Quality and Innovation and the Healthcare Science Connection Melanie Ogden,

1. Quality and Innovation and the Healthcare Science ConnectionMelanie Ogden, • Associate Director Quality & Innovation, NHS North of England

2. Quality, Innovation and the Healthcare Scientist8th November 2012

3. National Plan ‘Innovation Health and Wealth, Accelerating Adoption and diffusion in the NHS’ was published in Dec 2011 outlining the delivery agenda for spreading innovation at pace and scale throughout the NHS.

4. Reduce variation • The review process indentified 8 key areas for improvement. • We should reduce variation in the NHS, and drive greater compliance with NICE guidance. • Introduce a NICE compliance regime to reduce variation and drive up compliance with NICE Technology appraisals. • Require that all NICE Technology appraisal recommendations are incorporated automatically into relevant local NHS formularies in a planned way that supports safe and clinically appropriate practice • Establish a NICE implementation collaborative to support prompt implementation of NICE guidance.

5. Metrics • 2. Working with industry, we should develop and publish better innovation update metrics, and more accessible evidence and information about ideas. • Develop and publish an innovation scorecard to track compliance with NICE technology appraisals. • Produce a single comprehensive and publically available web portal for innovation in the NHS • Work with Which? to develop consumer campaigns to raise awareness amongst the public and patients of innovations in healthcare. • Establish the Clinical Practice Research Datalink (CPRD), a new secure data service within the medicines and health care products regulatory agency.

6. Systematic delivery mechanism • 3. We should establish a more systematic delivery mechanism for diffusion and collaboration within the NHS by building strong cross-boundary networks. • Establish a number of Academic Health Science Networks (AHSNs) across the country • Publish undertake a sunset review of all NHS/DH funded or sponsored innovation bodies and make recommendations as to their future form and funding • NICE will take responsibility for the iTAPP programme.

7. Incentives and Investment • 4. We should align organisational, financial and personal incentives and investment to reward and encourage innovation. • Increase the profile of, and maintain investment in, the NHS Innovation Challenge Prizes • Extend the ‘Never Events’ regime and encourage disinvestment in activities that no longer add value • Establish a Specialised Services Commissioning Innovation Fund

8. Procurement • 5. We should improve arrangements for procurement in the NHS to drive up quality and value, and to make the NHS a better place to do business. • We will publish a procurement strategy in March 2012. • We will double our investment in the small business research initiative to develop innovative solutions to healthcare challenges and help drive growth in the UK SME sector. • We will review existing NHS intellectual property strategy and develop a model for contracts that is fit for purpose.

9. Develop our people • 6. We should bring about a major shift in culture within the NHS, and develop our people by ‘hard-wiring’ innovation into training and education for manager and clinicians. • Ensure that innovation is ‘hard-wired’ into educational curricula, training programmes and competency frameworks at every level • Establish joint industry and NHS training and educational programmes for senior managers. • Establish an NHS Innovation Fellowship scheme,

10. Leadership • 7. We should strengthen leadership in innovation at all levels of the NHS, set clear priorities for innovation, and sharpen local accountability. • The NHS Operating Framework asks the NHS to prioritise the adoption and spread of effective innovation and good practice. • Clinical Commissioning Groups will be under a duty to seek out and adopt best practice, and promote innovation. • We will strengthen leadership and accountability for innovation at board level throughout the NHS.

11. High Impact Innovations We should indentify and mandate the adoption of high impact innovations in the NHS. 3 Million Lives Oesophageal Doppler Monitoring (ODM) Child in a chair in a day Digital by Default Carers for people with Dementia International Commercial Alliances From April 2013, compliance with the high impact innovations will become a pre-qualification requirement for CQUIN

12. 3 Million Lives • accelerate the use of assistive technologies in the NHS, aiming to improve at least 3 million lives over the next five years. • to make the most of these possibilities we need to spread the use of telehealth and telecare across the country. • taken together with service redesign they also have the potential to deliver significant cost savings • NoE share is 852,000 people supported • Investment of approx £148m needed

13. Oesophageal Doppler Monitoring (ODM) • ODM is a minimally invasive technology used by anaesthetists during surgery to assess the fluid status of the patient and guide the safe administration of fluids and drugs. • NICE recommended for patients undergoing major or high-risk surgery • Current information suggests that these technologies are used for less than 10% of applicable patients • NoE now at approx 50% of potential usage – but with significant variation • Ambition to achieve 80% by March 2014

14. Child in a chair in a day • Whizz-Kidz (a wheelchair services charity) set itself the ambition of getting disabled children into a wheelchair appropriate to their needs within one day • The NHS must do more to develop and spread of these types of transformational programmes at pace and scale, working with local stakeholders • Integration of the assessment and procurement function in paediatric wheelchair provision combined with strong leadership can realise this ambition • All children to receive bespoke wheelchairs within 18 weeks • The Charity subsidises the NW to the tune of £500,000 pa

15. Digital First • Electronic media is a part of our daily lives, the ability to use email for non-confidential communications, or to have a remote consultation using telephone or online technology, would offer a much more convenient way of accessing NHS services. • work towards reducing inappropriate face-to-face contacts and to switch to higher quality, more convenient, lower cost alternatives • every 1% reduction in face-to-face contact saves up to £200m. • NoE data shows non-face 2 face hospital consultations account for only 0.5% of the 23.6m outpatient consultations • Ambition to increase this to 10% by 2016

16. Carers for peoplewith Dementia • There are estimated to be 600,000 people in the UK acting as the primary carers for people with dementia. Caring can be an overwhelming experience, bringing irreversible changes to lives and relationships • The costs of caring are significant. Carers save the UK public purse £6bn every year. Without provision of better support for carers, such as the provision of carer breaks and access to a range of psychological therapies, an increasing number will be unable to continue caring and pressure on the health and care system will continue to grow. • The NHS must ensure that a range of these psychological therapies are being commissioned and are available in line with NICE-SCIE guidelines

17. BNP/NT pro-BNP testing in primary care • NT-proBNP (N-terminal pro-hormone brain-type natriuretic peptide) • A diagnostic test that is used by GPs and/or secondary care clinicians to detect, diagnose and evaluate the severity of heart failure.  • The principle benefits are a reduction in referrals for further investigations, e.g. echocardiogram.  The test can also be used to monitor drug therapy in patients with confirmed heart failure; aiming to reduce the number of visits to hospital.  • An adoption pack will be available soon from NTAC.  In the meantime, further information can be found here.

18. Healthcare scientists involvement . . . • On-line quality assurance network for diagnostic radiology services • North Western Medical Physics (NWMP) have implemented an on-line QA system in radiology depts across the NW to provide centralised records • Ensures radiology services produce optimum quality patient images with the lowest achievable radiation doses.  • Enables real-time information sharing • Maintains x-ray equipment performance and safety

19. Healthcare scientists involvement . . . • ICEPT – Improving the Care Experience Post renal Transplant • Development of a novel set of virology/biochemical tests based on Dried Blood Spot (DBS) • Introduce a DBS sample collection system , reducing OP clinic visits for routine tests • Enables self care with tele-consultation support. • Estimated savings of nearly £1m per annum anticipated

20. Healthcare scientists involvement . . . • GP electronic ordering and results viewing • Introduction of tQuest enabling GPs access to any tests undertaken in the hospital. • Reduces turnaround of some late in the day tests by 16 hours (overnight) • Reduction in repeat tests demonstrated • Reduction in time to order tests by healthcare assistants and GPs