13th October 2016

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Matthew Syed - author of 'Black Box Thinking'
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This is going to be a sell-out
In conversation with Roy Lilley
25th October 2016 - King's Fund - tickets here. Hurry they are whizzing out of the door!
It all exists, now.
News and Comment from Roy Lilley
The initials CH stand for CentreHealth a contractor to the NHS. Their unobtrusive sign is on the brick and razor-wire wall around the perimeter of an anonymous building on the outskirts of Milton Keynes.
Entry; by swipe-card then, a thumbprint recognition. From there into the air-lock and to the locker room. Mobile phones, tablets and keys are locked away. No personal items may be taken outside this room. Security; tight and routine.
The control room; somber, soft lighting, operator's faces illuminated by the screens in front of them.... speaking into headsets.
On the walls huge screens of real time information.
From here the whole of the NHS provider-side in England is controlled.
Schedulers are connected to every A&E in England. They monitor emergency calls, ambulance availability, arrivals, flow and predicted run-times. They are able to redirect ambulances to where demand is lowest and to A&E with capacity.
Algorithms predict demand. Next year they will take over operation of the national 999 ambulance service. Patient transport will follow.
Another row monitors staffing. For the past three years, all patient facing staff wear an NHS badge; in it there is RFID microchip which is activated as staff clock-in. They are individually identified. Their whereabouts in the hospital can be tracked, for safety and security purposes.
A new development it a sensor in each bed. The two signals identify the staff attending to the occupier of which bed... for how long. Patient-facing time is logged.
Drugs distribution is monitored centrally. Pharmacy technicians supervise an automatic system that reads bar-codes and creates individual 'blister packs' for each patient. Healthcare assistants now scan bar-codes on the boxes and on the patient's wristband... what used to be called the drugs round.
All drug restocking is managed by HC who are able to keep stocks at a minimum workable level, reducing storage and dead inventory costs.
Most hospital consumables are managed centrally by HC using Amazon style techniques and just in time delivery. As items are used the bar coded is read, local inventory up-dated and information forwarded to suppliers so that they can prepare replenishment. Over night a stock reconciliation is automatically sent to HC for cash-flow calculations and re-order triggers.
Round the clock imaging is managed by another cluster in the HC realtime management centre. As images are taken from the patient in the hospital they are coded and forwarded to the CH imaging centre. A computer reads the code and sends it to either a duty Interpretation Medic through three time zones or to any number of centres around the world, enabling 24/7 results. Simple X-rays are read by image algorithms.
Most diagnostics can be turned around in less than 37 minutes; the HC target.
From Milton Keynes all patients with uncomplicated long-term conditions are managed.
Patients are equipped with phone Apps, accessories and access to a personal web-portal. Suitable patients are required to self-test and forward their readings following a personal profile. They are matched against algorithms, outliers identified. Trained staff, supervised by specialist nurses, call the patient to make 'wellness assessments', give advice or recall the patient for a check up.
Trusts no longer have boards. Chief executives gone. Local Directors now responsible to Regional Leaders. Performance management is entirely data based.
Trends are analysed and HC email performance advisory warnings. Trust performance is measured against 28 parameters and compared in an audit family of similar Trusts. Drop-off is spotted very quickly and the Trust contacted with advice and examples of how similar Trusts are performing better.
All clinical outcomes are recorded measured and assessed longitudinally, together with a comprehensive patient satisfaction survey, completed on line and in confidence.
All system-measured outcomes are web-posted in the aggregate for the public to view. A daily performance report sent, overnight, to the NHS Controller, in Birmingham and the Secretary of State in Whitehall.
Jane Philimore runs the HC operation. She told me all efficiency indicators have improved, variation in outcomes reduced and the reduction in costs is shared 50-50 with the NHS.  The CH control system will pay for itself in five years.
I asked about the building under construction, next door ? HC take over back office functions of primary care next year.

Yes and no... 

HC don't exist but all the technology I describe does.
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Dr Paul Lambden
'...sounds like a gun, but it's not.  Really fascinating stuff , this is a must read....'
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Matthew Syed
Former Commonwealth Table Tennis Champion and author of Black Box Thinking

Half price tickets for IHM members
25th October
King's Fund
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - real concerns over the latest estimates of GP workforce demand.  There are no plans to get anywhere near enough doctors.
Dr Rodney Jones 
New Analysis
The Elephant in the Room and rising Emergency Admissions 
Need inspiration, a good idea or solve a problem
Dr Sir Sam Everington
Barrister, doctor, leader.
In conversation with 
Roy Lilley
He was even a 'rough-sleeper' and charged with making fraudulent job applications to highlight discrimination.  The first medic on the scene after the 7/7 bombings.
This will be a really interesting evening.  Medico-politics, the future of Primary Care.
Tickets for IHM members half price.