Healthcare for the future: Meeting the challenges Professor Hamish Laing Executive Medical Director & Chief Information Officer ABM University Health Board 14 th February 2017
Recap The challenges facing healthcare organisations Following Professor Andrew Davies: 7 th February 2017
Five disruptive Forces in Combination Greying patient (and provider) Rise of Chronic Disease Information Revolution Blessing and Curse of Technology New Health & Care Consumer From Advisory Board www.advisory.com
Estim ates (2013) Males Fem ales Projections (2036) Males Fem ales Age-group 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 1-4 0 6 4 2 0 2 4 6 More than a Million centenarians by 2070!
Worsening Inequality Male life expectancy Swansea 76.7 years Inequality gap 12years (11 in 2005) Male Healthy life expectancy Swansea 63 years Inequality gap 23years (was 22) www.publichealthwalesobservatory.wales.nhs.uk
Ageing beyond our ability to support Number of people 20-64 for every person over 65 1950 7.4 1980 5.1 Greying patient (and provider) 2011 4.1 2050 1 2.1 Source: OECD 1 Projected
The Health Foundation the path to sustainability Demography alone across Wales +1.3% spending increase Acute care costs increase significantly after 50-54 Costs are just acute care clearly there are other care costs
ABMU Financial health We spend 1.3BN a year ( 3.5M a day) We balanced our books in 2015-6, just! We have an underlying 15M operational deficit We have to save a further 35M this year Around 75% of our costs are wages and salaries These pressures continue to be as great for at least the next 3-4 years
An extinction Event for Healthcare? Greying patient (and provider) Rise of Chronic Disease Information Revolution Blessing and Curse of Technology New Health & Care Consumer From Advisory Board www.advisory.com
Meeting the challenges
The Challenges to Healthcare in the Future Demography Workforce Expectations Environment Behaviours The ten strategic issues that will influence the way health and social care is delivered in future The King s Fund Medical Advances Disease and Disability Economic Pressures Sustainability Digital Technologies
Waste, Harm and Variation Doctors differ and their patients die Isaac Cruikshank 1794 By kind permission of Huntingdon Museum, San Marino CA
Always Improving WASTE, HARM and VARIATION Bring no benefit to the patient Bring no benefit to clinicians Are financially crippling So. We can reduce our costs at the same time as improving the quality of care This is a win -win opportunity!
The Wellbeing of Future Generations (Wales) Act
Meeting the Challenges From a focus on Disease and treatment Service usage Separate health and care departments Professionals as the fixers Spending Providing Condition or procedure Hospitals Uniprofessional You come to us To a focus on Population health and prevention Benefits Integration of health and care Co-production Value Commissioning Person-centred care Primary first Peer teams More care locally - at home Digitally-enabled
What is digital?
Digital Exclusion Source: HMRC digital strategy: 2014
Digital Technology Today - examples for citizens/patients: CARedelivered with Telemedicine to support Rural Elderly and Frail patients, Betsi Cadwaladwr Atrial fibrillation detection, ABMU
Digital Technology Today - examples for clinicians: Refer Review Decision support Dictation into the record
Digital Technology Tomorrow the ability for new services: The imminent 5G standard will be all about new services enabled by a step change in data speed and an order of magnitude reduction in end-toend latency Tactile internet -the capability for people to wirelessly control both real and virtual objects, thus requiring tactile-based control signals and feedback of images and sounds.
Where Robots Roam the intersection of medical and digital technologies Autonomous driving medicines management Tactile internet remote surgery Source: James Martin/CNET Source: Surgrob.blogspot.com
Our Next Steps Our Digital Strategy
ARCH Our Aims
ARCH: What are the four ARCH programmes of work? Wellbeing Skills & Education Service Transformation Research, Enterprise & Innovation
ARCH: The journey so far ARCH builds on the priorities already established through the clinical strategies set out by both health boards ARCH Portfolio Delivery Plan to be submitted to Welsh Government 2017 Hywel Dda & ABMU launch Changing for the Better & Your Health: Your Future 2012 Hywel Dda is invited to join collaboration and ARCH is born 2014 2015 2016 Welsh Government awards 1.2million to fund ARCH Programme Office team ABMU & Swansea University begin to formalise collaboration already taking place
ARCH: The need to change how we do things ARCH is the vehicle to help us deliver strategic priorities which have previously been constrained
ARCH: Highlighting key deliverables Wellbeing Tackle underlying causes of ill health & long standing issues in the region s primary care provision: Through the creation of a regional network of health & wellbeing schemes The development of a wellbeing social impact bond Service Transformation Research, Enterprise & Innovation Deliver sustainable services and improve quality across the region: Development of series of regional service models Singleton Health Campus will become increasingly focused on providing services to avoid admissions and we will create new space to teach our future NHS workforce Morriston Health Campus will further develop as a regional centre Service of excellence Transformation Make significant investment in research & innovation and translate it into regional economic benefit: Expand the IP Commercialisation Framework to capitalise on the innovation taking place in the NHS Create a wider Health Technology Network across the region, and indeed Wales Create an open innovation environment and culture, co-locating science, practice and enterprise Skills & Education Address growing staff shortages & create a pipeline of talent to feed into health & life science sector: Expand Swansea University s Medical School Increase the number of nurse recruitment/development initiatives to reduce reliance on temporary staff Create new future-proofed, fit-for-purpose roles to help deliver new models of care Supporting sector-linked apprenticeship schemes and rollout the Talent Bank FE STEM programme
ARCH: What is a Health and Wellbeing scheme? Regional network of schemes will transform the way we deliver care and address key social determinants of health and wellbeing Schemes will partner first-class health, research and life science with innovative leisure & regeneration opportunities to help people live healthier lives The schemes are an innovative proposal with potential to improve health, but also to boost the economy and develop skills, recruit talent while supporting regeneration
ARCH: Swansea City Health Wellness Centre Modern world class accessible health and wellbeing facilities Co-location of a very wide range of community health services, multiple GP practices podiatry, dental services, speech & language, sexual health services, INR monitoring, integrated health & social care teams Wellbeing services co-location with library, multi functional space, 3 rd sector innovation hub Added value ILS (research and innovation), Talent Bank, Primary Care Academy, Health & Wellbeing Academy Digital Communities Wales
ARCH: Llanelli Wellness & Life Science Village ARCH is working with Carmarthenshire Council to create Wellness and Life Science Village The multi-million pound project will be the first of its kind, bringing economic regeneration to the area and also creating new jobs The village will have prevention at its heart, and will provide facilities and services to prevent ill-health and reduce pressure on health service The village could include a state-of-the-art wellness and leisure centre, health and wellbeing academy, research facilities, wellness hotel, conferencing and high-spec business suites and a wellness school
ARCH: Neath town centre regeneration scheme Potential for multi-site facility, Neath town centre Neath cluster - scoping of GP interest ongoing Close proximity to facilities to support social prescribing Education and information provision aimed at wellbeing & prevention
ARCH: What will health campuses look like? Singleton Health Campus Morriston Health Campus Hywel Dda Health Campus Centre of excellence for a range of diagnostic, rehab & treatment services including ambulatory care and will become an environment of co-production immersed in a teaching, research, innovation & translation culture Will establish single medical intake for Swansea & Neath Port Talbot & become Major Acute Centre for region. Faster & more effective cancer treatment, improved access to specialist services & 7-day surgical/medical services Will include a network of integrated community & primary care resource centres bringing care closer to home, community diagnostic hubs & develop digital health services at scale
ARCH: Changing landscape of NHS in Wales Morriston Health Campus will establish a single medical intake for Swansea and Neath Port Talbot and will become the Major Acute Centre for South West Wales ABMU, with support from Welsh Government, has invested millions to buy new land to expand Morriston. Acquiring this land shows the commitment to establishing Morriston as a health science campus
ARCH: Changing landscape of NHS in Wales Singleton Health Campus will be a centre of excellence for a range of diagnostic, rehab & treatment services including ambulatory care Swansea University s Medical School will build on the success of its Institute of Life Science, allowing growth of research activity, support companies in exploiting research output and allow the expansion of clinical trials Singleton Health Campus will become an environment of co-production immersed in a teaching, research, innovation & translation culture
ARCH: What will a City Deal mean to the region? Swansea Bay City Region, supported by ARCH is bidding to UK and Welsh Government to secure funding in excess of 500million over 20 years Create a vibrant, world-class regional economy, driven by a skilled and talented workforce City Deal aims: Help people living in the region stay healthier for longer and live a better quality of life Create more well-paid jobs and opportunities Create a truly smart, efficient and connected region which can maximise innovation & technology across all sectors
ARCH: Next steps - Portfolio Delivery Plan submission to Welsh Government Following the submission of the ARCH Prospectus to Welsh Government in June 2015, the ARCH partners are preparing to submit their Portfolio Delivery Plan in 2017 This document aims to set out in more detail the critical path of the ARCH Portfolio and the specific proposals for each of the 4 programmes of work
ARCH: Swansea Bay City Region - the City Deal as a funding route for ARCH... The City Deal should be seen as an opportunity to help deliver projects within ARCH
Our Next Steps -ARCH and the Swansea Bay City Region City Deal Connected: Health and Wellbeing Villages/Institute of Life Science Health Campuses/MediPark Digital District/Digital Quarters Open Innovation Ecosystem Academia eg. SAIL Commercial partners Centre of Excellence for Next Generation Digital Services Multi-agency intelligence and analytics, skills and talent development Infrastructure needs: 4G/G.fast wifi rollout 5G testbed transatlantic cable