Presentation on theme: "Transforming Care in Wales Opportunities RSA"— Presentation transcript:
1 Transforming Care in Wales Opportunities RSA Dr. M G MurphyClinical Director NWISCaldicott Guardian for WalesGeneral practitionerBlog sowhatfollows.wordpress.com
2 WCCG Innovation Space Work flow Pathways WORKING INSIDE OUR WELSH PSBA SECURENETWORKIDENTIFING STAFFUNIQUELYWITH NADEXInnovation SpaceWork flowPathwaysMHOLGP SystemWCP – CORECommunityMental healthSocial caresystemStructured dataDemographicPathologyRadiologyMedicationIHRUnstructured dataWCRSShared care recordExistingHospitalEtc.CONTROLACCESS TOWHO SEES WHATPROACTIVELYAUDIT EVERYACCESS TO EVERY RECORDWCCG
3 National Ophthalmology system WORKING INSIDEOUR WELSH PSBASECURENETWORKIDENTIFING STAFFUNIQUELYWITH NADEXInnovation SpaceWork flowPathwaysMHOLCORE RECORDCommunityMental healthSocial caresystemGP SystemStructured dataDemographicPathologyRadiologyMedicationIHRPatients DocumentsWCRSShared care recordNational DiabeticsystemExistingHospitalNational Ophthalmology systemEtc.CONTROLACCESS TOWHO SEES WHATPROACTIVELYAUDIT EVERYACCESS TO EVERY RECORDWCCG
4 Current position Modern SOA Architecture Private PSBA, data centers, Active DirectoryCore services provided provided slowly rolling outCreated room for innovation – to use Best of Breed appsAll our activity is internally focused – obsessed with communicating with each other
8 A short history of the NHS 1947 – but the care process is 150 years oldThe consultation – based on face to face contactThe patient travels to see the doctor / serviceInstitutional and building focus to provisionSystem was designed for episodic & infectious problemsSeparate health, social and mental health services
9 But We are facing a perfect storm Declining resourcesAging population with increasing care needs – social, mental , physicalHospital emergency care has clogged up already with the frail elderlyGreat difficulty in caring for people in their own home as numbers and frailty increasesPeople die in the wrong place – in hospital
11 A & E 714k (4% FU rate) 3.2M Welsh Citizens 800k LTC 15M new illness episodes(family, friends, voluntary help web etc)498GP Practices5.5M contact s unscheduled(16M total)84% surgery10% phone4% visits10m7+1Number of call centres , telephones calls7+641k1124kNHSDirectWebSite1515+143k403k392273k - 99966kDistrict nurse midwife14% pop. see DN per yearNHSDW239kPaid calls42731k2kDentist55% journeysstarted in eachcategory arestopped338k338k10k70% populationsee a dentistIn a year343k3k17k10kAmbulance325k calls500k journeysMental health servicesCommunity pharmacy70% population use in a year3k78k (1k )7kSocial worker32kGP OOH497k20k (3k)227k53k9kNursing HomeA & E714k(4% FU rate)19kPolice12k38k126k48kOutpatients6k20k7k pathAdmissions343k189kk1k Died10k18k emergency transfer
12 Transition in care services 20th Centaury CareMedical Hospital disease modelEpisodic reactive (fail and fix)Goal is Prevention of deathAll Care is provided by the state21st Century careHolistic Community health and social care modelLong term management ( predict and prevent)Goal is maximize quality of life & Good deathCoproduction self care
14 Dealing with risk Uncertainty = anxiety = risk = cost Its about human contact – not being aloneWe deal with risk – by keeping a closer eye on the patient i.e. by staying in contactThis is true during a single episodeBut 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 compressionAt the present time the lack of alternatives means we admit put people in hospital bedsOpportunity to use technology to stay in touch – in terms of distance and time
15 The Great Firewall of Wales (PSBA) Public servicesNHS,LASocial careMental healthThe PublicThe CitizenThe carerThe third sector
16 Can put the citizen at the Center in our networked world Paradigm shift - we use the technology they have to communicateOne global network, global services – no outside, no insideMobile Always on – anytime, any place, anywhereEach of the 15 links can carry voice, video & dataThe security of each link can change depending on type of communication and citizens requirement for confidentialityCarerThird sectorHealthCitizenSocial careMental health
17 GP system Health services Social care Voluntary services MHOL My global communicationsUsed for Tele HealthVideo , telephone, Text, IM, HTTPSSecure social networksInstant messagingCommunications HUBTele devicesMHOLBook appointmentsOrder prescriptionsMessage GPAccess to my GP recordHealth vault ( Own store)My copies ofCare plansContact details carersTestsScheduleSelf monitoring etcUndertake TasksUse my recordAccess KnowledgeMonitor myselfInternet – Ap CymruAccredited sitesConditionsTreatmentsPerformanceDirectoriesApps to help me manage my health and social problemsSelf monitoringPoint of care
18 What do we need ?Enable patients to use the technology they have to communicate with the serviceEnable staff to use the technology the patient has to communicate with patients and with each otherBut 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.
19 4 Strategic implications for Wales Separate the care record services from the communications services – they require different approaches to privacy, confidentiality & securityShrink the great firewall back to securing the care record data - the way other information services are deliveredProvision of the record data over secured link to mobile devices any where – including hospitals, estate & most importantly all homes in WalesShift the whole of human communications onto global cloud services available to the citizens
20 Opportunities ? Open Wi-Fi – in public estate and homes Simple reliable cloud VC – internet TVs etc.Mobile working – seamless use of the aboveTransformation of careunscheduled careLong termLong term condition managementIts 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.