Latest / Embedded / Embedded Podcast ep 1. with James Kingsland MBE

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Embedded Podcast ep 1. with James Kingsland MBE · Embedded

0:03
Hi everyone and welcome to the first
0:06
edition of the embedded podcast.
0:08
Embedded conversations as it's more
0:10
commonly going to be known. And I am
0:12
delighted to welcome a mate of mine,
0:15
Uncle James as I get to call him,
0:17
despite the fact there's only two years
0:19
age difference between us. He's always
0:21
been Uncle James to me because James was
0:23
really the first person that I worked
0:25
with um in my very early days of
0:27
consultancy. James, how are you? It's
0:28
lovely to see you. Gordon, thank you for
0:31
the opportunity to um air my thoughts on
0:34
your podcast as is this the f this is
0:36
the first is it
0:37
>> this is the first you are going to be
0:38
the very honor very first edition um of
0:42
it and it it really stems from
0:44
>> apart from the fact that we've been
0:46
really good mates the thing that I have
0:48
always admired about you is you are an
0:50
absolute heavyweight when it comes to
0:52
primary care health system reform not
0:55
just in in England but literally global
0:58
health policy
1:00
You know, I look at you and you've
1:01
dedicated the best part of four decades
1:04
to general practice, to medical
1:06
education, to healthcare leadership and
1:08
transformation. You led a a very
1:12
successful award-winning general
1:14
practice. And I know you've got a whole
1:17
raft of different roles and that we'll
1:19
get you to talk about as as you talk to
1:21
me today. But what I really wanted to
1:23
emphasize for people that don't know
1:25
James um is that James' work and his
1:28
impact goes far beyond everyday work of
1:31
a general practitioner. Um he's was the
1:34
chief architect of what became the
1:36
national roll out of primary care
1:37
networks through your early work James
1:40
in the primary care home and you really
1:42
do continue to drive change through
1:45
initiatives. Right now you're working
1:47
with health inequalities, community
1:49
based care and and digital innovation.
1:51
So, I'm going to look at all of these
1:52
things with James today. But James, give
1:55
people that don't know you a quick
1:57
introduction, a tour the force of of you
1:59
and your career, please.
2:01
>> Well, that's a very kind introduction.
2:04
Um, Scott, some of it you were in the
2:07
past tense. I'm getting to the stage of,
2:10
you know, it's almost Do you know who I
2:11
was? Um, because I've stepped down from
2:14
clinical practice almost 5 years ago
2:16
now, but still have a range of roles.
2:18
For example, I'm a clinical professor in
2:20
the school of medicine at the University
2:21
of Lancaster. So, some undergraduate
2:24
teaching and post-graduate research. I'm
2:26
at a stage where I'm trying to give
2:28
something back cuz the cumulative
2:30
knowledge and as you were saying that
2:32
goes outside of the NHS, there's a sense
2:35
of what happens to it all. So, I'm
2:38
delighted that I can give some back on
2:39
even podcasts like this as well as some
2:42
of the work I'm doing um internationally
2:44
and that goes from health and
2:46
equalities. As you say, I'm just
2:48
bringing to the close a 5-year program
2:50
that predates core 20 + 5. Uh, in fact,
2:53
has informed a lot of the core 20 plus 5
2:55
developments in looking at what the NHS
2:58
particularly can do about health
3:00
inequalities. When we talk about the
3:01
wider determinance, the digital um area,
3:04
which is is relatively new for me, but I
3:07
set up six years ago now a network for
3:11
digitally enabled online providers of
3:13
care in the independent sector. So these
3:15
are all the um the private providers
3:18
which is um dwarfing the NHS in the
3:22
delivery of care in terms of patient
3:24
numbers in in in the sort of digital
3:26
space
3:28
>> um and international work. I'm um long
3:31
story but uh I'm retained by the
3:33
Ministry of Health in Singapore uh in
3:36
Abu Dhabi and I'm still working in
3:38
Southeast Asia on a range of
3:41
undergraduate teaching in primary health
3:43
healthcare development but also another
3:45
area that I've become interested in
3:47
disaster medicine.
3:48
>> Yes,
3:49
>> which is relatively new. It's only been
3:51
around for about 30 or 40 years but as
3:53
we know that covers everything from
3:55
pandemics to earthquakes and everything
3:57
in between. and some of the things that
3:58
I'm uh focusing on in the primary care
4:01
support in disaster management. So,
4:04
there's a a range of of um things that
4:07
keep me still interested um and still
4:11
some I may be doing some work as I was
4:13
just saying offline. Yeah.
4:15
>> With the development of neighborhoods.
4:17
We we know we've now got the national
4:20
neighborhood um health improvement
4:22
program
4:23
>> but that's only for the 43
4:25
>> Yes. in the vertic successful sites.
4:28
There's others far greater number who
4:31
want to develop neighborhoods and don't
4:33
want to lose momentum. So I've been
4:35
asked by one region if I would help with
4:37
those who applied but weren't in this
4:39
first cohort. So maybe doing that next
4:41
year as well as a as a folks in the NHS.
4:44
>> Other than that, lots of spare time. So
4:46
if you want to go in the golf, I'm I'm
4:48
ready.
4:49
>> Busier busier now than you were when you
4:51
were a full-time GP. It's uh it's a
4:54
great insight and that's really what I
4:55
want to to pull on because in all the
4:58
time I've known you, you've had an
4:59
absolutely front row seat in shaping NHS
5:03
primary care. As I said in my
5:05
introduction from the original primary
5:07
care home that became the blueprint for
5:09
the primary care networks, advising on
5:11
health inequalities and the like. So
5:13
looking back, what do you think when it
5:16
comes to pharma, medtech, device
5:18
companies, life science industry? What
5:20
do they misunderstand
5:22
about how primary care systems really
5:24
work?
5:26
>> Well, probably not getting into
5:27
semantics, but the first thing about
5:29
primary care as a level in the system in
5:32
the NHS, it's for provider services.
5:35
>> And we often use primary care synonyms
5:37
with general practice. General practice
5:39
is one of the four primary care
5:40
providers. uh and then we conflate
5:43
primary care with primary health care
5:45
which is a sort of more philosophy and a
5:49
delivery of care and when we talk about
5:51
neighborhood delivery it's primary
5:53
health care not primary care contractors
5:56
so that's the first thing and I think
5:58
the other misconception
6:00
um and I'm I'm going to talk in a
6:01
generalist um hopefully a view from the
6:04
bridge because there's always that uh
6:06
old line is if you ask a 100 GPS their
6:09
opinion you'll get 101 opinions
6:11
So I'm trying to give an evidence base
6:14
behind what I'm saying.
6:15
>> Um but I think there's sometimes there's
6:18
the misconception about um the
6:21
scalability of general practice and it's
6:24
being a linear system when in reality of
6:27
the 7,000 or so practices now that are
6:30
still surviving. It's complex. It's
6:32
adaptive and they're often placebased
6:35
ecosystems. I.e. Uh the other one tongue
6:40
and cheek oneliner is once you've seen
6:41
one general practice in the UK, you've
6:44
seen one general practice because of its
6:46
um variety. And the other thing that is
6:50
is misunderstood by the public is the GP
6:54
contract
6:55
which is is the still the majority of
6:58
general practices
6:59
>> is based on a self-employed
7:02
independent contractor basis. So,
7:06
General Practice is a for-profit
7:09
uh organization.
7:10
>> Yeah. Yeah.
7:11
>> And um whilst the profit the income
7:14
levels are capped through the contract,
7:17
the profitability and where general
7:19
practice fails is in the management of
7:21
its overheads, its estate, its
7:23
workforce, its utilities. So, your
7:26
profit is entirely dependent on your
7:27
expenses. And the other thing that
7:30
sometimes isn't understood by general
7:31
practice, it's largely a partnership
7:34
model. And that model unless you have
7:37
your own partnership agreement is
7:39
governed by the law of England from the
7:41
partnership act of 1890.
7:43
>> Wow. So um there's all sorts of dangers
7:46
in not getting your business correct and
7:48
where farmer can help and interact
7:51
sometimes is understanding
7:53
>> the the nature of the business and as it
7:55
as it has scaled and sometimes it's been
7:58
the um the willing who have come
8:01
together in a primary care network and
8:02
the next neighborhoods
8:04
>> um sometimes there isn't the cohesion
8:08
and primary care networks as you were
8:10
saying I helped develop a blueprint
8:13
>> they're not many hospitals. They're not
8:16
out of hospital care. Um they are a
8:19
community based provider service. In
8:22
fact,
8:22
>> you've heard me say before I get quite
8:24
annoyed about out of hospital care, I um
8:27
was a non-exec director of three
8:29
hospitals.
8:31
I've often said I said at the board bit
8:33
tongue and cheek, but I as you know me,
8:35
I meant it. I saying why don't we rename
8:37
hospitals the out of community service?
8:39
>> Yeah. cuz we're talking about my
8:41
community services are being out of you
8:42
know either in the mothership or outside
8:44
the mothership and it gives a
8:45
misconception of what networks and now
8:49
neighborhoods are trying to be set up to
8:52
do in terms of an extended provider
8:55
service not just a sifting and sorting.
8:58
>> So PCN's were to enable collaboration
9:02
not necessarily build new organizational
9:04
layers. It was the success always
9:07
depends on relationships,
9:09
local history and I know you work with
9:11
lots of primary care networks you know
9:12
the local history is bad workforce
9:14
stability and the big one is trust
9:17
>> not just the contractual levers that NHS
9:19
England try and bring in you know with
9:21
the PCN contract
9:23
>> but evaluation show that the stronger
9:26
PCN's as they are rely on mature
9:28
relationships and collective leadership
9:31
purposeful not positional leadership of
9:34
you know I'm in charge much. Um,
9:37
>> one of the things, one of the things
9:39
that strikes me particularly about you,
9:41
James, is you've worked on so many
9:44
transformation projects both here in the
9:46
UK and as you've described globally. You
9:49
started to touch on it. What are the key
9:51
ingredients for lasting change within a
9:54
health system? And and where do the
9:57
external partners like industry help or
10:00
sometimes hinder that that process? she
10:03
just started to touch on it which is why
10:04
I thought I would interrupt and just try
10:05
and tease that out with you.
10:07
>> Well, it's where I can bring a bit of um
10:09
global research from the privilege I've
10:11
had probably over the last 15 plus years
10:14
of working in other health
10:15
jurisdictions. Um but the global
10:19
research on health system transformation
10:22
uh highlights several repeated success
10:26
factors.
10:27
>> Um and I go on to where the industry can
10:30
help. Some of it is well articulated but
10:33
not thoroughly understood or delivered.
10:36
So the success factors shared vision and
10:38
co-design. We often talk about
10:40
co-creation but major reviews of health
10:43
transformation show that most solutions
10:46
that are sustainable are co-developed.
10:48
>> Yes,
10:49
>> clinicians and the the public and
10:51
patients. So neighborhoods are going to
10:53
be dependent on a deep understanding of
10:56
the need of local populations and how
10:58
you engage them. give give agency to
11:01
that population to build
11:03
>> um uh new services.
11:06
Um with the left shift of the 10-year
11:09
plan, strong digital and organizational
11:12
capability where we've often talked
11:14
managerally enabled clinically services,
11:17
but you need both. Um and digital
11:22
capacity at community health worker
11:24
level strongly uh drives effective
11:27
implementation. So where there's digital
11:29
immaturity,
11:31
you do find some of these new designs
11:33
struggling
11:35
um clear governance and um disciplined
11:40
delivery.
11:41
>> Yeah. Yeah.
11:41
>> As opposed to um you know a scattergun
11:44
approach that sometimes is driven by
11:47
transactional or or loose contractual
11:50
arrangements which just direct you in
11:52
certain areas. uh so the systematic
11:54
reviews commonly uh identify the
11:56
critical success factors I've said
11:59
already purposeful not positional
12:01
leadership where the leaders get in
12:04
involved and demonstrate how to do it
12:07
not tell people how to do it um and then
12:11
improving skills at the workforce level
12:14
and recognizing team-based development.
12:17
Then the final thing we we always make a
12:20
mistake in when we've creating new
12:23
service delivery models like
12:24
neighborhoods is we don't measure from
12:26
the start.
12:27
>> Ah yes,
12:27
>> we do it as an afterthought. So NHS
12:30
industry partnership
12:33
guidance that this is foundational if
12:35
there's going to be a partnership with
12:36
industry when you're putting something
12:37
in place get the metrics. You're going
12:39
to have metrics. We always say metrics
12:41
that matter to patients but you've got
12:42
to have metrics that matter to the
12:43
service as well and start measuring from
12:46
day one. So I think ju just to round off
12:48
on that that the the industry can help
12:50
by there's definitely the technical
12:53
capability
12:54
>> data science analytics AI engineering
12:58
and AI as a a facilitator not a as a
13:02
replacement
13:03
>> um there's always about the the the
13:06
d-risking early changes by some flexible
13:09
funding in new innovations
13:11
and then the support for um improvement
13:16
capab capability and the capacity to to
13:18
deliver change management which we
13:20
loosely talk about but the the
13:23
structured approach to change
13:24
management.
13:25
>> Yeah, it's one of the things I took from
13:26
you in my very early days of getting to
13:29
know you was that point that you've just
13:31
made about measuring right from the word
13:32
go and it's one of the things that I've
13:35
carried with me through all my work with
13:37
the NHS. So often I'll be asked and
13:40
what's the measurable benefit of this or
13:42
that or the next thing and I can
13:43
instantly go and get it because we've
13:45
been measuring from day one. So I can
13:47
tell how many referrals were avoided.
13:49
How many patients were diagnosed and
13:51
managed totally in general practice
13:53
without onward referral. How many did we
13:56
ultimately have to refer on because the
13:58
condition was more complex than general
14:00
practice could be expected to deliver.
14:02
So we're looking at the measurable
14:04
benefit all the time. So, I think that's
14:06
a real top tip for industry is to go in
14:09
because if you're going to scale, you're
14:11
being really candid, if you're ever
14:13
going to scale it, you'll have to
14:14
measure it from day one. Other than
14:15
that, you're starting again with your
14:17
second pilot cuz you can't take any of
14:19
the learning from the first pilot
14:21
forward. Have you got hopefully you
14:24
have, have you got an example somewhere
14:26
of that actually working for you and
14:28
over all the years
14:30
>> of measuring from the start?
14:32
>> Of measuring from the start. Yeah.
14:34
>> Yeah. We've we've done that with the
14:35
what we call the complete care community
14:37
program, right,
14:38
>> that was set up 5 years ago. It sort of
14:41
was a fast forward from the development
14:43
of primary care networks. Fast
14:45
forwarding what would they be doing in
14:46
the most complex areas of care, people
14:49
with living with complex lives,
14:51
marginalized communities, people living
14:53
in areas of high deprivation. Yeah.
14:55
>> Um,
14:56
>> but what the NHS, as I was saying, what
14:58
can the NHS do about it and why do we
15:01
continually fail to reduce health
15:02
inequalities despite good people doing
15:04
good things over a long period of time?
15:06
>> Um, so we we built in a process of early
15:12
understanding and measuring what matters
15:15
in the design phase.
15:17
>> Yeah.
15:18
>> Um, how to focus on the clearly defined
15:21
population group that people were
15:22
working with. What were the things that
15:24
enabled them to have connection rather
15:27
than waiting for a uh an extended period
15:30
of time and reflecting on some of the
15:32
difficulties of design developing the
15:34
models of care? Even the importance of
15:39
recognizing when you're going down a
15:41
blind path,
15:42
>> when you're going down the and where you
15:44
can think to recalibrate,
15:47
um refocus, which the NHS doesn't do
15:50
well. Often that is a a linear process.
15:52
Start on day one, finish on three, day
15:55
365 and it's a success whatever happens
15:58
as opposed to
15:59
>> on day 100 we realized we were doing all
16:02
sorts of wrong things. Yes,
16:04
>> the experiment was going wrong and
16:06
that's where transformation works when
16:08
you look at it as experimental
16:11
sequential experiments that sometimes
16:13
fail but you can forgive yourself and
16:15
reset recalibrate and then focus. So you
16:19
can only find that when you're measuring
16:20
from day one. So we've measured and
16:22
produce reports of this clinical care
16:24
community program on a regular basis to
16:28
talk about how it's evolved what the
16:30
successes were but most importantly how
16:33
you learn from the failures and for
16:37
>> not forget the failures but accept that
16:39
that's going to happen and it's very
16:41
difficult NHS
16:42
>> yeah it absolutely happens I mean that
16:45
ties in kind of nicely to my next
16:47
question for you which was around um one
16:51
of the things I'll often get from the
16:52
customer base about digital solution is
16:55
Scott if it needs another login another
16:57
password if I'm logging out of what I'm
16:59
doing and into that and it's never going
17:01
to take take off so with your experience
17:05
in kind of the digital clinical
17:07
standards through dice how should
17:09
companies approach the development and
17:11
then the implementation of digital tools
17:14
in clinical care
17:17
>> well it it might sound strange when I
17:19
say start with clinical quality not
17:21
tech.
17:22
>> Yep.
17:23
>> So I'd say that you know early alignment
17:26
of clinical risk frameworks, governance,
17:29
professional standards
17:31
and those tools must support those as
17:33
opposed to just taking in the tech and
17:35
then deciding what the tech's going to
17:36
do.
17:37
>> Yeah. Um so it it enables clinical
17:41
decision making because this is a
17:44
enabler not a replacement as I was
17:47
saying particularly for things like AI
17:48
which is misunderstood or used in a very
17:52
um rudimentary way I just ambient
17:55
listening or helping to collect data
17:57
input to records. Um
18:01
but having said that the design tools
18:03
that we all know reduce administrative
18:07
load is an early welcome from
18:10
particularly general practitioners. Um
18:12
they've got to integrate whether the EHR
18:16
>> is good or not. It it is what we've got
18:19
and so it needs to integrate easily
18:22
rather than becoming a front end or
18:24
another complex connection.
18:27
Um
18:28
and I think for me because you you know
18:30
I've harped on about team based care as
18:32
opposed to individual specialties
18:34
working in their own silos. Um the the
18:38
tech that helps to maintain continuity
18:42
and bring team based care together so
18:45
that it's its functionality is across
18:47
disciplines.
18:48
Um
18:50
and um I think it's when you're taking
18:55
in new tech
18:57
uh adopting open standards um publishing
19:03
your
19:05
safety cases how it's how it's evolving
19:08
>> and involve that the complete team not
19:12
just the practice manager or the GP or
19:14
the IT lead. if it's not if their whole
19:17
team hasn't bought in and particularly
19:20
the interdisciplinary the multi-ipary
19:23
clinical teams. Um and then the the
19:26
thing that the industry can help with
19:28
and I've often said that would be really
19:30
beneficial is is the training within
19:33
those tools on boarding to especially
19:36
with a wider team. Um
19:40
and the nudges that helps with you know
19:42
how it improves workflow. Um and then
19:45
the metrics that that tech enables you
19:48
to to
19:49
>> that for me is the key that is is
19:52
industry. Not just turning up with the
19:54
tools in the kit, but actually turning
19:56
up with the replication packs, the
19:58
standard operating procedures, the
20:00
templates, the checklist, the things
20:02
that make it easy for people to adopt it
20:04
and implement it. If you don't do that,
20:06
it's another piece of kit gathering dust
20:08
on a shelf because if people are not
20:10
bought in
20:11
>> and you go around general practice,
20:13
you'll find lots of that kit on I know
20:15
that's unfortunate. It's really
20:16
unfortunate. If I I want to go back to
20:19
one of the things that absolutely
20:20
fascinates me is your work in health
20:22
inequalities. Um we've been talking
20:25
about it for as long as you and I have
20:26
been friends. So for over 25 years we've
20:29
been talking about tackling
20:30
inequalities.
20:32
Where do you see if we come right up to
20:34
date and where you are now the biggest
20:37
opportunities for pharma for medtech and
20:39
device companies to contribute really
20:41
meaningfully beyond selling you a
20:44
product so don't be a product vendor be
20:45
a pathway partner but where is my
20:47
opportunity if I am a pathway partner
20:51
>> yeah and it's interesting that I've seen
20:52
the farmer industry and some of the um
20:55
recent research shows the growing
20:58
engagement from the industry for about
21:01
the six or seven years or so. Um
21:06
and also recognizing that um meaningful
21:09
impact doesn't come from product alone
21:11
and I think you've already mentioned
21:12
that.
21:13
>> So the things that really matter in
21:17
health inequalities is
21:20
uh identifying the population group.
21:22
It's a horrible word but the segment
21:24
that you're going to work with because
21:26
you can't just reduce health
21:28
inequalities across a population. you
21:30
got to start with groups that are
21:32
debilitated or challenged by the same
21:35
issues.
21:36
>> So, um risk risk stratifying a
21:40
population
21:41
>> for and screening that
21:43
>> um
21:45
helping with outreach programs and
21:48
particularly where there's um
21:51
education required that's got to be
21:53
culturally tailored. people as their
21:56
first language.
21:57
>> Um, and often they are in underserved
21:59
populations.
22:01
>> Um, establishing the evidence of what
22:03
you're doing cuz I've often asked from a
22:06
long time ago, you know, the industry,
22:08
um, looking at where there there's any
22:11
established evidence, trials into
22:14
disparities,
22:15
um, or even if you're going to do some
22:17
research, even if it's real world
22:20
evidence.
22:20
>> Yeah. how the industry can help um
22:24
deliver that probably talking about
22:26
research there's the also the issues
22:29
that I know is well articulated but um
22:32
how research starts to embed and recruit
22:37
from underserved communities because
22:40
sometimes
22:41
>> it's difficult enough to recruit I
22:43
appreciate but um
22:45
um finding new research sites um
22:49
>> it's a really good point James Because
22:51
one of the things I often highlight is
22:53
that we might all think we know what the
22:56
pathways look like and the access points
22:58
and the touch points, but actually the
23:00
patients are the only people that walk
23:01
through metaphorically walk through the
23:04
pathways. So they're the ones that
23:05
really experience the care and see where
23:08
the bottlenecks and the backlogs and the
23:09
workarounds and the handoffs are. we
23:11
might have a sense of where they are. I
23:13
think it's a really great point that
23:14
you've made there that getting that
23:16
patient insight particularly from groups
23:18
that are underserved is so important and
23:21
and underplayed often.
23:23
>> Yeah. And I think there's lots of other
23:25
things that um the industry can do where
23:27
there's a real need.
23:29
>> Workforce training in this area. We
23:31
don't do uh certainly in undergraduate
23:33
teaching much in health inequalities,
23:36
>> patient education, co-produce sort of
23:38
patient education. um self-management
23:41
tools, things that are coming that are
23:44
really important now around social
23:45
prescribing and enable digital inclusion
23:48
etc. all of these areas that um the
23:50
industry can support um
23:55
and in the practical what the NHS is
23:57
doing, you know, new diagnostic hubs
23:59
where the industry can play a a part in
24:01
those. And then then the thing that I I
24:04
found probably consistently even with
24:07
enthused primary care networks in our
24:08
complete care community program is the
24:11
ability to do the analytics of um
24:14
population health and then its
24:15
management. they've really struggled to
24:18
identify a cohort of of people um
24:22
analyze their dability which sometimes
24:25
isn't available in public health um
24:27
information and of course public health
24:29
is only a subset of population health
24:31
and then to restratify because that the
24:35
disability
24:36
>> may be through
24:38
simply a diagnosis
24:41
>> but that diagnosis will affect people in
24:43
different ways. So risk ratifying and
24:45
therefore targeting your efforts and
24:46
screening all of that sort of analytics
24:48
where the industry is wellvered more
24:50
skilled at it.
24:51
>> That's great advice because I'm grinning
24:54
listening to you because last year this
24:56
time last year I interviewed 10 of my
24:59
NHS customers um from an industry
25:01
perspective about why they do and don't
25:03
work with industry, what they like and
25:05
don't like. And one of the questions I
25:06
had was around exactly what you've
25:08
talked about the budget impact models
25:10
the the data the tools the analytics and
25:13
whether there was any value on that and
25:16
all 10 of the customers and this was a
25:17
mix of general practice you know GPS I
25:20
had pharmacists I had ICB commissioners
25:23
I had optimization teams it was a full
25:26
range right across you know hospital
25:29
community general practice mental health
25:31
trust every single one of them said oh
25:33
for goodness sake do not take away the
25:36
budget impact models, the data, the
25:38
audits, the analytics cuz without that
25:40
we're going to be very datar but
25:43
information po. So it's really
25:44
interesting that you've also zoomed in
25:46
and said that's one of the areas that
25:48
industry could really help.
25:52
So if I
25:54
was to ask you um I'm going to ask you
25:57
actually I'm not if I was I'm going to
25:58
ask you. So you've advised health care
26:00
systems in places like India, Nepal,
26:02
Singapore that you've talked about. What
26:04
innovations or approaches from those
26:06
systems do you think the NHS could learn
26:09
from? And is there anything in there
26:11
that industry could support that
26:12
knowledge transfer?
26:15
>> That's a tough one. Um from India which
26:20
is just got 1.4 4 billion people now I
26:23
think more than that um what what
26:24
lessons can you learn well the the I
26:27
think because of that size India is
26:29
about lowcost high volume care so they
26:33
have digital innovations
26:35
>> where there's high areas of deprivation
26:38
and poverty everyone's got a mobile
26:40
phone so mobile first clinical pathways
26:44
and teleconultation models are being
26:46
developed because of the sheer vastness
26:49
of the population,
26:50
>> but the ability
26:52
>> um to utilize what they've all got,
26:55
mobile phones.
26:56
>> Um and there's there's an efficiency
26:59
lesson there where we're still a bit
27:02
wary um where the as I was saying the
27:05
independent the the online private
27:07
sector is really forging ahead. the NHS
27:10
is still talking about oh be careful
27:12
about emails
27:14
never or you know having only certain
27:16
times where patches works or you can
27:19
mobile phone. So I think the high volume
27:21
of digital innovations that that they're
27:23
doing and possibly um where we talk
27:27
about Brazil in the um community health
27:30
worker
27:31
>> in India there's um they call it task
27:35
shifting because again the demand on the
27:38
service by a rapidly ever increasing um
27:42
population is the community health
27:44
worker network that they're developing
27:46
as well and it seems to be a global
27:48
trend towards
27:50
um not less skilled but a different type
27:53
of community interaction with people who
27:56
need um care advice but don't need a a
28:01
clinician per se. So well led and well
28:05
trained um community- based workforce
28:07
models.
28:09
>> So that's India in a nutshell. I'd say
28:11
that that probably from the volume um
28:14
Nepal um that where I've done more of
28:16
disaster medicine But they're looking
28:19
because of the the terrain. Um there's
28:24
the the rural
28:26
>> health outreach and um where there's low
28:30
resources in some of these rural areas
28:33
um but it's showing how
28:36
decentralized
28:38
community embedded services could work.
28:40
Now, that's because of his terrain, but
28:42
if we're trying to decentralize from
28:44
hospitals and have more community- based
28:46
services in neighborhoods,
28:49
>> um,
28:50
>> and they're effective without thinking
28:53
about infrastructure, you know, all
28:55
already the NHS's and we're going to
28:57
build so many neighborhood centers.
28:59
>> Yeah. they've demonstrated with minimal
29:01
infrastructure
29:03
um with the extreme
29:05
um contextual constraints they can still
29:09
deliver team based care in communities
29:12
and I think there's something to learn
29:13
from there about where there's a need
29:14
because of the terrain you might be able
29:16
to do it without saying well we've got
29:18
to build the box first and then put the
29:20
tech in and then we'll worry about the
29:21
delivery
29:22
>> I think you and I might argue that we've
29:24
got 6,000 neighborhood health centers
29:27
already they're called general practice
29:29
why we need to build another 250 is
29:31
beyond me. But let's not go there
29:33
because we could have a whole other
29:34
podcast just on that topic.
29:37
>> And then finally, you mentioned about
29:38
Singapore. It's interesting over the
29:40
last 50 years, they've gone from
29:42
>> a relatively low income
29:45
um poorly developed health services to
29:47
one of the best health services in the
29:49
world, some of the best outcomes which
29:52
>> UK can only aspire to. um and their
29:57
healthier Singapore strategy
30:00
uh has emphasized for a long time what
30:03
we're talking about now the preventative
30:06
um enrollment and the development of
30:08
more screening early detection
30:11
um and strong data integration to target
30:15
where resources should be and they've
30:16
been very successful in that um and so
30:20
prevention as part of their development
30:22
has beened headed where you know I
30:26
sometimes you've heard me say with a
30:27
rice smile after 40 plus years in in
30:30
general practice somebody's finally told
30:32
me I'd never knew prevention was better
30:34
than cure. Who'd have known that?
30:35
>> Who'd have known that? I know
30:38
picked up on it and in fact do you know
30:40
where who first coined the phrase
30:41
prevention is better than cure.
30:43
>> Go on.
30:43
>> It was the um in the 1500s Arasmus a
30:47
Dutch philosopher. There's Arasmus
30:49
University in Rotterdam. But um you know
30:52
who have who have thought um that's my
30:55
phone's going now and I'm just
31:00
>> I'm sorry again if my my computer's been
31:02
beeping as emails keep coming.
31:04
>> Not at all. Not at all.
31:05
>> It makes it real though and it shows
31:06
it's live.
31:07
>> It does. Exact. It does. It shows we're
31:08
doing it live. Um one last question for
31:11
you mate. um you've got decades of
31:13
experience on different NHS boards in
31:17
education and frontline practice.
31:20
If you had one message for companies
31:22
trying to build long-term trusted
31:24
partnerships with the NHS, which is
31:26
really what most of my listeners will be
31:28
trying to do, what would it be?
31:31
>> Don't know whether I could say in one,
31:32
but I mean there's the the fastest way
31:34
to lose credibility
31:36
is um bringing in commercial models.
31:40
>> Yeah. Yeah.
31:40
>> And being clear about the use of patient
31:43
data and so being transparent.
31:47
>> Um committing to the long haul as well
31:49
because sometimes the relationships
31:52
so
31:53
>> NHS and particularly clinicians always
31:55
valued long-term partnerships. You know
31:57
we met first when you were still in the
31:59
industry many years ago when I was in
32:02
practice and met with representatives
32:05
from pharmaceutical companies. the
32:06
relationship I built was was more
32:09
important or as important as the
32:11
products they were going to sell because
32:12
that you know you could have a a candid
32:13
conversation. So committing to the the
32:16
long haul and solving problems that
32:18
matter to the service and local
32:20
populations as much as what matters to
32:23
the product that the or the the area of
32:26
care that the industry is in. Um
32:30
measurement measure what matters.
32:32
>> Yes.
32:32
um as opposed to measuring the outcome
32:35
of a partic particular problem. And then
32:37
probably the final bit is is the
32:38
alignment with um the public service
32:42
values.
32:43
>> Yeah.
32:43
>> And demonstrating that openness um that
32:46
supports health inequalities, fairness
32:49
and particularly builds in
32:51
sustainability because that is the thing
32:52
that blights the NHS. Yes.
32:54
shortterm cycle, the new ideas that last
32:58
for two years before they start to decay
32:59
and then the restructuring that every
33:01
single government goes through. Um,
33:04
>> it's really interesting, James, really
33:06
interesting that you picked up. So,
33:08
there's one thing I want to go back to
33:10
quickly because I've got you is that bit
33:12
about being in it for the long haul. Um,
33:15
I talk about that a lot in the in my
33:17
book embedded. Um, that's one there's a
33:19
whole chapter on that on don't turn up
33:21
with a short-term view thinking I'm
33:23
going to get in and get out as quickly
33:24
as I can. Come and embed and be in it
33:27
for the for the long haul. I I think
33:29
that's so important and so misunderstood
33:32
by industry. Um, we do turn we still
33:35
have that habit of turning up trying to
33:37
just do the short-term fix, but then it
33:39
withers on the vine and we wonder why we
33:41
don't get scale. That's why we don't get
33:43
scale because we're in it for the short
33:45
hole, not in it for the long haul.
33:47
No, I agree. And the NHS or should I say
33:50
the general practice,
33:52
the contractor to the NHS values,
33:55
>> yeah,
33:55
>> partners who stay through
33:58
um implementation,
34:00
iteration of the project
34:02
>> right the way through to evaluation or
34:04
even though evaluation starting at the
34:05
start.
34:06
>> Yes.
34:07
>> Not those who sort of disappear post
34:09
procurement um
34:11
>> or rapidly change that. So, and even the
34:13
continuity of relationships, the
34:15
relation relational
34:16
>> development um and that commitment
34:20
um does probably more for the industry's
34:23
name and brand than the the the product
34:27
being sold as a
34:30
top tip. Mate, I could go on. I think
34:32
what we'll do is we'll have you back.
34:34
We'll we'll have you back for another um
34:36
another conversation.
34:37
>> Scratch the surface.
34:39
>> Exactly. I've got a feeling that this is
34:41
a conversation I'll be coming back to
34:42
cuz I think you you will have generated
34:44
a lot of questions and if I do get some
34:46
I'll come back to you and we'll maybe do
34:48
a second little bit to answer some of
34:49
those questions. But
34:51
>> in the meantime, James, I'm really
34:52
grateful to you for your time, mate.
34:53
Thank you very much for coming along and
34:55
>> been a pleasure. Thanks for the
34:56
invitation. See you soon.
34:57
>> Thank you. We'll see you soon. Cheers,
34:58
mate.