Seize the day
What’s the secret of comedy? Hang on, it’ll come to me. Have you noticed how fed up Alan Johnson always looks in photos? That’s because… Timing. That’s it.
Timing is the secret of healthcare as well. The one thing no budget increase can give the NHS is time. And timing is the secret of business. We hear a lot about the difference between being efficient and being effective. The real distinction is: being efficient is saving time, being effective is using time well.
As the days begin to lengthen and the work schedules begin to bite, this issue of On Target is about making the best possible use of time.
In our lead article, Thoreya Swage discusses the Government’s 18-week target for patient pathways. This major challenge for the NHS is a golden opportunity for the medtech industry to provide new solutions. Swage examines the steps along the patient pathway, showing how innovative products and services can help the NHS to save time and thereby improve the patient experience.
Following this, we present two short articles on the future of telehealth – a new healthcare model driven by technological innovation. By reducing the frequency of hospital visits and the length of hospital stays for elderly patients, telehealth not only saves the NHS time but gives patients more quality time – in their own homes, in control of their own health.
In the second of our interview series ‘The Burning Question’, we ask healthcare logistics expert Akin Sawyerr whether NHS Supply Chain and its ten-year contract to drive down costs in NHS purchasing and distribution means that time has run out for medtech SMEs. His answer – that NHS Supply Chain looks for best value in terms of an effective system, not necessarily best price – is an important message for the industry.
The same message of using resources to best effect is underlined in two further articles. In an article on corporate social responsibility, Nick Tolhurst shows that voluntary action to help meet global healthcare needs can reap rewards in terms of training and contacts as well as reputation. And in ‘Remote Control’, Helen Stockill looks at strategies for harmonising the work of a sales team who are spread over a wide area. In both cases, the goal is not to get the most but to achieve the best.
Time can’t be manufactured: it has to be used. Efficiency is about not wasting time. Effectiveness is about not wasting anything else. When you put these two principles together, the result is more successful business, better health outcomes and better patient experience.
Nobody’s going to wait for you to get it right.
Chris Ross
Editor
Upgrading the NHS:medtech and the Darzi reviewThe healthcare market in 2008 will be profoundly changed by Lord Darzi’s review of the NHS. Thoreya Swage looks at the review’s progress and the new opportunities for the medtech industry.The Government has given a respected surgeon and junior health minister, Lord Darzi, the task of reviewing the structure and priorities of the NHS to continue the momentum of the reform agenda. After reviewing healthcare in London, Lord Darzi embarked on an energetic programme of consultation and informationgathering from the great and the ordinary in the NHS to help him decide what to do next for the whole of England. The result was the interim report Our NHS, Our Future, published in the autumn of 2007. A final report is promised in time for the 60th anniversary of the NHS this summer. The interim report identified a number of issues across healthcare, and has come up with solutions and pointers for action to please almost everyone involved. Lord Darzi, a pioneer and supporter of minimally invasive surgery that uses new imaging and robotic technologies, has set out some proposals with a strong positive meaning for the medtech industry. Targeting innovationRecognising the vital role of medical technologies in improving the quality of clinical care, Our NHS, Our Future announced the establishment of a new Health Innovation Council (HIC). The report described how key innovations such as arterial stents and laparoscopic surgical techniques have resulted in improved patient outcomes. However, such innovations have so far taken a long time to be recognised and adopted as routine procedure, despite strong evidence of their effectiveness. Lord Darzi, the designated ‘Champion of Innovation’, is to chair the HIC and ensure that its work dovetails with the wider NHS review. The Council will have representatives from the NHS, academia and industry to guide its work and ensure a more consistent uptake of innovative and cost-effective techniques. Five main categories of innovation will be addressed: pharmaceuticals, medical technologies, clinical practice, service delivery models and management. The Council will also examine all aspects of innovation that impact on the delivery of health and social care services. In order to support the HIC, £100m of joint funding from the Wellcome Trust and the Department of Health has been assigned to improve the development and deployment of hi-tech healthcare by the NHS. This initiative has been welcomed by health and industry organisations, and aims to build on the excellence of the UK’s medical sciences.
Improving the evidence baseSupporting the work of the HIC and other institutions such as NICE, the report proposes the setting up of a national clinical evidence base to hold the best available evidence about clinical practice, patient pathways, models of care and innovations. This evidence base will include international experience as well as UKwide experience. The NHS has been sporadic in its examination of international examples of good practice in the past, and this is an opportunity to look beyond the UK for better technologies. Extending primary careThe main message of Lord Darzi’s interim report was that despite some marked improvements in the NHS as a whole, patients were having difficulty in accessing services – especially in primary care. In response, there is a commitment to invest further resources in primary care services – and in particular, to develop at least 100 new GP practices with about 900 healthcare staff in a quarter of the PCTs in England. These new practices will be required to offer an innovative range of services, with the explicit aim of improving health outcomes, and be open longer than the usual GP surgery hours. The services may be provided by GPs or by the independent sector. Further resources are being channelled into developing a primary care centre for each English PCT, located in easily accessible places and offering services to the general public. The services envisaged are pre-bookable appointments, walk-in care and other primary care to the local population. The aim is to extend primary care services’ opening hours and be co-located with other community services, such as therapeutic and diagnostic services, pharmacy and social care. The emphasis is on moving more services from secondary care into the community. However, secondary care is not let off the hook either: hospital providers may come under closer scrutiny, and be required to offer more convenient opening hours for out-patients in the evenings and at weekends. Urgent care is also examined, with the recommendation that a review be carried out to improve access to emergency services across all health and social care sectors. All of this means that there will be more, and potentially new, customers for healthcare products emerging as more routine investigative and monitoring work is performed within primary care. Safer secondary careWhile primary care needs to increase patient access and capacity for diagnostic testing, secondary care needs to improve patient safety and reduce the impact of healthcare acquired infections. The report proposes a Bill (now forthcoming) that will create a new health and social care regulator with powers to inspect and fine organisations that fail to meet hygiene and infection control standards. Targets on reducing MRSA infections through screening before elective surgery and tackling C. difficile will feature as national priorities in 2008. Furthermore, all acute Trusts will be subject to an annual infection control inspection, be required to screen all emergency admissions within the next three years, and be penalised or rewarded on their performance with regard to hospital hygiene and healthcare-acquired infections. This will be supported by the development of guidelines for local NHS staff in order to improve their compliance with hospital cleanliness – in particular, empowering matrons to report any hygiene concerns directly to the new regulator and to order additional cleaning. In this context, the medtech industry needs to identify the potential areas of increased demand for products that support cleanliness and hygiene. There is also an opportunity to develop relationships with new customers, such as hospital matrons, who will influence the use of these products. New technologies for improving patient outcomes have moved to centre stage. Lord Darzi’s review gives the medtech industry a chance to demonstrate how effective medical technologies can be and to increase their profile within the NHS.Working with new technologyInformation technology in the NHS continues to lag behind the requirements of the service. The NHS is flooded with data, but remains poor at providing useful information. While the national IT infrastructure has connected every GP surgery and hospital to a common secure network, there is still much work to be done to make effective use of digital access to X-rays and scans through a national Picture Archiving and Communications System (PACS). Many organisations in the social care sector are taking on responsibility for investment in telecare services for older people and the disabled. These services represent a growing market for applications of new technology. The second stage of the review will consider in further detail how to achieve better use of IT. The medtech industry can play an important part in offering advice and training on the various technology systems in use and being procured. No healthcare organisation can operate effectively without well-trained staff, and the report identifies action required on workforce planning, education, training and information to support learning. Workforce planning needs to be linked to the development of new services and models of care in order to strengthen the competencies and skills of healthcare staff. In order to support the new Healthcare Innovation Council, £100m of joint funding from the Wellcome Trust and the Department of Health has been assigned to improve the development and deployment of hi-tech healthcare by the NHS. This initiative has been welcomed by health and industry organisations.The second stageThe second (and final) stage of the Darzi review involves bringing together about 1000 doctors, nurses and other health and social care staff across the country to look at identified areas of care and discuss how best to improve these. The goal is to develop a picture of world-class care in each of these areas, and to identify priorities following consultation with patients, the public, NHS staff and partner agencies. The second stage of the Darzi review will develop plans for:
Opportunities for medtechClearly, the Darzi report has set a number of expectations for the NHS. The challenges are great since the timescale is short, with a need to demonstrate significant changes by next summer. A number of opportunities therefore present themselves to the medtech industry. The procurement of new services in the community provides an opportunity to establish relationships with new providers, some from and others new to the NHS. Some of these providers may be setting up services from scratch, and information from medtech representatives will facilitate the use of evidence-based healthcare technologies. With new providers who are familiar with the local healthcare system, there is still an opportunity to identify new customers (e.g. practice nurses) for healthcare products, as new services will be developed requiring more near-patient testing and diagnostic support. New services usually imply the need for staff to be appropriately trained to carry out their roles effectively. An important role for the medtech industry is to ensure that staff who are handling new and different medical technologies have the appropriate competencies and skills to use them correctly. Another major role for the industry is in facilitating the uptake of IT. The continued development of the NHS IT infrastructure, which is increasingly extended to social care, creates opportunities for medtech companies to provide new systems to customers, backed up with training and support. Managing the risk of healthcare-acquired infections will be high on the NHS agenda, probably resulting in increased product demand. Demonstrating to doctors, nurses and other healthcare professionals that appropriate devices can help them achieve this will be valuable to all concerned. Perhaps the best opportunity for improving healthcare at a national level is that provided by the establishment of the Health Innovation Council and the national clinical evidence information base. The future is nowNew technologies for improving patient outcomes have moved to centre stage. Lord Darzi’s review gives the medtech industry a chance to demonstrate how effective medical technologies can be and to increase their profile within the NHS. Dr Thoreya Swage is the Clinical Lead for new projects at the Commercial Directorate at the DH, with a responsibility to transfer the clinical knowledge and experience acquired from the Independent Sector Treatment Programme to the wider NHS. She has worked in the NHS both as clinician (psychiatry) and as senior manager, including Executive Director for a Health Authority, in various NHS organisations covering acute as well as primary care. She can be contacted at t.swage@btinternet.com.
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