics

Challenges for HCS here and now

• Patient and public engagement

• Limited engagement with patients and public

• Lack of quality information for patients particularly to understand test results and support self-care

• Quality and Safety

• Significant variability in quality and access/waits for some services

• Patient safety issues uncovered

• Lack of robust assurance frameworks for all services

• Commissioning and improvement

• Commissioning models not well described or understood with services often ‘hidden’ in block contracts

• Areas for improvement not well recognised and best practise not adopted

• Lack of integration across sectors and limited offer in primary care

• Advice and expertise

• Knowledge and advice provided by HCS is a resource that the NHS still isn't using to the full

CSO team: Key aims

• We aim to drive a whole health system approach to providing high quality, innovative patient centred scientific services integrated across all delivery sectors with influential scientific leaders, aspirational providers and informed commissioners.

High quality care for all, now and for future generations

Healthcare Scientists-call to action

• Break the stereotype

• Always remind yourself why you became a HCS

• Don’t loose your passion and commitment

• Think about how you can play your part in this challenge

‘enthusiasm is contagious…..’

…Be Innovative

• Unleash your entrepreneurial spirit

• Think creatively

• Collaborate and build relationships with;

• Clinical colleagues

• Industry

• Academia

• Other Scientists

….Be a champion of quality

• Understand what quality means in your area

• Be proactive not reactive

• Don’t be complacent, always look to improve

• Use data to target problems and then show improvement

• Think end to end

…Always put the patient first

• How do your actions impact on patient care

• Not just a test result

• Think about patient experience and safety

• Work with patient groups

• Include them in your user survey

…Communicate your science

• Patients, public and professionals understand the value you add

• Think about language- make it accessible

• Opportunities as STEM ambassadors

• www.stemnet.org.uk

• We need to engage the workforce of the future

…Take your place in the team

• Multi-professional networks essential

• Part of clinical decision making

• Bringing expertise and scientific thinking

• Making a real difference to patient care

And be fearless !

• Think about how you can make a difference

• Challenge when things are not right

• Be a leader whatever grade you are

• Others may come with you!