Digital health technologies
Conference: COCIR digital health committee, Brussels, 22 January 2020
Author: Sarah Collen, Senior Policy Manager at the NHS Confederation
On 21 January we were invited to speak to the digital health committee of COCIR, the trade body for medical imaging and digital health technologies. The committee was interested in learning about the UK's new agency, NHSx and its priorities for digitalisation in the NHS.
Sarah Collen, Senior Policy Manager at the NHS Confederation's European Office, was able to share some of the detail of the ambitions of NHSx to ensure that the UK's health services are more effective and efficient, building on the recommendations of the 2016 Wachter report - these recommendations have been included in the NHS Long Term plan.
Sarah explained that NHSx's digitalisation project would need to deal with legacy issues of the past, and would seek to do so by listening to the healthcare workforce to establish why digitalisation has had such a limited uptake to date. For example, login times to IT systems have been identified as a key issue, with staff sometimes taking up to 30 mins to log on. Just this week, the government has recently made available £40m to address this specific problem.
Sarah highlighted that there are two significant data sharing initiatives running across the NHS, both of which involve populations of significant scale:
- Health Research Data UK (HRD UK), tasked with making sure that NHS and other real world data can be effectively and securely used for research while living up to strict confidentiality principles and
- local health and care records exemplars, who will be responsible for making sure that data can be shared primarily for care purposes across the health and care sector.
Sarah also explained that NHSx is working on the establishment of an NHS AI lab, building on the Code of Conduct for data driven health and care technologies. The new NHS AI lab will work with the Accelerated Access Collaborative and HRD UK to ensure AI can be used for the benefit of the NHS and its patients.
COCIR members were keen to express their interest in the AI work being undertaken by the UK and their willingness to collaborate in areas on mutual interest going forward.
More information on the NHSx AI work can be found here.
Innovations in health and social care
Conference: Innovations in health and social care - Enhancing health and wellbeing in Europe, Brussels, 3 December 2019
Author: Dr Layla McCay, Director of International Relations at the NHS Confederation
How do we go from a brilliant idea happening not just in one health service/organisation but across the whole system, in every country? This was the question being addressed at the Innovations in Health and Social Care – Enhancing Health and Wellbeing in Europe event run by the Finnish Presidency in Brussels on 3rd December 2019. The event was run in collaboration with the EC-funded TO-REACH initiative which focuses on how to disseminate innovation in health systems around the EU. And the conclusion: system change has turned out to be much more difficult than anyone expected - in healthcare and beyond.
The speakers reflected that part of the challenge is a lack of investment and recognition in innovation beyond the digital world. Martin Seychell, Deputy Director General for Health and Food Safety, European Commission, considered that to harness innovation to really improve patient care, we need to inspire and recognise more innovation in care models, in systems, and in workforce; and that we need to optimise the delivery process for innovation. This perspective was supported by Head of Unit, Health Innovations, Research and Innovation at the European Commission. She noted it both easier and more common to fund product innovation than process innovation – especially as process innovation is more bespoke for each setting. Every context is different, with different legal, professional, cultural and attitudinal barriers to overcome. One size does not fit all, but we should learn from each other rather than seeking to reinvent the wheel. Walter Ricciardi, who leads the To-Reach project summed up the challenge well: when it comes to innovation, we have Star Wars technology with Flintstones delivery.
At the session it was discussed that we need to more systematically harness lessons from different types of health service and policy innovation – not just what worked and why, but what failed and why; not just between entire nations in all their diversity, but at a more granular level between regions in different countries with similar characteristics and challenges.
The European Commission’s Health Directorate has started a “pairing and coaching” action learning project, stimulating innovation by bringing together health organisations working on similar challenges. The Confederation’s European Office will explore this further to see whether there is useful learning emerging for the NHS.
Strengthening social dialogue in the hospital sector in the East, South and Central Europe
Conference: Strengthening social dialogue: regional workshop 2 - Southern Europe, Rome, 15 November 2019
Author: Kate Ling, Senior Policy Manager at the NHS Confederation
On 15 November I attended a workshop in Rome jointly organised by HOSPEEM (the European Hospital and Healthcare Employers’ Association), and EPSU (European Public Service Union). The event was the second of 3 conferences funded by the European Union as part of a project to strengthen social dialogue across the EU - you can read more on this project here.
“Social dialogue” is a term unfamiliar to most people in the UK – it refers to joint working, including negotations, between representatives of employers’ associations and their trade union counterparts. In the UK for example this would be the CBI and the TUC – except that we don’t really “do” social dialogue in the UK in the way that it’s done in many European countries. In some countries, for example Austria, employment legislation is based on agreements reached between employers, trade unions and government, and this method of setting wages and terms and conditions is embedded in the Nordic countries. They find it rather odd that matters such as occupational health and safety and employee rights (for example maternity/paternity leave) are NOT reached by consensus between the two “sides” of the workforce at national level.
We do of course have social partnership working in England in the NHS - you can read more here on how NHS employers and the NHS trade unions do valuable joint work on a wide range of topics such as bullying and harassment, mental wellbeing and working longer, but this method of collaborating is not enshrined in legislation at national level.
Social partners have far more power at EU level and the NHS Confederation, through our membership of HOSPEEM, can speak up loudly for our members at this level. HOSPEEM and EPSU, as recognised social partners, have the right to be consulted about all proposed EU legislation touching on workers’ rights, such as working time, health and safety and work/life balance, and can significantly change and influence EU laws at all stages, including as they pass through the European Parliament. Social partners even have the right to conclude agreements which are then “rubberstamped” at EU level and become EU-wide law – an example of this is the Directive on protecting healthcare workers from sharps injuries, which started life as an agreement and became binding legislation.
In addition to legislation, social partners work together on codes of conduct, guidelines and good practice covering a wide range of employment-related areas.
Every country has a different history of industrial relations: in some social dialogue is strong, in others it’s non-existent. The healthcare sector is very diverse as in some EU countries healthcare workers in the public sector are employed directly by the State (the Ministry of Health). In others, healthcare is provided primarily by the private (profit or not for profit) sector, with a multiplicity of different employers, or certain groups of workers such as doctors (in secondary as well as primary care) are independent contractors. And in the UK we have a different model again whereby in secondary care each provider is an autonomous employer but pay and conditions of service are negotiated nationally.
The event in Rome, hosted by Italian healthcare employers and unions, brought together representatives of employers and trade unions from across Europe, but with a focus on Southern Europe, in particular those countries which do not currently have members in both HOSPEEM and CEEP. (Malta, Cyprus, Portugal, Spain, Greece). The workshop showcased the current work being undertaken by social partners on topics such recruitment and retention in the healthcare sector, lifelong learning, occupational safety and health, and tackling violence and harassment. A particularly interesting presentation from Sweden demonstrated how deeply embedded Swedish social partners are in influencing national social and economic policy and meeting EU recommendations in these areas.
I found especially interesting the dialogue with Malta and Cyprus, countries which have strong historic links with the UK and (for example) import a high proportion of medicines from the UK, train many professionals here, and send many patients for specialist treatment which is unavailable in their much smaller healthcare systems. This led to interesting conversations about the potential impact of Brexit, for example on supply of medicines and reciprocal healthcare.
A report on each of the “target” countries, developed collaboratively with the relevant employers/unions, was presented and discussed to identify the challenges in that country and the areas where social partner working could be most effective. Many of them identified similar issues such as staff shortages, need for digital upskilling and staff development, burnout, attracting young people to the sector, strained budgets and the need for reform and sustainability in the sector. The exchanges between the countries concerned, pointing up both similarities and differences, was fascinating and resulted in a determination to reinvigorate social dialogue and make the most of sharing good practices and experiences.
Digitally enabled care in Europe: The Confederation's European Office shares NHS experience on AI
Workshop: Digitally enabled healthcare, Brussels, 19 November 2019
Author: Sarah Collen, Senior Policy Manager at the NHS Confederation
The NHS European Office gave an account of the NHS’s work on harnessing the benefits of AI in a meeting on digitally enabled healthcare hosted by Digital Europe in November 2019. Other panellists included Ioana Gligor, the Head of Unit for the Commission’s Health department for digital health, and the chair of the European Parliament’s internal market committee, Petra de Sutter, a Belgian Green politician who is also a gynaecologist.
In her intervention, the Confederation's Sarah Collen gave a summary of the Code of Conduct on data driven health and care technologies and the recent NHSx report entitled “AI: Getting it right”
The general discussion focussed on the overall priorities for Europe over the coming European Commission mandate. The European Green Deal will be a major focus, with the second major focus being the European Digital Single Market. The new Commission has promised to deliver a draft proposal on new legislation to govern AI within its first 100 days.
In terms of health, this Commission has committed to the creation of a European health data space, which can be used by EU citizens to access their electronic health records throughout Europe, but can also be used to enhance the use of data for research purposes.
The value of regulatory ‘sandboxes’ in this field was discussed. Sandbox takes its name from the sandboxes where children play in a controlled environment. In the computer science world, a sandbox is a closed testing environment designed for experimenting safely with web or software projects. The concept is also being used in the digital economy arena to refer to regulatory sandboxes - testing grounds for new business models that are not protected by current regulation, or supervised by regulatory institutions. The purpose of the sandbox is to adapt compliance with strict regulations to the growth and pace of the most innovative companies, in a way that doesn’t smother the Fintech sector with rules, but also doesn’t diminish consumer protection. This model has been tested in the UK by Fintech companies and it could be a way forward for the digital health technology community.
Towards an international declaration around mental health crisis care
Conference: 2nd Crisis Global Conference, International initiative for mental health leadership, Washington, September 2019
Author: Dr Phil Moore, Chair of the Mental Health Commissioners Network
So, here’s the question. If I was at the lowest point in my life, distressed, disorientated, depressed, perhaps with some loss of contact with reality because of my mental state, what would I want to happen to me?
If I was injured in a car crash or having a heart attack, the services would be on the spot to stabilise me, scoop me up and take me for help. In fact, we have come to expect that as the norm. And the hospital services are geared up to accept me and channel me through a quality-assured management and treatment process.
Whereas, in a psychiatric emergency, the norm is too often delays, detainments and, also too often, denial of service. Or at least, long periods spent waiting in an emergency department.
It’s not that the will, commitment and passion are not there in so many of the professionals who are involved. They frequently give way over and beyond any norm, as do so many health and social care professionals. The problem is our services and investment have fallen way behind other aspects of health care. And it is taking time to rectify that imbalance, even though stunning progress has been made. The fact that stunning is not yet enough is an indication of how bad things had become!
Worse, in many places around the world, the norm is police intervention, a police cell and even prison. Such was the case in the UK until the last few years and we are not entirely free of this, even now after years of reforms. Many places are making the use of a police cell as a place of safety a never event.
All the services that respond to urgent and emergency mental health crises have the same issue. Where do I take this person for appropriate and safe care, for themselves and others? All too often A&E, the emergency room, is the easy solution. But not a great place if you are distressed, disorientated, depressed and worse. The lowest point in your life. We really do not provide the best services for people who are in crisis.
Of course A&E staff do a sterling job and psychiatric liaison services help. But A&E? Noisy, busy, overstimulating, disorientating, doing their best to cope with urgent trauma and medical emergencies. Not a great place to be.
In September this year, 64 experts from 9 countries met in Washington DC at the second global urgent and emergency mental health crisis care summit.
We spent the two days working on what might be the strongest content for an international declaration around mental health crisis care. Crisis care that comes to anyone, anytime, anywhere. I would not want crisis services with gaps that I can fall through. We need a continuum that picks people up from the moment they feel they’re in crisis, right through their treatment and into recovery and the support that continues beyond.
This was a coming together of huge expertise, huge experience to put together our joint brain power to say how can we design something that will influence governments to put in place the right policies and the right procedures so that we can get mental health crisis care properly operating in all areas around the world.
We plan to publish the declaration in the spring of 2020. We hope it will influence nations to commit to improved crisis mental health care and the investment these will require.
Tackling stress in the workplace: employers and trade unions working together
Conference: Time to end stress: professionals and managers in the frontline, Lisbon 17-18 October 2019
Author: Kate Ling, Senior Policy Manager at the NHS Confederation
I was recently invited to speak at an event in Lisbon “Time to end stress: Professionals and Managers in the frontline”. The invite was extended to me in my capacity as the NHS‘s representative on CEEP, the pan-European confederation of public sector employers.
The event was organised by Eurocadres, the Council of European Professional and Managerial Staff, and the participants were trade unionists from a wide swathe of European countries, from the north (Finland, Sweden and Norway) to the south (Malta, Spain, Switzerland, Italy), the east (Romania, Croatia, Poland, Hungary, Czech Republic, Serbia) and west (Ireland, Portugal, France, Belgium, UK). All shared the concerns across a range of sectors about the ever-rising burden on employers, individuals and their families and wider society of mental ill health arising from psycho-social risks (stress) at work.
Current EU legislation on occupational health and safety includes around 60 directives, none of which specifically cover stress in the workplace, though arguably employers’ duty to assess risks in the workplace and take appropriate action to safeguard workers’ health encompasses duty of care towards employees’ mental as well as physical health. Also, unlike the many Directives dealing with specific hazards and (for example) setting evidence-based EU-wide limits on workers’ exposure, occupational stress is less easy to measure and remedy. Eurocadres is nevertheless spearheading a campaign with ETUC (the European Trade Union Council) to push for an EU Directive on psycho-social risks in the workplace.
There are examples from other European countries of public and private sector organisations who have taken the initiative to tackle stress at work, a couple of which (from Spain and Portugal) were showcased at the conference. I was invited to speak and debate in a panel session asking what policy makers can do to address the “stress epidemic”.
I began with some facts and figures from the UK and elsewhere. According to a survey by UNISON, stress is the biggest reason behind sickness absence in the UK, costing an estimated 105 million working days and 1.67 billion euros, and affecting 30% of NHS staff every year. The German trade union ver.di reports that mental ill health accounts for about 13% of total days of work and will become the most common cause of early retirement in the near future. The picture across Europe is similar: an opinion poll conducted by EU-OSHA (the EU’s health and safety agency) showed that 51% of workers report that stress is common in their workplace, and 4 in 10 think it is not handled well.
From the perspective of an employer providing public services – in this case healthcare services – this scenario is especially challenging, as healthcare sector employers already experience significant difficulty recruiting and retaining staff. Whilst it can be very rewarding (and there is plenty of evidence that working per se is good for people), healthcare work can be perceived as unattractive. It is often physically and emotionally stressful, and existing workforce shortages are likely to be exacerbated as the European population ages. Greater numbers of older and sicker people, new technologies requiring constant upskilling, and more demanding patient expectations combine to result in high rates of turnover and burnout. Staff caring for other people are at risk of not being looked after themselves.
So what is or can be done to tackle this? There is joint work being done at European level by the social partners HOSPEEM, the European Hospital and Healthcare Workers' Association, and EPSU, the European Federation of Public Services Unions, to reduce the burden of occupational psycho-social ill health in the healthcare sector. In their joint project, HOSPEEM and EPSU have run workshops and produced resources including a toolkit sharing good examples of employers and trade unions working together successfully. An example from the Netherlands of engaging staff at workplace level in dialogue with team leaders and Board members in 10 organisations (235 teams) about changing their “organisational climate” resulted in a reduction of 68% in work-related sickness absence, less self-reported emotional exhaustion (down by 15%) and an 11% improvement in quality of care six months later.
At one of the HOSPEEM/EPSU workshops, an English ambulance trust presented their peer-to-peer support network for workers, in which staff provide a listening service for colleagues experiencing upset or trauma and signpost them to appropriate help. NHS employers and trade unions have established a Health Safety and Wellbeing Partnership working group, and developed a Health and Wellbeing framework and online resources – a “Roadmap to improving health and wellbeing” - to support staff and managers.
Take-home messages from the project were that success depended upon a genuinely participatory approach involving staff in identifying risk factors and developing and implementing strategies to manage (prevent and/or mitigate) those risks. Successful strategies vary according to the context but a common factor was giving teams and individuals a greater sense of control and autonomy, for example in developing more flexible working patterns where possible, offering opportunities for training and development to all staff, young and old, and upskilling staff to help them cope with the new digital skills they require. For these changes to happen, there needed to be a recognition of “burnout” as an occupational hazard, and good human resource management including a willingness to address safe staffing levels. Above all there needs to be on the one hand, committed and proactive leadership, and on the other hand staff prepared to take responsibility to address the problems and take up the opportunities offered.
In my final remarks to conference colleagues, I suggested that more legislation is not the answer. The current Directives oblige employers to conduct risk assessments and take appropriate action, but despite being in place for a long time legislation hasn’t stemmed the rising tide of work-related stress. EU law is often not effectively transposed and implemented at national level. Experience from CEEP and HOSPEEM and their trade union partners shows that what really makes a difference in the workplace is employers and trade unions getting together at local level to effect real, concrete changes. Compliance with the law incentivises employers, but much more compelling are the sound economic arguments for investing in a healthy and productive workforce, resulting in better staff retention and motivation and a better service to patients or customers.
Integrated care: why does it matter and what it means for patients
Conference: Medicongress, Oulu, Finland, 1-2 October 2019
Author: Niall Dickson, Chief Executive of the NHS Confederation
When I was invited to speak about the UK’s integrated care journey at Finland’s Medical Congress in Oulu, I thought it might be more helpful if they were presenting about their model rather than the other way around. Finland is at the forefront of efforts to integrate health and social care. This Nordic country is at the cutting edge of attempts across Europe to combat the inefficiencies and duplication of providing care through separate professional “silos”. Though it was clear there are strong parallels between Finland and England: the inability of our two systems to legislate effectively for reform and the struggle we all face to manage demand for healthcare as our societies age.
Earlier this year, Finland’s government resigned over failed healthcare reform. Like many developed nations, Finland has an ageing population that is putting financial pressure on its social welfare systems. In 2018, those aged 65 or over made up 21.4% of Finland's population, the joint fourth highest in Europe alongside Germany — with only Portugal, Greece, and Italy having a higher proportion 1. As we move into a new decade, Europe and developed nations will have no choice but to grapple with the reality of what it will mean to become an integrated system. There is no alternative.
The European Health Conference 2019: another contender for health’s answer to Davos
Conference: The European Health Forum Gastein, 2-4 October 2019
Author: Dr. Layla McCay, Director of International Relations at the NHS Confederation.
Ever since I joined the NHS European Office, Brussels-based stakeholders have asked me: are you going to Gastein? The European Health Conference in Gastein, Austria clearly has a mythical status but without having been, I found it hard to get a feel for exactly what it involved. All I knew was: everyone seemed to be going. So this year, when our office helped to get Indra Joshi from NHSX a main stage speaking slot on AI, I knew the time had come. I set off to support her, to learn from our neighbours’ experiences with health systems, and to promote the work of the NHS European Office.
Gastein turns out to be an alpine village with conference venues and hotels spread out around a park, with a backdrop of snow-capped mountains soaring on every side. And in some ways, it felt like a conference from years gone by. The sessions followed the theme du jour of disruptive innovation. I saw my first play about the future of healthcare financing. I heard a lot about various digital matters. I went to a most enjoyable #fakenews session, and I chaired one on overcoming barriers in genomic medicine. The topics were interesting. What was more interesting was the attendees: it’s a relatively small event but it takes over the village. With health ministers everywhere you looked, and senior representatives of EU institutions breakfasting next to you, it became clear that Gastein’s formal plenaries and workshops function largely as a reason to bring these people together and get them talking. As Britain prepares to leave the EU, relationships with health leaders in our neighbouring countries will become more important than ever. I learned a little about disruptive innovation at Gastein; I learned more from my dinner companions. And I left with a lot of business cards - and I’ll be using them to benefit the NHS.
THET Conference 2019: transforming global healthcare
Conference: THET Annual Conference 2019, Imperial College London, 26-27 September 2019
Author: James Maddocks, International Policy and Programme Office at the NHS Confederation
Members of the global health community gathered at the annual Tropical Health Education Trust (THET) conference this week and offered an insightful and inspiring, yet challenging, update on the current state of global health.
Delegates addressed the desperate need for quality to keep pace with coverage if Universal Health Coverage (UHC) is to be truly transformative and discussed the crucial role that equal and collaborative partnerships will play in achieving this.
Dr Shams Syed, Coordinator of the WHO Quality Systems and Resilience Unit, highlighted this during his opening address by sharing the worrying statistic that in the poorest 137 low-and middle-income countries, 8.6 million people die annually of inadequate healthcare provision, but of these 8.6 million, 5 million died as a result of receiving care that was not of an appropriate quality, not simply no healthcare at all.
This isn’t solely a by-product of the continued under-funding of health and the associated challenges in many low-and-middle-income countries though. As we heard from many delegates, despite the well-intentioned actions of those in wealthy nations, poorly planned and ill-thought out approaches that don’t consider and engage the communities they hope to help can end up doing far more harm than good.
Dr Tom Bashford talked of his experience as an anaesthetist working in Ethiopia and the realisation that, whilst beneficial for himself, his presence offered little long-term benefit to the progression of the health system, and actually probably undermined its development in the long term. He spoke of how this made him evaluate the role that he could and should play in global health development and how this has informed his contributions in the following 8 years through organisations including Lifebox and Cambridge Global-Health Partnership.
NHS Confederation’s Director of International Relations Dr Layla McCay and the Confed’s Chief Executive of the Independent Healthcare Provider Network took to the stage to discuss frugal innovation, the role of public-private partnerships in fostering innovation in low-income health systems, and examples where these have been used in higher-income settings. They discussed the need for mutual learning, and overcoming biases and practical barriers to help the NHS make use of cost-effective, high-quality solutions from low-income countries. Examples included using drones to deliver medical goods to remote locations and the development of drill covers that enable DIY drills to be used as surgical drills at far lower cost.
It was good to see the UK’s global health community collaborating with health leaders from other countries, and this was reflected in the diversity of the individuals, organisations and partnerships present at the conference. Delegates heard from multiple speakers representing governments, academic institutions, private sector organisations and the NHS; all of whom shared their experience of the need for continued collaboration in order to successfully deliver the innovations in medical technology, sharing the responsibility of delivery, and furthering the equity of individuals and communities that are vital for the delivery of quality UHC to the world’s most disadvantaged.