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Transforming Care in Wales Opportunities RSA
Dr. M G Murphy Clinical Director NWIS Caldicott Guardian for Wales General practitioner Blog sowhatfollows.wordpress.com
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WCCG Innovation Space Work flow Pathways WORKING INSIDE OUR WELSH PSBA
SECURE NETWORK IDENTIFING STAFF UNIQUELY WITH NADEX Innovation Space Work flow Pathways MHOL GP System WCP – CORE Community Mental health Social care system Structured data Demographic Pathology Radiology Medication IHR Unstructured data WCRS Shared care record Existing Hospital Etc. CONTROL ACCESS TO WHO SEES WHAT PROACTIVELY AUDIT EVERY ACCESS TO EVERY RECORD WCCG
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National Ophthalmology system
WORKING INSIDE OUR WELSH PSBA SECURE NETWORK IDENTIFING STAFF UNIQUELY WITH NADEX Innovation Space Work flow Pathways MHOL CORE RECORD Community Mental health Social care system GP System Structured data Demographic Pathology Radiology Medication IHR Patients Documents WCRS Shared care record National Diabetic system Existing Hospital National Ophthalmology system Etc. CONTROL ACCESS TO WHO SEES WHAT PROACTIVELY AUDIT EVERY ACCESS TO EVERY RECORD WCCG
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Current position Modern SOA Architecture
Private PSBA, data centers, Active Directory Core services provided provided slowly rolling out Created room for innovation – to use Best of Breed apps All our activity is internally focused – obsessed with communicating with each other
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So What ? sowhatfollows.wordpress.com
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ZZZZZZZZZZ….
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A short history of the NHS
1947 – but the care process is 150 years old The consultation – based on face to face contact The patient travels to see the doctor / service Institutional and building focus to provision System was designed for episodic & infectious problems Separate health, social and mental health services
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But We are facing a perfect storm
Declining resources Aging population with increasing care needs – social, mental , physical Hospital emergency care has clogged up already with the frail elderly Great difficulty in caring for people in their own home as numbers and frailty increases People die in the wrong place – in hospital
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A & E 714k (4% FU rate) 3.2M Welsh Citizens 800k LTC
15M new illness episodes (family, friends, voluntary help web etc) 498 GP Practices 5.5M contact s unscheduled (16M total) 84% surgery 10% phone 4% visits 10m 7+ 1 Number of call centres , telephones calls 7+ 641k 1 1 24k NHS Direct Web Site 15 15+ 143k 403k 392 273k - 999 66k District nurse midwife 14% pop. see DN per year NHSDW 239k Paid calls 427 31k 2k Dentist 55% journeys started in each category are stopped 338k338k 10k 70% population see a dentist In a year 343k 3k 17k 10k Ambulance 325k calls 500k journeys Mental health services Community pharmacy 70% population use in a year 3k 78k (1k ) 7k Social worker 32k GP OOH 497k 20k (3k) 227k 53k 9k Nursing Home A & E 714k (4% FU rate) 19k Police 12k 38k 126k 48k Outpatients 6k 20k 7k path Admissions 343k 189kk 1k Died 10k 18k emergency transfer
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Transition in care services
20th Centaury Care Medical Hospital disease model Episodic reactive (fail and fix) Goal is Prevention of death All Care is provided by the state 21st Century care Holistic Community health and social care model Long term management ( predict and prevent) Goal is maximize quality of life & Good death Coproduction self care
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The Visual Care Cycle The basic risk management process in all care services Individual at home or usual place of residence If the individual or family feel they cannot manage the problem themselves and feel at risk they ring for help When the service believes the risk has diminished to an acceptable level the individual return home or to their usual place of residence Individual continues to self care 24 hour care usually in hospital Telephone advice or telephone consultation If after assessment the professional feels that there is residual risk and they cannot safely be returned home they arrange that the person stays in contact with the service 24 hours a day Individual continues to self care If the professional feels they cannot manage the risk without seeing the individual they arrange a face to face assessment Face to face consultation with professional Travel – 99.8% they citizen travel to the services ©MGMurphy
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Dealing with risk Uncertainty = anxiety = risk = cost
Its about human contact – not being alone We deal with risk – by keeping a closer eye on the patient i.e. by staying in contact This is true during a single episode But it is also true over your lifetime and the reason that 70% of the cost of care is incurred during the last year of life – morbidity compression At the present time the lack of alternatives means we admit put people in hospital beds Opportunity to use technology to stay in touch – in terms of distance and time
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The Great Firewall of Wales (PSBA)
Public services NHS,LA Social care Mental health The Public The Citizen The carer The third sector
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Can put the citizen at the Center in our networked world Paradigm shift - we use the technology they have to communicate One global network, global services – no outside, no inside Mobile Always on – anytime, any place, anywhere Each of the 15 links can carry voice, video & data The security of each link can change depending on type of communication and citizens requirement for confidentiality Carer Third sector Health Citizen Social care Mental health
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GP system Health services Social care Voluntary services MHOL
My global communications Used for Tele Health Video , telephone , Text, IM, HTTPS Secure social networks Instant messaging Communications HUB Tele devices MHOL Book appointments Order prescriptions Message GP Access to my GP record Health vault ( Own store) My copies of Care plans Contact details carers Tests Schedule Self monitoring etc Undertake Tasks Use my record Access Knowledge Monitor myself Internet – Ap Cymru Accredited sites Conditions Treatments Performance Directories Apps to help me manage my health and social problems Self monitoring Point of care
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What do we need ? Enable patients to use the technology they have to communicate with the service Enable staff to use the technology the patient has to communicate with patients and with each other But there is a problem with current way our Networks, PSBA, security & Data centers are configured that will get in the way of delivering this change.
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4 Strategic implications for Wales
Separate the care record services from the communications services – they require different approaches to privacy, confidentiality & security Shrink the great firewall back to securing the care record data - the way other information services are delivered Provision of the record data over secured link to mobile devices any where – including hospitals, estate & most importantly all homes in Wales Shift the whole of human communications onto global cloud services available to the citizens
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Opportunities ? Open Wi-Fi – in public estate and homes
Simple reliable cloud VC – internet TVs etc. Mobile working – seamless use of the above Transformation of care unscheduled care Long term Long term condition management Its the right time finally for this revolution because we now have a network that reaches into people homes & the technology has moved beyond public services ability to manage it.
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Wakey Wakey ...
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USC episode Individual unwell Home Residual Risk individual
Family friends individual Stable at home Individual unwell Voluntary sector Home Residual Risk Web Directory Physical & virtual Call center With call location & demographic linkage 111 call handler 999 call handler Signpost “Phone First” For help Hot transfer Hot transfer Advice & information Phone(SKYPE) Clinical assessment Mental health assessment Social care assessment With access to the IHR, Core H & SC records Care plan (ELP) & Specialist advice for staff on MH, palliative care Acute physicians e Transport Assess Face To Clinic OP appointment Specialist advice e.g. Diabetic nurse Optomatrist Private sector DN/CPN OOH appointment Community Pharmacy Holistic assessment Social Worker Monitoring at home OOH visit A&E Ambulance GP surgery Rapid response Home care Hospital at home 24 hour Care Hospital Inpatient 24/7 home Care package Nursing Residential Emergency Respite Safe haven
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