Andy Kinnear opened BCS Health and Care Scotland’s 2017 Health Informatics conference with a statement: ‘How lucky we are. We’re lucky to do what we do, and to work in this space’.
With nearly 100 registered delegates, the event was large, lively and bustling, held at the Surgeon’s Hall in Edinburgh. Kinnear - director of digital transformation NHS South, Central and West CSU and chair BCS health and care executive - explored why people are more important than technology and how culture in digital health is changing.
To emphasise his point about people, he said: ‘We’re coming up for a bit of an anniversary - it’s the NHS’ 70th birthday next year. And, when I talk about what we do here, I’m always proud to reference the fact that we’re part of a national health service that has been free at the point of care for 70 years. This is unique. It’s something to be proud of and it’s a people story. It’s why we come to work each day.’
Inside the story
He continued with a frank acknowledgement: life within health and social care isn’t always great. Siloed working and badly implemented digital systems have combined to make clinicians’ lives tough.
To illustrate just how bad, Kinnear pointed to an anecdote told my Professor Robert Watcher - author of the Digital Doctor and NHS England’s Wachter Review. Watcher said he knew something was desperately wrong in health care when he saw a job that offered a great benefits package including a six figure salary, a car, and ‘no electronic medical record’ - the digital records system was so bad it was considered a job perk to be spared using it.
‘One of the job’s attractions was that you could carry on working on paper,’ Kinnear said, despairingly.
This, to Kinnear, was just another example of what happens when digital transformation places technology ahead of people. ‘They just weren’t involving clinicians in the design,’ he told the audience.
Kinnear’s main job is helping to create Connected Care. The project covers a huge geographic area, pretty much from the west of London right down to Cornwall and services around a million people. The project’s aim is to join up the silos of health and care information that exist across the network of organisations and bodies. And there are a lot of different organisations operating under the NHS logo in any one area.
If you access health and social care in just Bristol, for example, you could be interacting with one of 17 organisations. These include South Western Ambulance Service, South Gloucestershire Council, Bristol City Council, North Somerset Council and a hat full of different trusts. Across Connected Care’s whole geographic patch there are 97 GP practices and nine provider organisations.
‘Historically we’ve digitised records as best we can and we’ve done it in a spectacularly siloed fashion across organisations,’ Kinnear said. ‘We’ve created a legacy that we can’t be proud of.’
‘But,’ he explained, ‘We’ve also created an opportunity - an opportunity to join up all those records and that’s what Connected Care is all about.’
Despite its size, Connected Care has one aim: enabling all the professionals involved in looking after people to access information quick, safely and easily. In other words, Connected Care aims to produce a shared record system. This contrasts with the historic process of capturing patient information on paper, storing that paper and moving it between care settings so different practitioners can make the right decisions.
‘We have a duty to care,’ Kinnear explains. ‘And we also have a duty to share. Colleagues were frustrated about not having information that they knew was being collected elsewhere in the system. They needed that information to support their clinical decisions.’
On a national level, Connected Care is driven - in part - by the Caldicott Review. The independent review was called Information: to share or not to share? The Information Governance Review. Following a request from the Secretary of State for Health, Dame Fiona Caldicott carried out this independent review of information sharing to ensure that there is an appropriate balance between the protection of patient information and the use and sharing of information to improve patient care.
Done correctly this kind of shared record system should do more than ensure information moves smoothly between GPs and hospitals. It also enables information to flow in and out of social care too. This linking of services also means that terrible cases of abuse - such as the Victoria Climbié case - should be harder to hide and so preventable before they become truly dangerous.
‘Nobody had pulled the full story together,’ Kinnear explained, sighting Lord Laming’s report into the case. Services had a lot of contact with Victoria Climbié but nobody joined all the dots. ‘And the same happened at Winterbourne View in Bristol. There was a lot of abuse but people had failed to link up all the information around the individuals receiving care.’
‘So, we began the project in 2011,’ Kinnear explained. ‘The original vision was very simple: is it possible to build a shared record and if we build it, will people find it useful?’
The team spent 2012 in procurement, signed a contract in early 2013 and went live it at the end of that year with 500 users.
‘Since then we’ve grown. We’ve added more users, more functionality, more richness in the records and more source systems feeding in,’ said Kinnear.
The system offered two types of benefit. One is purely financial - through efficient communication the interoperable shared record system enabled organisations to save money. Secondly the system also offered profound time savings for practitioners.
‘More importantly though, the system also enables safer decision making,’ Kinnear revealed. ‘Practitioners are operating in a risk based environment. Most of the time you’re making risk based decisions. What’s the risk of doing one thing verses the risk of doing another? By giving a care professional more information, you’re enabling them to make better risk based assessments. And we’re getting anecdotal evidence about the system is changing the decisions people are making. They’ve done things differently, simply because they had more information available.’
Don’t be seduced by tech
Rather than being a technical triumph, Kinnear was keen to emphasise that the project is really a success story about people. ‘Sure we built some nice tech but that counts for nothing if there isn’t a doctor on the end of it, accessing that information and making a different decision about the care they provide their patients.’
The shared record system was complex to build - from a people perspective and also a techinal nuts and technical view. And rather than point to Agile or Scrum as the silver bullets, Kinnear offered a more basic recipe: collective will.
‘If you’ve got a collective will to make a programme like this happen, you can do it. As much as I talk about the huge number of people using the system, there’s about fifteen people at its core,’ he says. ‘It’s fifteen people, drawn from fifteen different organisations. We’re a tight bunch and its people factor - that high trust environment - that’s enabled us to deliver this project.’
The TITTAN project
The European population is ageing rapidly. The number of people aged 65 and over is projected to increase from 14 per cent in 2010 to 25 per cent in 2050. Advances in science and technology can contribute to prolong people’s lifespan, but unfortunately that does not necessarily mean that they will live healthier lives.
In its headline strategic document EU2020 Strategy, the EC has identified ‘active and healthy ageing’ as a major societal challenge common to all European countries. The TITTAN project (Network for Technology, Innovation and Translation in Ageing) aims to tackle that challenge, by improving the quality and performance of European regional healthcare systems, looking specifically at promoting ‘healthy and active’ ageing.
The aim of TITTAN is to identify, assess, share and implement examples of best practices across 7 European regions. The network aims to develop and promote policies which can foster the design, up-taking and use of innovative technology solutions and services for ‘healthy and active’ ageing. To find out more, visit the TITTAN website.