17 Sep 2018
Chief Executive, Prof Ben Bridgewater, is attending the UK-China Health Dialogue in Beijing today (17 September 2018), along with the UK’s Health and Social Care Secretary, Matt Hancock and other health and industry leaders. Read his speech below about digital transformation, precision healthcare and patient safety.
“We all know that most healthcare systems are struggling with similar challenges as a consequence of an increasing volume of elderly patients, a rising burden of lifestyle diseases, increasing consumer expectations, unacceptable variation in outcomes and escalating costs of care delivery.
And for the large part we know what we need to do to meet these challenges, including greater education and empowerment of citizens and pivoting our focus to prevention of disease as much as treatment.
Digital will be key to delivering cost effective solutions, and our real problem is now how to seek out winning approaches and deliver them in at pace and scale.
In Greater Manchester, devolution has been our catalyst for change – in 2016, we became the first region in the country to take charge of our £6bn health and care budget and be granted powers to make decisions about how to best to meet the needs of local people.
Leaders from the NHS and Councils are now united and working together to improve local health and wellbeing. And the conversation is no longer about health and social care, but about health and social care integration with wider public service reform, driving maintenance of wellness along with detection and treatment of disease.
Early indications are of benefit from this approach with good financial control, increasing access to primary care services, strong metrics on smoking cessation and we are now making choices, such as greater investment in children and young people’s mental health services.
But we recognise that we need to do things radically differently, which led to the creation of Health Innovation Manchester in October 2017. We have brought together our fantastic researchers and innovators from across Greater Manchester to drive improvements forward at quicker pace.
We operate as part of a national academic health science network (AHSN) which has collectively benefited more than 22 million patients, leveraged £330m investment, created more than 500 jobs and introduced more than 330 innovations into the NHS.
Thanks to devolution and the formation of Health Innovation Manchester, we are now on our way to becoming a fully joined up innovation system making shared decisions for local people, and driving rapid improvements through research, innovation and partnerships. And here we mean partnership both across healthcare organisations and importantly partnerships with industry.
I have a background both as a cardiac surgeon in the NHS and as global leader in a technology business. I have come to release that to deliver successful solutions in healthcare we need to take the lessons from digitally transformed industries and apply them systematically in healthcare. Healthcare is special, but when it comes to technology, it isn’t really as different as many would claim.
This starts with the requirement to understand our populations and the needs of individuals much better, to enable us to target effective and efficient strategies. This includes increasing our understanding of biomarkers, lifestyle factors and the mechanisms of disease to deliver more targeted approaches for the benefits of both individuals and the health economy.
And we need to prioritise. In Greater Manchester many of our innovation programmes are targeted towards risk factor detection and management in cardiac disease, the treatment of respiratory conditions, and new approaches for supporting the frail and elderly – three areas where we know that we have particular problems.
For our academics, one of our key research themes is precision medicine and we are well aware that driving better care in a personalised way is highly complex.
There have been great advances in many areas recently, including particularly genomics and proteomics, as well as technology including big data and Artificial Intelligence, all areas where we are strong in Manchester.
But no one person is able to keep abreast of all developments across sectors, so we need to pull together academia, care delivery, commissioning and industry through effective partnerships, recognising that these organisations and their people have different cultures, behaviours and languages.
Our recent partnership with Qiagen to develop a world-leading genomics campus in Manchester is a key example of our public-private partnership approach.
Health economics is one particularly important bit of the jigsaw, another area we are prioritising, so that we can tie together personalised medicine with sustainable services.
Extreme collaboration is at the heart of what we are doing in Health Innovation Manchester to deliver value from disparate assets.
One area which exemplifies this is our approach to breast cancer screening, where the Manchester Centre for Genomic Medicine, a partnership between Manchester University Foundation Trust and the University of Manchester, is enhancing existing services, to combine screening and personalised medicine.
Previously women have been stratified based on age and offered mammography for screening, with some patients offered genetic testing on the basis of family history. Our researchers have recently used next generation genomics to more accurately determine risk prediction and enable more active personalised screening, surgery or treatment options.
This has led to some women who were previously thought to be of high risk to be re-classified, with obvious benefits to them as individuals and the health economy, with a 30% reduction in the need for prophylactic surgery. Other patients have been found to be of higher risk, enabling more personalised and efficient screening, prevention and treatment.
Through our devolved system, we in the process of delivering these research advances across the city-region, giving a much accelerated time to value, from both a patient and a Manchester pound perspective.
Another essential foundation for delivering safe, affordable and high quality care is fostering a culture to ensure that patient safety is at the heart of everything we do. When things go wrong they can often be tracked back to problems inherent in the system, human relationships, behaviours and attitudes to safety. This is a top priority for the NHS nationally and in Greater Manchester through our Patient Safety Collaborative.
We share good practice across the health system, focus on people-centred care and build relationships between clinicians, businesses and academia to stimulate innovation and improvement.
The Patient Safety Collaborative focuses on three areas of work:
• Creating the conditions that will enable healthcare organisations to nurture and develop a culture of safety.
• Reducing harm for patients who are deteriorating in hospital.
• Improving maternity and neonatal care,
As an example, we have worked with Saint Mary’s Hospital in Manchester, part of Manchester University Foundation Trust to develop a specialist clinic, the Rainbow clinic, to support women and their families during a subsequent pregnancy after suffering the horrific experience of a previous stillbirth or perinatal death. The team works with the family at every stage, ensuring they receive the right specialist treatment to meet their needs. Funding is provided by the charity Tommy’s.
This has resulted in improved outcomes for both mothers and babies, with both clinical and economic benefit. The team has cared for around 550 families to date, with spectacular results with respect to fetal mortality and the incidence of low birthweight deliveries. We are now rolling out the model to maternity units across Greater Manchester, with the aim of reducing deaths or stillbirths by 20% by in the next two years and by 50% by 2030.
Of course, technology is key to delivery of all of these solutions. To deliver benefits at scale we will increasingly need to move existing applications to modern infrastructure to tackle the challenges of richer data, along with the need for enhanced compute power and stringent security requirements. We need to augment existing systems of record with genomics, proteomic, patient held and internet of things data.
We will need to drive enhanced insights from the data, which will require greater interoperability and next generation big data techniques. And of importance, we need to use those insights well by engaging far more effectively with patients, people at risk of disease and clinicians to ensure that we deliver value from the technology spend, including embedding enhanced decision support to ensure consistent quality.
And to generate a virtuous cycle from the use of technology, we need to ensure that specific digital initiatives deliver value in short order, including quality improvement and financial return on investment, which requires both a rigorous digital transformation methodology, as well as development and support for leaders running healthcare organisations, focusing on people, process and culture, every bit as much as tools and technology, and here we must learn from success in other industries.
We particularly welcome the recent NHS England nomination of Greater Manchester as a local health and care record exemplar to enhance our system of record to create a single, joined up health and social care record for each of our 2.8m population, and deliver an interoperable platform for better direct patient care.
This platform will allow those of us in the innovation space to deliver faster and more comprehensive innovations.
So in order to deliver the best care now and into the future, leaders have a duty to ensure the safety of both patients and staff and must foster a climate driven by collaboration that avoids harm, promotes learning from error, enables excellence and unlocks data to allow staff to drive continuous improvement in the areas they work.
This, combined with a more personalised approach to medicine, underpinned by digital and partnership, will ensure that the health systems become safer, innovative and sustainable. We are pioneering this approach in Greater Manchester.”