Latest / Embedded / What Value-Based Healthcare Actually Looks Like in Practice | Embedded Conversations With David Thorne. Ep 7

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What Value-Based Healthcare Actually Looks Like in Practice | Embedded Conversations With David Thorne. Ep 7 · Embedded

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Welcome to Embedded Conversations, the podcast that explores what it takes to
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embed ideas, innovations and partnerships inside the NHS.
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I'm Scott McKenzie and I work with NHS leaders, commissioners and life science
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companies to change patient pathways for the better.
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This podcast brings those ideas to life through shared stories from people inside
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the system who talk honestly about what works, what doesn't and what it takes
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to embed change in the real world.
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If you're working in, around or with the NHS and you want to understand how
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change really happens, you're in the right place.
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Hi everyone, welcome to the latest edition of Embedded Conversations where I
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am genuinely delighted to welcome today's guest, David Thorne.
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David is one of those really rare NHS leaders who manages to be quietly influential
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would be my observation he's very consistent in his thoughtfulness,
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and refreshingly honest about the realities going on inside the system particularly
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when it comes to system change.
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In fact i often get people joke with me they never see david and scott in the
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same room and yet here we are today and finally we're going to do a podcast together
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now what makes this even more interesting is for those of you that follow david
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on linkedin you'd have picked up what i picked up a couple of weeks ago he's just entered
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his 46th year working in the nhs which in itself,
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is remarkable even more remarkable is that despite everything,
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the service has faced david remains deeply engaged optimistic when it matters,
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and unafraid to call out the things that really determine whether,
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systems succeed or stall in that post david really reflected on how polarized
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the NHS feels right now with some places racing ahead embracing opportunity
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and collaboration while others are really stuck and remain stuck.
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I think his conclusion was really characteristically simple, but really powerful.
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Progress ultimately comes down to trust, to be the ability to compromise and
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teamwork across the NHS and many tribes and organisations that have to come together to do that.
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Now, today, I'm going to be talking to David about one of the things that he's
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been a real long-standing advocate for,
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which is value-based healthcare and outcome-focused commissioning using real
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data including tools like plix so we're going to move into conversations way
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beyond the rhetoric and actually into to practical and.
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Deliverable outcomes so let's see where we go risk sharing value-based partnerships
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and what good really looks like david it is an absolute pleasure to get you
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on today and i'm really delighted that you've come to talk to us,
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thank you very much that's very kind of you no it's just a a realistic reflection
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of the david that i know and and respect completely i've known you for a very
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long time always had complete respect for you and
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i've just tried to reflect that but that linkedin post really did catch my eye
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because it was absolutely honest,
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that to in fact i was talking about this to alison oliver who i think you might know as well alison's at,
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the podcast guests, and we were talking about that,
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that to do the collaboration, you have to be prepared to forgo a little bit of your independence.
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You've got to let that go and trust that the neighbourhood or the network or
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the federation is going to act in your best interest. So it was just a really
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good reflection of what you'd said.
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Yeah. And what else I just wanted to add, Scott, for our friends out there,
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is I'll be very practical today. Yes.
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I know the questions, or I can guess the questions you're going to ask me.
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Well, I think it's very difficult at the moment for people out there,
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given all the chaos that's going on, to separate the rhetoric from the reality.
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Oh, totally. And if you're a key account manager for a company,
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what do you actually do? Yes.
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You know, it's a great opportunity for me to listen to you as well, Scott.
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Both of us are practical people yes practical advice can we give to people okay
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that's what we try and do we try and keep it really grounded and practical so,
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um let's start then let's let's dive in so you have been,
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and it's one of the things i picked up from you really early when i got to know
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you been a real advocate for value-based health care so from your perspective,
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what needs to happen for outcome-based contracts to move from that kind of pilot
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phase to be business as usual in the NHS?
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And is there a role for industry to really get involved and engaged in accelerating that transition?
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Yeah, I agree, and I think it'd be really easy for someone out there or someone
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in marketing or in a heavy office function to think, well, I've heard it all
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before, and where's the evidence of it?
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But firstly, I used to work in industry, carry the bag.
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I can remember selling in an outcome-based contract, wait for it,
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in 1997, okay? These things can happen.
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It can happen if the right ingredients are there. So I think what's going to
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run through a lot of my responses today is segmentation, is finding the right partners.
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You need to find people who've got that strategic breadth. So which accounts
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are moving further on integration?
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Just to pick up what Scott was saying at the start, don't think that was just
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his nice introduction. There's some really salient points in there around which
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areas on your accounts or nationally, where does that trust exist?
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Yeah where's some examples already that people work across primary secondary,
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tertiary care gp practices can compromise people can let you use premises where
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you've got that kind of flexibility you might even start soon to see posts,
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i i was at a meeting locally in my role i met two young women uh both consultants
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and uh what do they expect to be clinical directors of integrated services,
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one for diabetes, one for respiratory. There you go.
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So where are the areas moving in that kind of direction?
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So there's some heavy segmentation, keep the faith, other stuff that I'm sure
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we're going to get into, Scott.
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Where does informatics exist that allow this to happen?
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But I would immediately look for areas where there's local variations,
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traditional contracts, and there's plenty of those.
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Yes. Where people have used their imagination, or whether there's been cross-francy
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working across organizations. Okay?
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It doesn't have to be in the same specialty that you work in.
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It could be in oncology, and you're working fine. But if there's a local precedent,
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that's one that you can use. That's key. Yeah.
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Get beyond the strategic stuff and think a little bit tactically about people's
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relationships and some of the basic things they need.
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One of the things they might need, it could be as simple as someone saying,
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I can fund a meeting room one afternoon.
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We'll get everyone together for a couple of hours. We'll put on some sandwiches.
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I'm not trying to trivialize the role of key account managers or companies,
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but this is where you come in.
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You can just do that final thing that brings people together across sectors. Yes.
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Totally. I think there's a few things there that I just want to go back and
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pick up with you, because I think you've absolutely nailed something that I'm
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absolutely passionate about when I'm working with industry and advising them. Look for track record.
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And it doesn't need to be the service that you're working with.
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It can just be the fact that the hospital trust or the GP federation or the
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neighborhood team or the network have got a track record of partnering,
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collaborating, working with industry, outcome-based contracts.
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Look for track record. It's a great indicator.
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Previous behavior is a good indicator of what likely future behavior is going to be.
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Yeah, and just to reiterate the part, I think you agree, Scott.
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It could be in mental health, and you work in a totally different area. Yeah.
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You'd be surprised how much of that is transferable.
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Yeah. And that's what helps you to take away the obvious obstacles about people
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worrying about risks and things like that, which is a classic,
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I just think. So keep the faith.
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It is possible. People want it to happen. And there are no local examples of it happening already.
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Yeah, yeah. Brilliant. Absolutely great answer, David. Really spot on and very
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aligned with my thinking.
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If I move it on just a little step further, again, one of the other things that
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comes up a lot in my work is risk sharing agreements, sometimes called gain share.
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Long discussed, relatively still rare in practice. I've had a couple in my work
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over time, but not for a while.
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What do you see as the kind of key ingredients for a risk-share model?
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And what are the pitfalls that both NHS and industry have absolutely got to avoid?
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Yeah, and I think the first one of it is picking up immediate theme.
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I wasn't expecting it to be so immediate, which is just about simple clarity and honesty.
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What I look for, once you get beyond the pages of compliance documentation,
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when I'm looking at a potential project.
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Let's do it simply. Let's imagine I work in a primary care network, say. What do I put in?
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What does the company put in? What's the risk to each of us?
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What I often hear on these occasions is all kinds of hypotheticals of risk.
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And when you actually play it through, it's not a nice phrase, war game.
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If you war game it through, the risk is actually quite marginal.
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And you can build in the contingencies around that.
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So people tend to be scared about all kinds of things that probably won't happen
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anyway, whether it's to clearly separate them into compartments.
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What's the clinical risk?
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Is it a financial risk? Is it a risk to reputations in some way?
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And to be really clear about specifying them and get very simple on the language.
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And then I think they can usually be resolved. But invariably,
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it starts off with the thing I started off with.
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What do you want us to do? So do we have to supply a training day?
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Do we have to supply an advanced time?
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If it goes over budget, what exactly?
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So that's the question I ask all the time, is be precise, be excellent,
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what game it through, and then you find out it's a lot simpler and less risky than people think.
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I think you've made, again, a really good point that often we look at it in totality.
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I liked your word that you used earlier, segment it what's the clinical risk
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what's the financial risk what's the path look at it in step by step and actually
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address each of the concerns as
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you go and it's much easier to take people with you than if you it's like,
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i suppose like follow a bit like following a recipe we know what we want at
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the end but it doesn't start out like that it's all the individual ingredients
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are totally segmented until you mix them.
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Yeah, and you've got to remember from an industry point of view that the people
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in NSS side, just how many people they've got to bring together. Totally.
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And they sometimes underestimate on your side the number of moving parts on
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your side, the compliance and managing and the changes you're going through as a company.
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So just be honest about those at the start.
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My final bit of advice on all of that is to be careful.
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Is is to um it's much more successful to be modest in in europe yeah so
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there's a temptation people sit in front of me and say we can do this we can
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do that and it will get um i don't know some opportunity cost benefit to um
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your organization i've gone great you sold it to me
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oh and then it will get people back to work and it will um it will alleviate the pressures of brexit,
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yeah or to stop trees being cut down, and he's like, whoa, whoa,
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whoa, hang on a minute. I was happy where I was.
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Yeah, and let's focus on that, and let's not spread the decision space too much.
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Yeah. Just to keep it very, anyway. So it seems to be a favourite word of mine
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at the moment. It's about precision.
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Let's just be precision. I think that's a good word.
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I do think that's a good word because, I mean, one of the observations I make
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about certainly working with general practice just now, but the whole of the NHS,
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We're drowning in workload. We haven't got the people to meet the demand.
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So yes, we want innovation, but that innovation has to be without adding extra
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work, extra steps, or any extra complexity.
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If you do any of those things, you can almost see people going,
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that's not for me, because it's adding.
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It's what we want to know. It's what are we taking out, really, is where we want to go.
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That's great. And my final point, you just reminded me of something I would
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say in all these things, is be very clear at the start with somebody.
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Set yourself a time limit.
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And say, okay, it's the 20th of January. If we, on both our sides,
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if we can't get this progressed by the 4th of March, we're going to walk away
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and we're going to agree to walk away.
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I think that's a really good point. Everybody out there will say,
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oh, I've been involved in stuff that's been a couple of years and it goes in
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and that and goes right. Yeah, set yourself a time and give some urgency and put some lids on it.
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It's a great, again, another great point because the number of times I'll hear,
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oh, we've got X number of projects And I'm like, yeah, but how many of them,
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are really within that two-month window? How many of them are six months,
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nine months, 12 months or more? You can't really count them.
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And yet we have that habit. We do count them. Yeah. Right. Good.
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Again, one of the other things that, so this is, again, learning from David,
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one of the things I did right back at the beginning, in fact,
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one of the first times I met you in Newcastle when you were on the commissioning
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side of the fence, and I took this away, and I've really embedded it in my work all the way through,
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is what we commonly call PLICS, patient level information costing system.
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What Scott in simple terms says is costing every step in the pathway not in
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theory but in practice patient level so we can see where the resources are actually
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being used where variation sits and what really changes,
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when outcomes improve so how do you believe plics could probably be more effectively,
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used to underpin outcome-based contracts the risk sharing agreements that we're talking about,
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particularly if we're going to justify cost or impact of innovative medicines
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and devices where do you see that fitting,
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well firstly you've done a service to everyone scott because there'll be people
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out there saying i've never heard of plix despite the fact as we're saying you
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know you and i've been around a long time it's been around a long time,
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yeah yeah um the the the basic point is if i'm looking to write a business case
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i don't use has data i I use Plix data. You're like me. Okay.
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HES is available. I'm not knocking the people who've got it and supply it.
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It's sometimes the most easily accessible or the only accessible source for people in industry.
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But it's price data, it's not cost data. Yes.
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So the example that Scott's talking about, there's a maternity unit on my locality.
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If they were in payment by results, they would get, what, about 1,000 quid to deliver a baby.
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Right. The real cost of a baby being born at that unit is 23,000 pounds.
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Well, look at that. Because it's the cost of running a unit in a small rural
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area. Yeah, of course. By the number of women who have a baby there. Yeah.
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So, cost and price are different things. Yeah. So, when you're looking at business
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case, the real costs are important.
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You can also differentiate yourself. a top tip if you're an account manager
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and you're going to a hospital you talk to people and you say well look i haven't
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seen it but what's your clicks position yes yes already you're different from
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the average bear and it'd be really interesting what people say to you
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it's not fantastic information don't be put off by people saying oh it's not
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perfect it is still it's the best we've got that's it the nhs data and that's
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what the chief execs and people like that,
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look at okay so i like scott i really advocate you use plix data it's fundamental um.
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It's used across the community it's used across mental health issues and used
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in ambulance and the ambulance plix data is particularly useful for pharma but
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that's there we are there's a top tip for you that's a great tip i'm always
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interested in the ambulance data it's uh uh,
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going back to the p word it's much more precise,
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so if you're looking at something like diabetic hypos you've got to look at
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the ambulance PIX data because if I have a hypo in the street it's the ambulance
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service who's going to come and look at me and not necessarily show up elsewhere so you,
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could talk about PIX all day if you're not familiar with it find out about it
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if you are familiar with it,
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Keep going because you can get Plix data. I won't name the company,
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but I know there's a company in surgical devices used to value proposition.
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They quoted Plix data, used it appropriately in reference, and it made a big
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difference to their sales.
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It's fundamental, as Scott says. If you're looking at the outcome-based,
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if you're looking at setting your risk levels, if you're trying to work out the benefits.
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I mentioned something, opportunity cost benefit before.
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So what's the cost of a district nurse going out and fixing a wound,
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rural area or in inner city, they're going to differ aren't they they're going to differ whether it's,
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somebody who's housebound with six other conditions or whether it's somebody
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who's 32 and got a sports injury and they just need a quick dressing on their
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leg temporarily Plixtata reflects that.
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I'm with you it is brilliant data I'm finding it more and more,
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and people are interested from an nhs side and what are all the steps in the
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pathway because we hear a lot at the time well i certainly pick it up in my
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work i have to do this because it's the cheapest option and i'm always is it,
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is it actually the cheapest option because a lot of the time without being rude,
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we end up comparing bananas with cucumbers because we're just looking at the
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acquisition cost of one drug one device over the other we're not looking at,
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does it deliver the patient outcome that I'm trying to deliver,
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extra steps, extra complexity, duplication, avoidable waste.
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We don't factor those in. We, well, the people are a number of times I hear,
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oh, well, the people are there anyway, yes, but what could they be doing?
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If the pathway was much smoother, it's that opportunity. Entirely,
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you and I are very passionate about medicine and devices. When you look at Plex
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data, they come out in the context of a woman having a baby and it costs 23,000,
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right? That's an extreme example.
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What medicine or dressing or what sutures that lady has, that's immaterial when
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it costs $23,000, right?
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But you even bring it down to things like, I mean, obvious example of generic statins, you know? Yes.
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Somebody, a company the other day, a director of a company said to me,
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I won't name what it was, it was a device.
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And she said, the only problem with this is expensive.
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You know, don't use that word. But how much is it? Well, it was about 70 quid.
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You go back to when you mentioned when
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we first met Scott, when I was the commissioner. Yeah. 70 quid is free.
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Right you don't worry about anything that costs less the health care is so phenomenally expensive,
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so you can educate your customers if they knew that there is a drug or device
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and it costs a few quid more than something else but as scott's saying what
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could achieve is a length of stay reduction yeah or it could free up um time
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of a doctor or nurse yeah it doesn't
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have to empty a bed it doesn't have to make a redundancy,
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if it can produce that productivity benefit it so plix,
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if you only remember one thing from scott's great podcast.
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Plix is the friend of farmer and life sciences it really is it really is it
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helps to prove your value proposition totally i,
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without getting again i'm like you don't want to name customers or that but i had one recently where,
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we're looking at a pathway and we were able to eliminate 12 weeks of the patient
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being seen once a week for 12 weeks with a change in the in the product because what it meant was,
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where we went from half of them not responding to treatment we went to one in
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ten not responding to treatment so a huge workload release but all it had been done was,
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that's more expensive than that yeah but you're not looking at the workload
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that goes with it once we'd established that with a completely different outcome
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but it was complex data that showed it yeah and it really shows up things like
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I was chatting with the practice nurse earlier,
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who's master level nurse practitioner.
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So quite rightly, she'd be getting 60 odd thousand a year.
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She's talking about a change they've made in the practice. The healthcare assistants
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do it now. Okay. So they're getting paid less than half of it.
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That is the benefit that public starts to show up. Yeah, absolutely.
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I couldn't agree more, David. I could not agree more.
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If I, again, move the conversation on a little bit, from an industry perspective.
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I get lots of but like you do we get lots of contact from the industry about
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where should i focus my efforts you get a lot of people where they're totally focused on icbs,
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at system level we've got others that work at provider level i'm thinking more
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provider collaborative i've got people that will just focus at neighborhood level or pcn level,
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where should we focus if we're going to make a outcome-based partnership i'm
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going to get a slightly different answer go on then so you You should focus on,
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the people who are most able to respond to what you're going to say.
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And so you've really got, I mentioned at the start about segmentation.
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Broadly, I'll be interested in what you think, Scott. 10 to 20% of the NHS,
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which is progressing at the moment, going ahead.
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I'd agree. The opportunities of what we're going through. And the rest is stuck.
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I'm not having a go at people because there's reasons why they might be stuck.
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I'm in an ICB that is not changing very much. That's not the case elsewhere.
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There's different financial pressures or CQC pressures and other things like that.
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But you need to find the people, the right people. Now, they could be at neighborhood.
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I was actually just talking to somebody who's leaving an ICB to work at neighborhood
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level as part of the voluntary redundancies.
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Now, they are just as innovative.
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They are just as different. They're just as attractive to you in the industry,
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in the ICB, as they now will be in the neighborhood.
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So look at the person and what they represent in terms of their cultural affiliation
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and their ability to move things. So it depends.
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Really, it matters less, I think, about whether it's wound care or it's scanners, whatever.
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It's find the right people and the right organization. There are thriving ones
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and there are ones that are stuck.
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You need to find the ones that are going to be progressive.
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And the rest of it, I'm not sure too much. There's rarely been a time,
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even we as a relatively small neighborhood, we could agree an outcome-based
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contract for many products.
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And I would say if we have a chat in a year's time, that would include medicines
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as well, or many medicines that used to take care.
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So don't worry about your product necessarily.
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I am working, in fact, tomorrow I'm working on it, on us doing MRI scans. Wow.
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Who would have thought that at primary care? Yeah, exactly. So find the right
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account, if you like, and the right people and the right mentality and the people
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who are trying to work the project through.
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And don't worry about what layer of the system it is i'm so pleased you said that because,
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i've got your outlook there is no one right answer yeah there isn't there isn't
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one magic bullet to this it really is about i think one of the phrases i use
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a lot with industry is be curious,
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ask curious questions put the product to one side just leave it over there and
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ask really curious questions about what keeps david awake at night from a work
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perspective what's turning over in his mind.
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What are the top three things you can ask them about what his personal goals
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are from the neighbourhood what's the neighbourhood trying to do and achieve and,
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I remember I had a lovely customer, she's still a good customer,
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and Catherine won't mind me naming her, Catherine Patrick, she's Medical Director
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for Primary Care for Somerset Foundation Trust, and I remember speaking to Catherine,
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and she said to me, Scott, the issue I have is that I really don't mind industry
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coming in and having 20 minutes, half an hour of me, I'm very open to it,
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and I remember putting her hand up and she said, but what I really want you to do,
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is to ask me lots of good questions about what's on my agenda,
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then pick something off it that you can help me with and i'm going to engage
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but if you give me a heavy product pitch,
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i'm just going to wait on you going through the door and then that's meeting
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over and i've forgotten we've even met the top tip i learned from somebody years ago,
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about in-call behavior is you should speak about 20 to 25 percent of the time
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and the customer should fill the rest and you you sell against what they say
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when they reveal their needs and build up the trust and,
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um i think it's strange people have moved away from that if people do come and
25:08
see me the ipad comes out and straight away they're into it um.
25:13
Uh without understanding what you just said what's on my metaphor on your agenda,
25:18
yeah it's a real struggle isn't it for industry to get beyond the product features
25:23
and start conversations about the things we've talked about today,
25:26
PLEX, shared risk, outcome based, that still seems to be a real struggle.
25:33
Is there any advice that you would give the industry leaders who are genuinely
25:37
trying to shift the internal culture?
25:40
And the external offer towards the value-based proposition what would you what
25:44
would your advice be to them
25:45
i do it it sounds simplistic but to get close yeah it's the thing exactly what
25:50
you're saying there is they they need to talk to the the like the lady you just
25:54
mentioned yeah yeah what they shouldn't get put off with with um let's say that the woman
26:00
that i'm talking about my colleague this morning let's call her sue for now
26:03
she's moved from an icb to a neighborhood i've got I've got a feeling somebody's
26:07
going to say to their bosses,
26:09
Sue's gone from the RCB. Well, that's the end of that then.
26:13
Instead of saying, well, she's just gone across to transition to a role in a neighborhood. Yeah.
26:18
Totally different role in some respects, but she'll be doing very similar things.
26:22
Right, she will. And she's just as curious. She's just as innovative.
26:26
And she's probably still got as positive a relationship with companies.
26:30
So I would like to see more people come out and about.
26:35
I often give the opportunity for people to come out. I know you do.
26:38
Some companies take it up, some don't. And we take them around the practices.
26:41
We get them to meet people.
26:43
Yeah. The more you're in that kind of mode and doing the sort of things that
26:48
you advocated, you don't have to do things in a hurry.
26:52
No. Without being too trained about it, you've got to walk in other people's shoes.
26:59
And yet I hear people in fact leaders in market access in industry will say
27:05
to NHS people well I know what your priorities are I know what West Street is
27:09
telling you and you say hang on a minute.
27:14
Yeah, just ask them some open-ended questions to see where you go,
27:17
because you might be in for a surprise.
27:20
And I think we would both agree that the energy generally, I don't think has
27:24
ever been more open to working with industry. Completely, completely.
27:28
I totally agree. And the opportunity's there. I've got customers now,
27:32
David, that if we roll back literally just pre-pandemic, if we use that as the
27:36
benchmark, I've got customers that would have said to me then,
27:40
Scott, you know we don't really work with industry.
27:42
But we don't for a variety of reasons but we don't really do it,
27:45
who are now saying to me Scott, you couldn't find us a project that will look
27:49
at A, B and C or we've got DNF is a real problem for us.
27:53
Do you know anybody I'm now regularly getting requests can you find an industry
27:58
partner for us from organisations that prior to pandemic would not have talked
28:03
to industry never been more open to it Yeah, absolutely,
28:08
at every level whether it's scientific research through to,
28:13
can you get us a bit of software we want to try it out and we want to give it
28:16
absolutely spot on can you support an away day,
28:20
our practice nurses meet up once a month they they accept classic kind of sponsorship
28:24
and presentations from companies and we sometimes struggle to get people to support it you.
28:31
Know they're prescribers they're interested um,
28:35
and it goes back to something else you're saying about the ability of people
28:37
to push upwards yeah so if those practice nurses are influenced and they have
28:41
a go at me and say, so why haven't we got this and
28:44
everybody else has got this point
28:46
of care device or everyone else is using this drug. It has an effect.
28:52
Very, very effective. I often highlight that to people. If you win the clinical argument,
28:58
they can engage the business development manager, the business manager for the
29:02
department, the business development
29:03
manager for the federation or the network or the neighbourhood.
29:06
They can get contracting and finance involved and suddenly things begin to move.
29:10
Yeah, absolutely. They can be your best salespeople. Yeah, totally.
29:15
I've got one last quick question for you. Yeah, what's that then?
29:18
So, if I get you to crystal ballgays and you look ahead for the next four or
29:22
five years, so kind of the end of this parliament, where we might be.
29:27
In terms of nhs and industry collaboration just like we've been talking about
29:30
never been more open to it,
29:33
can you paint me a picture of what you think a mature embedded outcome-based
29:38
partnership might involve and whether or not plics
29:41
or data would play a role in it what would that look like what does yeah and
29:44
it's easy to do because i'm very fortunate where i work and where i live um,
29:50
so let's use some new terms in okay what's in five years in two years um,
29:57
we expect to have the first advanced foundation trust and to be the first ihl
30:01
integrated healthcare organization i would be stunned if you're not
30:04
with a multi-neighborhood provider contract what that allows us to go right
30:08
back to the start of scott's question so the reason why why am i still here
30:12
when i could have retired right i can see i hope that we're gonna have it So,
30:16
I mentioned earlier as well about a clinical director for diabetes.
30:20
Yes. The hope is that she will control a multidisciplinary team that is all
30:25
the way from Zumba classes...
30:27
And fitting type one devices to pumps to kids who are 10 years old all the way
30:33
through to cutting people's feet off and everything in between and her being
30:37
the clinical leader of that with a with a group of people around her,
30:41
um so you can look at the budget on that,
30:44
you can say we're going to use a preventative medicine and it stops someone
30:48
having their feet cut off therefore it will save 15 000 quid or something like
30:51
that and as i always say the feet don't grow back yeah No, they don't.
30:55
So you get all those kind of benefits. Yeah. We could be close to that.
30:59
The challenge that you guys have got, whether it's a year, two years,
31:03
or five years, is the variation. Yes.
31:06
We're progressive on that. You can go to other areas of the country. Scott would name them.
31:12
And they're in similar positions. But there are other areas where they say,
31:15
we just can't imagine that. Yeah. We just can't get people together.
31:19
We're so busy firefighting. We've got such financial problems.
31:23
A lot of that. We've got a huge problem to do with our maternity unit,
31:26
with the CQC, and we just can't move forward.
31:29
But that hope exists. Now, we've got 65,000 patients.
31:36
We would expect, certainly in less than five years, the reason I was talking
31:40
about MRI scans, we'll have neighborhood health hubs. We would hope to have
31:44
those operational next year, three.
31:46
Brilliant. Health hubs. That opens up amazing opportunities for everybody on
31:51
this call, whatever you make and sell. Okay.
31:54
Um, but imagine one team, the public bless them. So there's one team health and social care.
32:00
Yeah. Um, I'm a trustee of the hospices, right? We just got system one.
32:05
So that's all to do with me as a potential patient.
32:10
Specialist nurse in the hospital, district nurse, tissue viability nurse,
32:14
practice nurse, the hospice staff, people potentially, I don't know,
32:18
from MIND or McMillan, everybody having.
32:22
An impact on my care as an individual, all the clinicians being able to see
32:26
that care and having one single record, that opens up all the opportunities
32:30
and everything that Scott's talked about.
32:31
So the final thing I wanted to say, if you're looking for a proxy of where to
32:35
go first where's the places that are most advanced on single patient records
32:40
yep and having that shared aspect across teams they exist already um,
32:45
in in many localities in the country we're actually a bit further behind and
32:51
some okay seriously catch up okay,
32:54
But in less than five years, we will either have achieved that or we'll have
32:59
some real problems, some real challenges.
33:02
There's no alternative to that. Yeah, that interoperability is so important.
33:05
I had that conversation in a different part of your ICB this morning.
33:09
Oh, good. Mental health patients, exactly that. We've got to have one version
33:13
of the truth, one patient record, one single record is where they're going.
33:18
I often quite actually often highlight to the companies, do not bring something
33:22
else that needs another login. then I've got to log out of this and you pass. Oh, just don't.
33:28
It has to be interoperable, we hope we've got currently. Yeah,
33:31
well, that's the thing, you know, I'm saying about going out in mid-sup,
33:34
it's not about the relationships.
33:37
You and I, we'd scream out to people, come and have a look at a GP screen and
33:41
see how proud it is and the way that the systems interact.
33:44
And that'll teach you a lot about, so if you sell seven different drugs in the
33:50
same category, why is it such a challenge that maybe yours, as a small market share.
33:55
When you see the screen and the fact that one of my rhetorical questions I often
34:00
ask companies, how long is a GP appointment? How many people would a GP see in a day?
34:04
And sadly, people are clueless about that.
34:08
If you think in practice a GP's got what, six, seven minutes to really see you?
34:12
Six, seven minutes, that's it. That screen and that crowded screen,
34:16
and it's got saying if a patient's got an app for asthma, one for heart disease
34:21
and one for arthritis, it's not going to help.
34:23
Not going to happen interoperability all the rest of it yeah
34:27
that's great that's got well David thank you I'm going to ask you will you be
34:31
happy to come back again can we keep any time you made me think about all kinds
34:35
of stuff that's brilliant listen an absolute joy a real pleasure to get us both in the same room
34:41
comparing notes and having a chat I'm so very very grateful to you oh any time
34:45
I'm going to talk about one out there keep going that's my main message right
34:48
that's the one that's the right message as well keep going thank you David.
34:52
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