Economic Summit 2017
Introduction to the fourth WMAHSN Economic Summit Professor Michael Sheppard, Chair, WMAHSN
Housekeeping No planned fire alarm tests today Fire assembly point St. Jude s NCP car park Toilets are located on the downstairs along the corridor Photographer Wifi use thebcec and code freewifi and accept T&Cs Twitter use hashtag #WMAHSNsummit17 Change to agenda Elodie from Give Vision
Seven point growth plan Tony Davis Commercial Director, WMAHSN
Sustainability and Transformation Partnerships (STPs)
Increasing the Economic Impact of the NHS in the Black Country
Introduction Andy Williams, Black Country & West Birmingham STP Lead 9
The NHS as a major economic player Up to 1 in every 15 in the economy is said to be an NHS pound. By any reckoning the NHS is a major economic player just through its direct expenditure. By its actions, the NHS also has significant indirect impacts on many aspects of the wider economy ( externalities ), for example Transport costs and other impacts ( staff and patients) Productivity consequences or how we serve people managing their own health Impact on local population make up and its economic leverage. These indirect factors seem to be less well understood and are often missing from NHS strategic considerations. 10
The NHS as a major economic player Supported by the Strategy Unit and ICF Consulting we set out to unpack these economic factors and how they impact the health, wellbeing and prosperity of the local population. Our intention was two-fold: To describe the NHS in the Black Country and West Birmingham as an economic actor in the region, so as to raise awareness and understanding ; To take that understanding and to use it to test ideas about how the local NHS might shape its priorities in order to increase the wider impacts of its economic power (e.g. to achieve productivity benefits in the wider economy). Full report available at - http://www.strategyunitwm.nhs.uk/publications/economic-impact-nhs-spendingblack-country-full-version 11
Why does this matter to the Black Country & West Birmingham STP? Andy Williams, Black Country & West Birmingham STP Lead 12
STP rationale One of the major drivers of the financial gap in the Black Country STP is projected increases in demands for health and care over the planning period. There is a clear evidence base to demonstrate that the wider determinants of health and wellbeing lie mainly outside of the health and care system and relate to employment, wealth, education and housing. STP 2016 The challenge Standard STP interventions (shift to more local care, acute reconfiguration, etc.) not enough to close the triple gap. The opportunity West Midlands Combined Authority including emerging devolution deal. Association of Black Country Authorities proactive leadership by Public Health departments & LA role in place-making. Acceptance by local NHS partners of the scale of their combined economic influence. 13
STP rationale Principles Genuine collaboration not command and control Cross-sectoral action breaking down silos Focus on population wellbeing not just health A recognised relationship between the health sector and another sector that has been formed to take action on an issue or to achieve health outcomes in a way that is more effective, efficient or sustainable than could be achieved by the health sector working alone. World Health Organization framework for tackling inequities arising from the social determinants of health 14
STP rationale Initial logic 15
What is the economic impact of the NHS and how might it be increased? James Medhurst - ICF Consulting James Kearney - ICF Consulting 16
NHS spending and jobs in the Black Country Expenditure 2014/15 (based on a review of local CCG and NHS Trust accounts) Annual spend of 2 billion on o Wages / other benefits: 1.1bn o Purchases: 0.9bn Gross Value Added 2014/15 (based on wages and reported surpluses) Direct economic impact: 1.1bn o 5.5% of Black Country GVA Total impact (after multipliers): 1.5bn o 7.9% of Black Country GVA Employment 2014/15 (based on review of local CCG and NHS Trust accounts) Permanent employment: 29,000 jobs (24,200 fulltime (FTE) equivalent jobs) Plus Bank (4,400) and Agency staff (2,100) FTE Total direct jobs funded by the NHS: 30,800 FTE o 6.3% of the Black Country workforce Total impact (after multipliers): 40,800 FTE o 8.3% of the Black Country workforce Informal care: 3.9m hours per week (c100,000 FTE) 17
Increasing the economic impact of the NHS Three scenarios to examine the impacts of limited NHS and partner resources targeted on employed individuals Scenario 1: Access to healthcare appointments - changes in form of access / location of services Scenario 2: Support for common mental health problems Scenario 3: Support for informal carers to remain/return to employment Impacts estimated on the basis of modelling assumptions and calculations of supply of additional working time valued at average output per worker Sensitivity analyses suggests there maybe scope for higher net returns Some limits to scaling up beyond the assumed take-up of services 18
Increasing the economic impact of the NHS improving access to appointments To make it easier and quicker for workers to attend appointments the NHS could: Provide more GP consultations by phone or video Use GP surgeries for some hospital outpatient appointments This will provide a benefit to the entire working age population (722,000) and provide an economic benefit to the Black Country for a cost of 1 million. 19
Increasing the economic impact of the NHS support for common mental health problems The NHS could provide additional support to individuals with mental health conditions such as stress and anxiety which will help them to: Stay in work or return to work Reduce absence Supporting 20% of individuals with these mental health conditions would cost 2 million, and lead to larger benefits to the economy 20
Increasing the economic impact of the NHS Support for informal carers Providing support to help informal carers develop care plans would help carers: Stay in or return to work Reduce absence Providing this support to 10% of informal carers would cost under 1 million and provide large economic benefits to the Black Country 21
How is the Black Country & West Birmingham STP building on this work? Andy Williams, Black Country & West Birmingham STP Lead 22
Emerging STP initiatives Stakeholders Local Authority Public Health leads Public Health England Adult Social Care West Midlands Combined Authority Wellbeing Board/Mental Health Commission Black Country Consortium Clinical Leadership Group Initial aims Work towards a number of wellbeing deals between health and other sectors Demonstrate proof of concept for The initiatives selected The value of collaborative action at STP level Priority focus Targeted prevention at scale Children and young people Workplaces 23
1. Targeted prevention at scale Detailed Black Country Prevention Framework developed covering core and aspirational actions Core actions generally amenable to action at local level Other actions may benefit from concerted STP-wide action Initial prevention priorities identified by STP Clinical Leadership Group If the Black Country performed as well as similar areas - Hypertension and atrial fibrillation 436 fewer under 75 deaths from heart disease, stroke & dementia 4m costs saved Smoking in pregnancy 46 fewer infant deaths 325 fewer babies with low birth weight 451 fewer infants admitted with respiratory tract infections 784 women quitting smoking pre-delivery 24
2. Schools Wellbeing Deal Opportunities Government obesity strategy Strategic School Improvement Partnerships To improve outcomes for children and young people and reduce demand on health, care and other public services Outline aims Narrow the gap in educational attainment and readiness for work in the Black County; Enhance the mental and physical health and wellbeing of children and young people, including their health literacy ; and Improve access to services provided by STP partners that can contribute to better health and wellbeing (e.g. CAMHS, Sexual Health services, school nursing, etc.). 25
3. Workplace Wellbeing Deal Opportunities Economic power of health and care sector Emerging health devolution deal for West Midlands Encourage the biggest employers and spenders in an area, such as large companies, hospitals, universities, local authorities, to become local anchors by using their collective spending power, know-how and networks to better connect jobs and opportunities to neighbourhoods and businesses that would benefit the most disadvantaged people and places. Outline aims Make standard NHS appointments more accessible (through out of hours or remote/virtual provision), increasing both patient convenience and economic productivity; Implement evidence based healthy working practices in all STP partner organisations,; Provide support to those with common mental health issues or informal caring responsibilities to stay in/return to work, improving opportunity and productivity; and Contribute to social value by o o Recruiting from the local population with an initial focus on the provision of employment, apprenticeships and mentoring for children looked after by STP partners and Seeking to ensure that procurement decisions bring benefits to local communities. We can solve poverty in the UK (Joseph Rowntree Foundation, 2016). 26
Next steps Refine focus Engage stakeholder Develop focused plans for limited number of initiatives Test logic Plan to evaluate Share learning Expand range/scale of initiatives 27
Contact T: 07720 341303 E: david.frith@nhs.net W: www.strategyunitwm.nhs.uk Twitter: @Strategy_Unit LinkedIn David Frith, Managing Consultant Leading research, analysis and change from within the NHS. 28
Birmingham and Solihull STP Dr Kathryn Hudson, Birmingham and Solihull STP Programme Director
Sustainability and Transformation Partnership Birmingham and Solihull
Our STP has: 2 local authorities; 3 clinical commissioning groups merging by 1 st April 2018 Seven hospitals Good Hope One mental health Trust One community healthcare Trust 182 GP practices Birmingham Children s Birmingham Community Health Trust Heartlands Queen Elizabeth Hospital Birmingham Birmingham Women s Birmingham and Solihull Mental Health Foundation Trust Delivering services to 1.3 million people Royal Orthopaedic Solihull
Health is everyone s business 32
STP aim to improve health outcomes 33
STP aim to improve quality of life Extract from Public Health England 'Fingertips tool 34
STP aim to address inequalities Index of multiple deprivation 35
STP ambitions for a transformed health and care system What would system transformation look and feel like? Focus on prevention Promoting independence Delivering excellence in health and care Improved health and well being Tailored health and wellbeing messages enabling people to make positive choices Fewer people requiring specialist mental health support More people retuning to work after a health problem People will have control over their choices and support to manage their health & wellbeing Fewer Adverse Childhood Experiences Shift towards a recovery (achievement) based approach to care A place based approach with service offers tailored to the unique demands of our different communities Improved access to quality services More integrated service offers across health, care, education and employment Better life experiences (achieving potential) for the most vulnerable People will have control and support for their treatment and care choices More people returning to and remaining in their own home to live independently Access to consistently high quality services across the whole of Birmingham & Solihull People s contact with services will be simple and consistent Joined up care that supports the individual single access point to health and care Maximised resources and productivity Reduction in demand due to improved lifestyle choices Less reliance on crisis and hospital based models of care, enabling the left shift, reduction in demand for services Increasing personal budgets and direct payments Improved utilisation of resources across the STP: workforce, estate, digital infrastructure 36
Future operating model The primary lens through which we view place (but not the only one) will be Parliamentary constituencies 37
STP evidence base for action When we look across the life courses and pathways of care, we need to decide which segments have the greatest potential to improve population health, reduce variations in care and to release efficiencies (i.e. the FYFV 3 gaps). This needs to be based on the best available evidence (JSNA, PHOF, ASCOF, Children s outcome framework etc.), with sensitivity at locality level (e.g. constituency/ward level). Evidence base for the areas of highest priority and the interventions to address them (WMAHSN). The priorities should span the life course, pathways of care and major enablers. 38
System inter-dependencies The STP operates in a complex system of overlapping geographies, public services and systems of accountability. The STP will focus principally on where we can come together to deliver most benefit for health and social care in BSOL. But many of the determinants of health lie outside the STP s immediate remit, or across a wider geography. We must be smart at how we identify inter-dependencies and leverage support between agencies and stakeholders to support our strategic aims and theirs. Important inter-dependencies (not exhaustive) are: the Combined Authority and its programmes, other West Midlands STPs, Local Enterprise Partnerships, Mayoral Poverty Commission, HS2, Commonwealth Games, East Birmingham and North Solihull Project, Health and Well Being Boards, NHS specialised commissioning etc. 39
Refreshment break and networking
Digital health, disruption and economic benefits Neil Mortimer @neil_a_mortimer neil.mortimer@wmahsn.org
What do we mean by disruption?
The NHS, then and now
Years until used by 25% of Americans Pace of digital adoption 50 45 46 Acceleration of Technological Adoption Curves 1867-2017 40 35 30 25 35 31 26 20 15 16 13 10 5 7 5 0 Electricity Telephone Radio Television PC Mobile Phone 1867 1877 1887 1897 1907 1917 1927 1937 1947 1957 1967 1977 1987 1997 2007 2017 Internet Social Media
Digital Health West Midlands A comprehensive service to WMAHSN Members Digital Health and Data Service Digital Health Education and Skills Digital Health Accelerator and Incubator The core service is now live, with expansion planned from 2018
Cliff Dennett: cliffd@innovationbham.com, @cliffdennett Nurturing digital brilliance
The good news Year Digital start-ups 4.6K 2017 509 YTD (771) 2016 699 2015 383 3 rd place across Europe cliffd@innovationbham.com, @cliffdennett
The challenge As a startup CEO, I slept like a baby. I woke up every 2 hours and cried. Ben Horowitz Andreessen Horowitz cliffd@innovationbham.com, @cliffdennett
The challenge Source: Scaleup Institute First mover advantage doesn t go to the first company that launches, it goes to the first company that scales. Reid Hoffman, co-founder of Linkedin cliffd@innovationbham.com, @cliffdennett
3 incubators in the UK s largest campus dedicated to digital businesses www.innovationbham.com
Cliff Dennett: cliffd@innovationbham.com, @cliffdennett Nurturing digital brilliance
USER
1ST GEN OF SIGHT AID FOR STATIONARY ACTIVITIES
250 PATIENT TRIALS 15 CLINICIANS 2 HOSPITALS >1000 WAITING LIST >800K FUNDING MEDIA COVERAGE
LET S WORK TOGETHER TO TACKLE SIGHT LOSS THROUGH TECHNOLOGY.
Olivia Hind, Head of Partnerships OVIVA and NHS England National Innovation Accelerator (NIA) Fellow Already helping patients across 20 NHS CCGs, including: 59
Oviva was founded in 2014 to revolutionise access and outcomes in dietetic therapy by incorporating new technologies into care. We provide dietetic services in more than 500 locations across Europe, including: 20 NHS CCGs 2 Local Authorities More than 500 GP practices across Switzerland & Germany Selected awards and service sites: 60
10% of the NHS budget 3.4m people (& 5m at risk) 8.8 billion per year Source: NHS England 61
Source: National Diabetes Audit and Diabetes UK 62
60% Not achieving treatment targets for HbA1c, blood pressure and cholesterol Source: National Diabetes Audit 2016/17 63
As the nation s waistline keeps piling on the pounds, we re piling on billions of pounds in future taxes just to pay for preventable illnesses. We want to see patients and carers involved in decisions about their care, receiving appropriate structured education to support self-management, having more control and managing their own health, care and treatment. NHS England 64
1 2 3 Personalised highfrequency dietitian support Evidence-based written and video educational materials Oviva app 65
66
Home screen Activity tracker Weight tracker Personal goals 67
Pre-diabetes Oviva Diabetes Prevention 24 month digital education and behaviour change programme Type 2 diabetes Oviva Diabetes Support 3 month digital education and behaviour change programme 68
75% uptake rate 11mmol/mol HbA1c reduction There is one word to describe this programme - brilliant Participant in North West London Source: Oviva data from NHS contracts (c.3,000 participants) 69
1,000 in NHS savings per participant 100 million in NHS savings if 1/3 of all people newly diagnosed with type 2 completed Oviva Diabetes Support. Source: Frontier Economics 70
Lunch and networking
Introduction Tony Davis - Commercial Director, WMAHSN
MIDLANDS ENGINE AND WEST MIDLANDS SCIENCE AND INNOVATION AUDITS (SIAs) Dr Pam Waddell, Director of Birmingham Science City Alliance
National life sciences innovation policy context: UK industrial strategy and budget Innovation and Places 2 of 5 foundations Grand challenges include: Putting UK at forefront of AI and Data revolution Harnessing innovation to meet needs of ageing society Raise investment in R&D to 2.4% of GDP by 2027 Increase R&D Tax Credit to 12% + 725 Industrial Strategy Challenge Fund Sector deals including life sciences Local Industrial Strategies
Regional life sciences innovation policy context The Midlands Engine Vision for Growth - Innovation one of five priorities West Midlands Combined Authority (WMCA): Mayor and 4th(Digital) Industrial Revolution Emerging WMCA Digital and Innovation Boards Productivity and Skills Commission with innovation key driver Local Industrial Strategy led by WMCA New Shared Prosperity Fund to replace ERDF
Rationale for Science and Innovation Audits (SIAs) 1. Evidence areas of global competitive advantage across the UK 2. Inform strategic decision making on local innovation priorities 3. Strengthen business case for investment and funding 4. Foster collaboration between universities and local businesses, local authorities and LEPs
Midlands Engine Science and Innovation Audit (ME SIA) Part of 1 st wave of BEIS National SIA programme Resourced by Midlands Innovation and Birmingham Science City Consultants (SQW) and regional private/ public/ university, multisector delivery group Analysis of extensive national and local data sources plus consultation with 80 stakeholders Published Nov 2016 and publically available https://www.midlandsengine.org/our-five-themes/innovation/
The ME SIA Framework
West Midlands Science and Innovation Audit (WM SIA) Sponsored by Black Country, Coventry & Warwickshire, Greater Birmingham & Solihull LEPs Supported by WM Combined Authority and Mayor Consultants (SQW) and regional private/public/university multisector steering group Analysis of extensive national and local data sources plus consultation with 80 stakeholders Published June 2017 and publically available http://www.birminghamsciencecity.co.uk/groups-and-networks/advisory-and-steering-groups- 2/wmca-innovation-working-group/
People & Skills Networks & Knowledge Exchange Th Policy & Regulation Funding & Support Physical Assets & Infrastructure Driving-up WM productivity through science & innovation Place holder text Advanced Manufacturing & Engineering Next Generation Transport Place holder text Market Strengths Enabling Place holder text Competencies Place holder text Digital Technology & Data Sustainable Construction Technologies for Better Health Systems Integration The WM SIA Energy Storage & Systems Framework
Market strength: Technologies for Better Health Existing market strengths: R&D, design and production of devices and diagnostics Software as a medical device Opportunity from application of research strengths: Translational medicine and accelerated access to new drugs, treatments and health technologies (particular spatial opportunity around Birmingham s developing Life Sciences Campus)
Locations of med tech companies (2015)
Technologies for Better Health research centres Aston University Aston Brain Centre Aston Research Centre for Healthy Ageing Centre for Vision and Hearing Research Aston Medical Research Institute Birmingham Health Partners Birmingham Centre for Clinical Trials The UK s largest NIHR/Wellcome Trust Clinical Research Facility West Midlands Genomics Medicine Centre West Midlands Regional Genetics Laboratory Royal Centre for Defence Medicine and The National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre - a national centre for trauma research Institute for Translational Medicine Arthritis Research UK Experimental Arthritis Treatment Centre EPSRC CDT in Physical Sciences for Health NIHR Biomedical Research Centre in Inflammatory Disease MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research Cancer Research UK Clinical Trials Unit Medical Devices Testing and Evaluation Centre (MD- TEC) Cancer Research UK Centre and Experimental Cancer Medicine Centre Centre for Precision Spinal Rehabilitation Warwick University Institute of Digital Healthcare Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research Wolverhampton University Centre of Health and Social Care Innovations Neuro-Oncology Research Centre Research Institute in Healthcare Science
WM innovation ecosystem Range of strong S&I assets - needs to be maintained and geographically spread for access Well-developed set of networks and relationships Policy commitment from LEPs and WMCA supports innovation behaviours in business base Low skills levels greatest weakness in ecosystem More/ consistent public and private funding to turn innovation to productivity (loss of ERDF an issue)
Moving forward and grasping the opportunity ME Innovation Group large scale propositions in discussion WMCA Innovation Board - strategic lead rolling forward WM SIA findings New Innovation Alliance WM of wide-ranging innovation stakeholders working with LEPs: Key aims to build innovation ecosystem and catalyse collaborative business/ demand-led activity that exploits findings of WM SIA At the heart of Alliance is series of existing and working groups covering S&I strengths and competencies including Innovative Health WG Support from e.g. ERDF joint calls, Industrial Strategy Challenge Fund, new Shared Prosperity Fund? Potential to address Grand Challenges Putting UK at forefront of AI and Data revolution Harnessing innovation to meet needs of ageing society
Tony Davis,Commercial Director, WMAHSN
West Midlands Combined Authority and the synergies with WMAHSN and West Midlands STPs Innovation Productivity Skills Health and Wellbeing Mental Health Commission
WMCA innovation Science and Innovation Consultation Innovation Board Innovation Alliance Industrial Strategy Investments
Productivity and skills Productivity and Skills Audit Productivity and Skills Commission
Productivity and skills consultation Productivity DriverWMCA Gather intelligence on what skills are needed in which sectors, and co-ordinate locally designed, Potential Ac joined up and long-term skills development policy Link the provision of skills to the demands of employers/industry, and ensure activity is employerled Ensure technological change is included within discussions on skills development policy Encourage joint working between Department of Work and Pensions and Department for Education Drive the benefits of apprenticeships and maximise the value of the apprenticeship levy and reforms Ensure unspent levy funds are not lost to the region but ring-fenced Encourage greater collaboration between schools and industry on careers advice, including raising work experience activity Place a greater focus on the link between employers and the health and wellbeing of the workforce
Productivity and skills consultation Productivity DriverWMCA Targeted subsidies for apprenticeships in relevant technical subjects Link with the WMCA Mental Health Commission to identify complementary and shared agendas Potential Prioritise the provision of targeted, mid-career access to new skills and refresher courses, including more technical apprenticeships Lobby government for clarity on Brexit situation and urge residency rights Drive up demand from employers for upskilling, particularly for leadership and management, largely through the greater promotion of benefits
Productivity Skills Commission Life sciences and healthcare as a sector Percentage of total WMCA Gross Value Add (GVA) 7.9% Percentage of total WMCA Jobs 13.1% WMCA Life Sciences/Healthcare GVA per employee 25,000 National Life Sciences/Healthcare GVA per employee 27,000 Health and life sciences GVA breakdown Health activities 5.1% Social work activities1.4% Residential care activities 0.9% Veterinary activity 0.1% Scientific research and development 0.1%
Productivity Skills Commission Life sciences and healthcare as a sector. Current GVA based on 2013 data* GVA 6.1billion Target GVA for 2030 GVA 12.1 billion Current performance GVA generated by the top 50 Businesses has increased by 25.8% in a one year period 32 of the top 50 businesses has increased GVA in one year period 11 businesses have increased GVA by over 20% in a one year Period
WMCA Health and Wellbeing STP alignment and engagement Future WMAHSN plans
WMCA Mental Health Commission Productivity and mental health Productivity and MSK Productivity and weight related health conditions
tony.davis@wmahsn.org
West Midlands Mental Health Commission Sean Russell, Director of Implementation
Life Sciences Strategy - a LEP perspective Katie Judge Greater Birmingham & Solihull LEP
About LEPs Voluntary, business-led partnerships with local government, HE & FE Lead on local economic growth strategy & negotiate Growth Deals with Government Non-constituent members of the WMCA, lead on CA Strategic Economic Plan
Strategic Economic Plans
Local Industrial Strategy Focused on local strengths, challenges and opportunities Focused on clusters of expertise and centres of economic activity to drive wider regional growth Establish new ways of working
WM life sciences 255 companies, 5221 employees, 838.5m turnover 18 FDIs (618 jobs) over 5 years Strengths in medical technologies and translational medicine Edgbaston cluster and numerous centres of excellence extending more widely
Opportunities and challenges Leverage our translational assets for economic impact Support firm growth (markets, finance) Strong innovation ecosystem Skills Inward Investment Strategy
Closing remarks Tony Davis, Commercial Director, WMAHSN
Networking and refreshments