5. Professionals and patients need clean clear knowledge for decision making just as they need clean clear water for hand washing Water may look clear but be polluted and poisonous

6. At present people simply hold out a basin to collect knowledge, or dip a bucket in the sea of PubMed, one of the wonders of modern healthcare but peer review is no guarantee of freedom from pollutants - bias and errors due to chance- or poison due to the deficiencies of the peer review and editorial process

7. Rainfall Earth Sea Rivers Underground springs Wells

8. 3 types of generalisable knowledge Knowledge from research - Evidence Knowledge from measurement of healthcare performance-Statistics Knowledge from experience-Of patients and clinicians 2 types of particular knowledge Knowledge about this patient Knowledge about this service

9. Why a National Service is needed Nationally produced knowledge is not put into practice, or even available consistently Clinicians are confused by multiple sources of NHS/DH advice Clinicians and patients have different sources of knowledge Every organisation has a different knowledge base More agency and part time staff- only the patient is constant Urgent, important safety information cannot be promptly delivered

10. Better Consultations, Better Decisions, Better Communication Generation Organisation Localisation Mobilisation Utilisation National Oral Health Knowledge Service Co-ordinated procurement & Production National Library for Oral Health Library of Tools and Rules Map of medicine & evidence based pathways, NHS Care Record Service N3 National knowledge & decision support Patient & professional Education & services Question Answering Service

11. Rainfall Earth Sea Rivers Underground springs Reservoirs Wells Settling and sunshine Filters Chemical purification Water fit for drinking Sewage

12. Clean clear water Sewage Thirsty people Water sub stations Pumping stations Bottled water Pepsi Whisky

13. “The false positive rate is especially important in low prevalence settings where the number of false positives may exceed the number of true positives” Booth JCL et al (2001) Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27

14. “The false positive rate is especially important in low prevalence settings where the number of false positives may exceed the number of true positives” Booth JCL et al (2001) Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27

15. Royal Cornwall Lab Service Muir Gray Date of Birth 21/06/1964 NHS Number 400 186 6897 ELISA test on 7/4/2006 26.5 Hepatitis C is of low prevalence in Cornwall. National Guidance is that diagnosis should be confirmed by PCR test in low prevalence populations For PCR test click here For access to full text of National Guidance click here

16. The future is not a destination like Manchester or Bradford, waiting for our arrival; it is something we have to create

17. The future is here; it is just not evenly distributed

18. Healthcare 2011

19. Professional centred Patient centred Effectiveness & efficiency Value Opinion based Evidence based Event Pathway Organisation Network Structure System Clinical practice peripheral Clinical practice central Money driven Knowledge driven Research findings Systematic reviews 2006----------------------2011

20. Most patients in 2011 will Feel responsible for their own record Know their NHS number Read and think about the quality assured knowledge sent to them before the consultation Enter their own data before the consultation Use a decision aid before taking the decision to have an operation Know where they are on a care pathway Accept that medical knowledge is of variable quality

21. Let’s stop making bits of Lego; we need to decide what we want to build Let’s move from visions to plans

22. Muir Gray has familial hypercholesterolaemia Every six months he receives an email reminder to have a blood test He receives 2 SMS reminders if no blood sample is received within 2 weeks If no specimen is received his GP receives a copy email If there is a result is sent to the GP and to his Healthspace where it is stored in sequence Appropriate advice and support is automatically generated

23. New style consultations Patient learns about condition from NHS Direct TV at home at the suggestion of the GP or receptionist Patient interacts and informs using patient data entry Face to face consultation Patient works through options using a patient decision aid, considering likely outcomes against their values Face to face consultation Patient reflects at home, drawing on the values of other patients from the Database of Individual Patient Experiences

24. Muir Gray is told he needs implants for his third molars