There was consensus at the roundtable of the need to celebrate success and to spread innovation and different ways of working.
Below are a few examples of successful cross-sector collaboration across the NHS that demonstrate the pragmatic adoption of innovation across England and Wales. There are numerous other examples around the country which demonstrate that there is effective joint work underway the ambition must be to use these collaborations to encourage similar initiatives and stimulate innovation elsewhere.
Some of the examples are targeted clinical interventions, while others organisational and systemic.
Nevertheless, the challenge remains to adopt successful approaches, scale them up and diffuse them into other diseases and areas of health need.
England’s NHS Long Term Plan, published in January 2019, included a commitment to take a more holistic approach to how care is delivered, embracing technology and shifting the focus to prevention and care in the community. The Health and Social Care Delivery Plan in Scotland, Health and Wellbeing: Delivering Together in Northern Ireland and A Healthier Wales: our Plan for Health and Social Care in Wales articulate the same goal.
Issue: Metastatic breast cancer patient numbers and the treatments available to them are rising and many specialist NHS cancer centres are struggling to meet this increasing demand with a holistic personalised care plan for every patient.
Intervention: The Velindre University NHS Trust, who provide specialist cancer services across South and Mid Wales through Velindre Cancer Centre, partnered with Novartis on a two-year joint working project in December 2016 to ensure treatment optimisation for metastatic breast cancer patients. This partnership enabled Velindre NHS University Trust to develop their service and implement a system of stratifying patients into different models of care based on their needs and provided by a non-medical prescriber pharmacist (NMP). It achieved this by establishing oral systemic Anticancer treatment (SACT) dedicated clinics with links to multidisciplinary care teams across the South East Wales Area.
Results: This project resulted in an average reduction in overall patient waiting times from arrival at hospital to departure with oral SATC medicine of one hour and one minute in NMP-led clinics compared with consultant-led clinics. The learning from this model has also been shared across two other clinics and at a national level with the British Oncology Pharmacy Association.
Issue: Many patients with coronary heart disease and myocardial infarction are on suboptimal secondary prevention therapy, with around 40 per cent not adhering to these lifesaving therapies.
Intervention: AstraZeneca and Leeds Teaching Hospitals NHS Trust collaborated to re-engineer the post-myocardial infarction medicines optimisation pathway. This joint project adopted a patient-centred approach with shared decision-making strategies to provide all who had recently suffered a myocardial infarction with a comprehensive medicines review.
Results: The project enabled over 500 patients to go through a review process and freed up capacity with cardiology outpatient clinics leading to a drop in post-discharge waiting times of over 50 per cent and a reduction in Acute Coronary Syndrome readmissions of around 50 per cent.
There is acceptance that the potential for the NHS to adopt and scale up innovation is considerable. Greater Manchester is one of the few examples of a new intervention gaining a foothold and being successfully scaled up.
Issue: Despite the potential to catalyse pharmacological learning and provide a platform for the development and distribution of high-quality interventions, there remained opportunities for NHS trusts and clinical commissioning groups to engage more with industry to provide improved outcomes for people, address clinical and financial sustainability challenges and routinely play a role in medicines research.
Intervention: In 2017 the pharmaceutical industry signed the UK’s first Memorandum of Understanding with Greater Manchester to co-create new models of collaborative working to improve outcomes by optimising use of medicines and develop a ‘living lab’ to make Manchester a global hub for medical and pharmacological innovation.
Results: This partnership has spurred a 4.4 per cent increase in commercial studies, with 100 per cent of trusts now ‘research active.’ It has led to 34.5 per cent increase in trial participants in 2017/18 and more effective approaches to collaborative working encompassing programme management and enhanced use of digital products. An ambitious work programme includes optimising medicine for 67,000 chronic obstructive pulmonary disease patients and a mental health outcomes-based pricing programme, taken up by two of the three mental health trusts in Greater Manchester, has been shared nationally via the AHSN Network for potential wider deployment.
The focus on patient safety initiatives is and should be a spur to innovation and to bringing new ideas and ways of delivering care. Innovative service interventions have the potential to help provide safer care in a pressurised environment where the likelihood of adverse incidents is more likely.
Issue: Avoidable harm from prescription errors endangers patients and incurs significant costs.
Intervention: The Effective Performance Insight for the Future initiative (EPIFFANY) is a training programme between a series of NHS organisations and Pfizer aimed to significantly reduce the risk of prescribing errors amongst junior doctors. It seeks to achieve this by making small changes to the way that doctors are educated about prescribing and seeks to create a safe learning environment in order to boost the confidence of doctors in training to make the right decisions.
Result: Results from the initiative suggested that junior doctors who undertook the training made 50 per cent fewer prescribing errors than a control group who had not received the training- an improvement equivalent to an extra 12 months of clinical experience. The training can also improve the confidence and morale of junior doctors, giving them a stronger sense that they are supported and valued. In the long term, this may improve junior doctor recruitment and retention.
Harnessing NHS data has the potential to help transform patient care, the life science and tech sectors and the economy more widely. The NHS differentiates the UK from the rest of the world by providing a unique opportunity to the life sciences sector: 66 million people’s data. With appropriate safeguards, access to anonymised patient data offers the potential to support drug discovery, monitoring the effectiveness of treatments, understand the basis of the disease and importantly, support targeted care.
Issue: Data capture for cancer patients in Wales has historically taken place through a system designed for solid tumours rather than haematological diseases. This same system is also ill-equipped for the requirements of quality of life data capture or treatment response leading to wasted resources and ineffective treatment plans for patients.
Intervention: The NHS in Wales, Welsh Government and Janssen forged an agreement to move away from a broad catch-all system to create a personalised data solution for haematological conditions which can critically analyse the outcome data for patients with myeloma and eventually all other haematological malignancies. To achieve this, they have laid out plans to implement such a data solution across the whole of the NHS in Wales.
Result: This data solution will enable NHS Wales to consider the outcomes for approved medicines and to make informed decisions about which treatments and interventions to invest in or stop funding. It will also provide patients with a more honest assessment of what to expect from treatment pathways.
Issue: Moving diabetic care from a secondary to primary setting in the context of system working requires the provision of educational support to primary care providers in order to address variation within a system.
Intervention: MSD partnered with Buckinghamshire integrated care system to support the variation that exists in management of diabetes between primary care providers within their integrated care system. To reduce variation and improve care, MSD will run an analysis of practice informatics data to understand their approach to diabetes care. This will allow the system to review their guidelines and implement a change management programme, enabling primary care providers to use this data and the change management programme it informs to improve patient care.
Results: The project will seek to standardise ways of working, produce more cost-effective care through better prescribing and fewer admissions and extend patient access by enabling practices to work at scale.
The future of health services across the UK will certainly involve a much greater focus on prevention. In England, integrated care systems will have a key role in helping to deliver these programmes and in working with local authorities, the voluntary sector and other local partners to improve population health and tackle the wider determinants of ill health.
The rise and spread of antimicrobial resistance infections are estimated to cause 700,000 deaths each year globally. The case study below illustrates how we can develop different approaches to prevention.
Issue: Some estimates suggest that increasing levels of antimicrobial resistance (AMR) could cause up to 10 million deaths globally by the year 2050.
Intervention: Along with other ABPI companies, Pfizer has begun working with partners across the health sector to develop a new reimbursement model to incentivize the development of new anti-infectives and encouraging public education about the issues around AMR.
Results: Pfizer has initiated a national campaign aimed at teachers of primary school children designed to provide compelling materials with which they can deliver lessons about antibiotics, antibiotic resistance, the role of vaccines and personal hygiene.
Issue: 1.4 million people in England have AF and 425,000 are undiagnosed. Fifty per cent of patients with AF were not receiving stroke prevention medication.
Intervention: Bayer staff were seconded to support the West of England AHSN to establish a quality improvement programme. This programme helped upskill GP practices in the management of stroke prevention for patients with AF. The project produced a number of tools to help both physicians and patients underpinned by a website to help other health economies replicate the project.
Results: Fifty-one practices underwent a quality improvement programme which left a lasting legacy by upskilling the members of the primary care team in managing the anticoagulation of AF patients. An estimated 21 AF-related strokes were prevented. Additionally, there was an increase in the documented prevalence of AF and an increase in the numbers of patients being anticoagulated to prevent stroke. This project has since been spread across the AHSN network nationally.