Pharma Market Access Insights - from Mtech Access

Population health management: a community effort across health and life sciences

• Mtech Access • Season 5 • Episode 6

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How can our community support NHS leaders to deliver a data-led, people-centric health service?

Dr Mark Davies (Global Chief Health Officer, IBM) joins Prof. Phil Richardson (Chair and Chief Innovation Officer, Mtech Access) to explore the power of data, the role of community and how the health and life sciences ecosystem can support the NHS’s population health management goals.

Population health management has the potential to be a powerful tool for healthcare systems, effecting the way health and care is strategised, budgeted, targeted, and delivered. We see a future where key decisions in the NHS are driven by population health data. What we now need is a new way of working powered by local need, quality evidence and a systematic approach.

In this webinar, Phil and Mark explore:

 - How the NHS can use population health management to transform the system
 - The importance of community in population health management
 - How Pharma, Medtech, and the wider life sciences sector can work above brand to support the NHS with population health management
 - What a data-driven, people-centric approach means for the way treatments are valued
 - How population health management could transform the economics of healthcare

This episode was first broadcast as a live webinar on Friday 8th September 2023. Learn more at: https://mtechaccess.co.uk/uk-nhs-insights/

Discover more about our work in this area at: https://mtechaccess.co.uk/uk-nhs-insights/

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- [Narrator] Welcome to this Mtech Access webinar. At Mtech Access, we provide health economics and outcomes research and market access services from strategy through to implementation. Our unique NHS relationships guide and validate everything we do in the UK. We work with over 80 NHS associates to bring our pharmaceutical and MedTech clients authentic insights into the NHS. We can help you answer key questions related to the NHS, from how to communicate with integrated care systems, places and primary care networks, to how to capture pathways of care. Get in touch today to discuss your market access goals. First though, I hope you enjoy the webinar.- Welcome everybody to NHS Whispers, I'm Phil Richardson, and our webinar today will be on population health management, a community effort across health and life sciences. I'd particularly like to welcome our NHS Associates who play a key role in the work we do. For those of who don't know Mtech Access, we're a specialist global health economics, outcomes and market access consultancy, with a track record and expert delivery, and we provide specialist support to healthtech clients. We work as a collaborative partner with the NHS. Today our focus is on population health, and I'm delighted to welcome our guest, Dr. Mark Davies, who's a medic by background, a GP, and is currently the Global Chief Health Officer for IBM. Welcome, Mark.- Thank you, thank you very much.- Perhaps we could start by just doing an introduction about who you are.- Yeah, certainly. Happy to do that, so Phil, as you mentioned, my background is as a clinician. I spent 25 years in the NHS as a general practitioner. And I guess the other kind of aspects of my career, I spent about 15 years working in central governments, largely around data policy, large infrastructure projects, digital transformation initiatives on a national scale, and spent some time both in cabinet office and as the medical director of what became NHS Digital. And then for the last 10 years I've worked in industry, so in a number of different guises, most luckily in IBM, as you mentioned, as the Chief Health Officer, where I have a remit that's now global. So I guess, I guess in summary, my career is kind of a bit of a mix of frontline service delivery as a clinician, policy from a political perspective and industry.- Brilliant, thanks, Mark. I mean that is a great blend for our audience today. Who some will be from the NHS, some will come from industry, some interested in the broader healthtech space and some with a clinical background. You should have friends with everybody in the audience.- Everybody needs friends. That's good.- Everybody does need friends. So if you think about what are the sort of things that are matter to you at the moment, what would you say your current focus is or current priorities?- Yeah, so I mean, a good question. So predominantly IBM is a digital transformation organisation. So we support most industries in the world really in kind of rethinking themselves based on digital capability. And I lead that work from a healthcare perspective. And I suppose my main focus in that regard is in three main boxes. One is the digitalisation of providers. So thinking about how hospitals think about their operating models and the opportunities for digital technology to kind of enable them to do what they do today better, but also rethink and redesign their operational practice for tomorrow. The second is the digitalisation between providers. So most healthcare systems in the world are starting to realise that we can only dig ourselves out of the current challenges by cooperating and operating as a health system. But of course there is a set of digital needs to kind of defragment that world of kind of siloed providers. So whether it's data or whether it's processes or whether it's health records or automation. So I spend a fair amount of time talking about how you digitalise between providers and the creation of systems. I guess that will be the focus of this conversation. And the third is around the digitalisation of the interface between the citizen and the service. And most other industries have put a lot of work into taking the friction out of that experience and perhaps giving clients, customers, citizens more control of their of their workforce. And we're starting to pivot towards that as service users in health and indeed in social care. I guess the other bucket of work I'm quite involved with, Phil, and you'll know about this, is wellness. And increasingly we are seeing a more eclectic number of players operating in the wellness space. So non-traditional healthcare organisations. So thinking about banks and financial institutions, thinking about retailers, obviously community pharmacies and the like, and many of them are working at how they can step into the wellness space and make a positive contribution to the overall wellbeing of a population. So I'm quite active in helping organisations navigate that.- Yeah, it's fascinating Mark, I love the way you've pivoted from what effectively is healthtech into well tech, I've heard you talk about that before and the lens of population health management. And I'm going to ask you to help me unpick that a little bit in a second. But just with population health management being solved by the population in the main rather than somebody with a database in our cupboard trying to make lists of things. But I'd be really interested if you just gimme your view, I know you're nodding.'Cause then I know you and I talked about this before, but is there a bit which is, how do we bring it to life and avoid almost the rhetoric around everybody's stating these are the problems that health service has and nobody's really thinking about solving it. And here is the description of a data based view of the world. Yours is very different, isn't it? Could you maybe help us unpack a little bit around what is population health management almost?- Yeah, no, of course. And I mean there are lots of kind of definitions of pop health kind of circulating, but in my mind, it really is something that sits at the interface between direct patient care and public health. So in most of my career there's been quite a significant distance professionally between public health organisations that are really quite expert at a whole population and thinking about what the problem is and direct patient care, people that deal with an individual, but they're relatively isolated and one doesn't feed into the other, which is clearly ridiculous from a distance. So for me, the magic about population health is it sits at that interface population health management. So it sits in that interface. And I think that's really, really important. Another way of looking at it is to think what it isn't, what population health management isn't is where we are today and where we have historically been. And that is basically organisational health management. So we think that the running of organisations well from a financial, operational and clinical perspective, is going to improve the health and wellbeing of the population. And that has been the received wisdom and the basis of the essentially Victorian healthcare systems that we've built up over decades. And we have an international body of evidence that has told us that is complete rubbish.- Yeah.- So moving away from that organisation centric view of the world and everything that that means in terms of management focus, in terms of operational model and data insights and regulation, to essentially a model that starts with a population. It starts with the exam question of how do we improve the health and wellbeing of a population? How do we improve the experience and outcomes of care? And how do we do it within an increasingly tight and cash envelope? And you will recognise those as the triple aim. And I think that is the north star of healthcare. I think it always has been like it always will be. And starting with the question, what the needs of the segments in a population is the right way to design the system, not starting with an established organisation.- Yeah, I think that's a really refreshing way of thinking about it. And I do think we're a bit trapped in the paradigm of body parts and activity around body parts and hoping that it all adds up. Oh, and there's mental health, so there's that whole thing. It crashes through all of that, doesn't it? And and it also, I completely agree with you about the public health position typically has been the drink less, eat less, stop smoking, exercise more. And that's really just appealed in a small circular economy for the people who eat less, drink less exercise and don't smoke. And I think we can collapse that can't we, by saying actually what really is the problem we're trying to solve, as opposed to what is the thing we've always done?'Cause there are two, I think very different things, aren't they?- Yeah, I think that's right. But also, I think we should acknowledge just how profound what we've just said is, and how difficult it is, so this is a paradigm change. This isn't an adjustment on what we're currently doing. This isn't a rethinking or setting up of a directorate within an organisation. You know, I often liken it to the NHS used to speak French, now were saying you have to speak Italian, this is difficult. And you know, we have developed, trained, rewarded, recognised leaders in the system for behaving in a particular way. Now all of a sudden we're saying, okay, going to have to start behaving in a different way. And it's hard. It's in long haul, but I am sort of passionately of the view that that's what we need to do to have a sustainable, publicly funded health and care system.- Yes, and I think the funded bit is around intelligent decision making, isn't it? And resource allocation and then development of the right skillset and all of the things that sit around, I think there is a tendency for the funding bit to end up being a spreadsheet and end up being, micromanaged at the how many pencils do we need? And the question of do we need to write things down anymore, isn't always asked. So I think just connecting those dots together is important, isn't it?- It is fascinating the way we often start the conversation in the wrong place. So we often start the conversation of this is our fixed point, this is how the money flows. So what's possible as opposed to, what are we trying to achieve? What kind of structures and systems do we need in order to achieve it? And then what workforce, financial flows, regulatory framework do we need to ensure that it's done well? So the how you do it and the what you are doing, we keep on getting the wrong way around. And for good reason. I think it's understandable why that happens. But I think one of the reasons that I'm quite optimistic and I am optimistic about the future in healthcare is because that that debate has really become front and centre and people are talking quite openly about A, it's very difficult. But B, this is an operational imperative. This isn't nice to have, population health management has to become the way we do stuff, or we're bankrupt.- Yes, well, fiscally and biologically, we will end up in that, both things will fail, won't they?- Yeah, yeah, for sure.- So can I bring it to life a little bit around, so, you practised as a GP for a good length of time. What does it mean for frontline clinicians like GPs and others in the community?'Cause this feels like a community effort rather than it's a hospital-based clinical specialty effort. It feels like we're flipping the switch the opposite way. And maybe later you could talk about hospitals being the providers of the things that can only be fixed in a hospital type setting. But I think GPs, I interviewed with the BMJ probably 10 years ago and said GPs are going to become the MDs of health systems. And then nobody liked that at all. But I'm just wondering what your sense is on the what the changing role of a GP might be or whether it might be just bringing to life what the role of the GP always was and just getting the balance shifted in a place.- I think the first thing we should say about in the role of the general practise is just how stressed it is at the moment. And most of the GPs that you talk to are probably working harder now than they have ever worked in their career. And we should acknowledge the level of burnout and the level of stress amongst general practitioners, so nothing in what I'm about to do suggests that this should be added on or they haven't been doing a good job in any way. I think that would be grossly unfair. And, I work, as I was saying at the beginning, internationally, and I often talk to governments of other countries who will say something like, we are a very hospital dominant healthcare system. We really see the value of primary care. We want to build something in our country that's like you've got in the UK, we really look at your UK healthcare system and we think your general practise primary care is magnificent. And yet here we are in the UK thinking, oh my goodness, you know, primary care is really struggling. It's kind of, response times are not good, the staff aren't happy, the patients aren't happy. And it's really needing significant reform. So I think it's important to start the conversation just reflecting that. I'm a big fan of primary care networks. I worked in the early days with NAPC around the development of primary care home and how you might apply that model. And then certainly that's been built on by the fuller inquiry and subsequent report, which I think is really to be welcomed. I think there is a really helpful direction of travel in that report, is obviously, for the conversations to have around exact implementation, local versus national, but the director of travel is absolutely right. And I think really, I think really helpful and at the heart, rather than a general practitioner being the kind of single point of access and then referring out to other professionals. We create a network of care around multidisciplinary principles, which incorporates both health and social care at the neighbourhood level. And in that regard, GP's roles slightly changes. So in that kind of rich, multidisciplinary that perhaps are an escalation route for complexity or higher risk from a clinical perspective, they potentially have a kind of training and developments and supervision role for the multidisciplinary team. And they have a critical role in kind of overall leadership and vision. What I just described is a bit like a consultant in a hospital. It's starting to shift towards that a consultant type model rather than a practitioner type model. So I think that's the direction that we need to do. And GPs and other professionals working in primary care operating as part of a network. But you alluded to the word community, and I'm particularly passionate about the opportunities for community groups to get more involved in wellness initiatives, prevention initiatives, kind of screening engagement initiatives. And it's really the opportunities for using those hidden assets within communities that I think isn't the thing that can probably make the biggest difference at neighbourhood level.- No thanks about, that's really helpful way of just connecting the dots together on that. And I think if we just build on that community part of the conversation, is the community becoming a healthcare provider for its own health?- So I haven't really thought about it like that, but I think that's spot on, I mean, every industry apart from healthcare has recognised the opportunities of pivoting towards a more self-service model for the very good reasons that if you start to harness that workforce, that part of the workforce in patients, sorry, and citizens, then you end up with better results, better levels of participation. People are more engaged and bought into a process and it's cheaper. But then you use the resources in a more efficient way. And, we have, I think learned that lesson on an individual basis. So in my professional career, been a very strong focus around patient centred care, very strong focus around consultation models that involve the patient more actively as equal partners in planning their own treatment goals. But we have not learned that lesson at a community level, at a population level. And I think that's in essence what we need to do.- Yeah, does that extend then to the whole system model design bit you talked about earlier. So we are shifting from one paradigm to another. Feels like quite a lot of the insight and intelligence sits within the community, either in community groups or in individuals. We've traditionally done service reconfiguration by getting the people delivering the service to develop what it looks like and then test it out with patients, that sort of model. So it's a post rational type model rather than an evidence-based needs led model. But, but I'm just wondering, the co-development and co-production going forward, which we've seen very successfully work in some mental health site type services, should we be scaling that to whole system? I don't try to put words in your mouth, should the ICS be a population ICS rather than a public sector ICS?- I think the ICS is a population ICS.- Okay.- I see it as the organisation that doesn't run providers. It's an organisation that holds the exam question around what they're trying to achieve. And in that regard, is responsible for holding systems of providers together to deliver those aims. Your point around co-production I think is a really good one. If you don't mind me saying, we've taken a really good concept like consultation and we've sort of wrecked it really, we've turned it into a kind of regulatory requirement for change, for reconfiguration of a hospital, And we've lost the magic the consultation's supposed to be about, which is around that participation co-production model of tapping into the wisdom of communities and unleashing, not only the kind of design, creativity and insights that exist within communities, but actually the potential to deliver itself. So just look at voluntary patient transport systems, for example, and how effective they can be to augment statutory transport systems. So I think there is a need for co-production to come of age and I don't want to sound like a broken record, I think there are important lessons to be learned from other industries around how you adopt techniques like user-centered design, in order to create personas and accelerate that co-production. Because I see lots of people using the words, but perhaps when you get scratch the service, they're not getting quite the value that they could be doing.- Yeah, I think it's interesting, so I've certainly seen that too, and where when it is evidence-based and leads led and focused on that way with the right people in the room, there is a bit of magic that happens where if everybody has an equal contributory voice and then it's considered collectively and it's not a clinical decision at the end just to see what the right answer is. It is a composite answer. I've seen that work so much better. And I've certainly been involved touch on mental health in an acute mental health pathway, where we ended up designing locally, a solution that was then delivered by peers who'd experienced that that piece. So rather than having a psychiatrist or a community psychiatric nurse being the lead for something, the patient group themselves led the service, supported by the relevant expertise. That's another paradigm shift really, isn't it, that, if we can get to that sort of sort of position.- Yeah, it's funny you're talking about mental health'cause it's true, I think there are many examples in the mental health sector of them having led the way, but there are other examples as well. So end of life is another example where communities with common interests have come together and helped craft problems. And I was heavily involved in some of the early work around gold standards. And that was entirely an exercise in co-production. So the real experts on the receiving end of an end of life pathway are people who are on an end of life pathway or have been recently bereaved, and actually tapping into their experiences and their ideas for what their pain points were and indeed how things could be better for them was what drove a lot of the thinking around gold standards. I'm fond of describing population health management, what we're talking about here, as an exercise in which is fundamentally about redesign, informed by the best available insights and often conversations about population health management could either be dominated, often more dominated by the data.- Yes.- And the analytics around the data rather than the design, the actual, and the real magic is where you bring those things together. So where you've got sophisticated and even less sophisticated ways of segmenting the population and understanding cohorts that is driven in a data led way, and you use that to drive your design conversations, then really exciting things can happen and in a way that allows you to capture impact and therefore drive effectiveness and efficiency at the same time. But, so I use the word insight intentionally because people always talk about intelligence and they mean data and analytics. But of course some of the best insights we get is around qualitative data v quantitative data. It's about narrative. It's about narrative insights, it's the stories. If you profoundly want to understand what's going on, you should be identifying the personas of the people whose wisdom you want to tap into. And then go and talk to them and they will tell you.- I love the idea of narratives and I don't know if you've come across this before, the narrative of narratives, which starts to being, well, what are all these stories telling us? And then how do we play that back? And then, what is the evidence that sits underneath? I completely agree with you. We've done a translation from data to intelligence, but we just really mean data still. And I think there's a whole piece to be done around decision making and informed decision making, which comes from insight. But insight only really comes from being connected. So there's a big difference, isn't there?- And I can't help but not leave my clinical background, but it would be a bit like making therapeutic decisions by reading the electronic healthcare record and not looking up at the patient. I mean it would be completely ridiculous. And yet, often that's what we do with populations, you know, it's actually much too hard and expensive. It's going to take too long, what we're supposed to do. We supposed to interview 50,000 people. We can't do that. So we'll just look at the data. Well of course, there are well established techniques around kind of engaging with different cohorts and personas in the population that allow you in a very quick way to do user research to get to gain those insights. It's interesting 'cause a lot of those disciplines are actually around anthropology. These are social scientists, I honestly think that anthropological and anthropological disciplines should be our new best friend in health and care.- I agree with you. I've had you kept talking about consultations earlier on, and I was involved in the Dorset reconfiguration and sitting in Wimborne with somebody next to a small community hospital, who for them, that was their healthcare world, who were GPs and then this was the hospital and we were using Keogh's review about urgent care and how outcomes were better by having centralised specialist units, which in our case was going to be eight miles down the road from where I was currently standing. And I had two people send them to me and say, I think I'd rather have poorer care closer to home, that would be my choice. And that just plays completely into the anthropology, doesn't it? And it plays into social science, and how groups of people think and act, you can't give a clinical answer to that view, but you can give a population health management answer to it. And I think that's important thing in what you're saying.- Yeah, yeah, yeah. So I think that's really interesting. So we didn't, we're too young, but when a chap called set up the NHS he wrote a document called "In Place of Fear", which is fascinating paper to go back to actually, just historically. And that the social contract at that point was, do you know what, we'll look after you, don't worry, this system's here to look after you, if you get ill, we've got you. And that was essentially the deal. And the public compact moving forward, it has to be different. We can't afford that kind of, we'll look after you model, whatever, it has to be much more of a kind of partnership model. But we will support you in keeping well and we will endeavour to look after the whole population, to close the gaps between the haves and the have nots. And we will do it in a way that pays deep respect to all the cohorts and all the groups because that's the principle of universal care. But there are trade-offs and you need to be involved in those mature discussions around trade-offs.- Yeah, and I think that's important. I'd like to just connect back to the resourcing. We talked about the financial envelope earlier, and I sort of expanded that out to be resourcing more generally. And we've got a health service, which as you said, these aren't your words, these are my words. But just paraphrasing what you said, it's running on fumes pretty much at the moment. It's overextended, feels a little bit like the anxiety you might have with an electric car where it says you haven't got any, you have no miles left, but you've still, you seem to have done another three. It feels like we're in that sort of position. There's no headroom to think because it is, I just need to get through my today list or tasks or something. And some of the numbers I've looked at with GPs you could easily be doing 250 prescriptions on top of the eConsults that are come and on top of the people. And then there's emergencies on top of that. Oh, and by the way, there's a whole lot of QOF data that needs to be calculated and there's a whole lot of practice stuff needs to be done. And there's just the where would you even start in that mix? But if we think that's where the health service is, we've got industry who are championing the bit, so I have loads of conversations on that basis, which is how can we help, how can we get involved? You obviously will have experienced that through IBM and the other things you've been involved with. And I'm experienced that now and sitting surrounded by health economists and data scientists and people who can help with things. How do we mobilise the whole resource that wants to get the job done rather than the current feels like a bit, it feels, well, it feels dysfunctional with barriers put in the way to improve the dysfunctionality of it. Well, how do we fix it, Martin? How are we going to fix it?- Yeah, yeah. I set myself up for this one by telling you how optimistic I was, didn't I?- Pretty much, yeah.- Yeah, yeah. So obviously, I recognise the picture that you described, I think one of the interesting discussions is why haven't we done this already? So what are some of the barriers that stopped us pivoting from what I described as a Victorian operating model to one that is more fit for the current challenges of our population. I think if there's a victim of the pressures that you've described, it's some of those barriers. So there are a whole raft of sacred cows that frankly, we just can't afford anymore. And people are going into, I think much more creative conversations and considering things that they just would never have considered before. If you look at a pressured industry, they kind of have three options, really. Number one, this is outside healthcare, you can significantly start restricting your services.- Yeah.- But that's kind of hard in healthcare, though obviously we have a and we have nice kind of guiding and most effective and cost effective services, which is an important part, but we can't, we still provide healthcare to everyone by and large, most things, you can start pivoting towards a self-care model in the way that I've described. Or you can apply very significant levels of digital transformation and automation across your processes. And by and large, outside healthcare people do one or more of those. And I think honestly, that's what we need to be doing. So I've talked already about sharing the load with populations and sharing the load with individual citizens, which I think is very important. So the personal and participatory model of healthcare is where we are heading, and frankly, my children who are in their twenties, that's what they expect. They're slightly aghast when they're not engaged with in that way. And that contrasts with my parents' generation who were happy to have that done to mentality. But the second is around kind of digital optimisation and automation and by and large in healthcare, and sorry to say this Phil, but when we've had a problem, we've kind of thrown people at it. That's the way we've solved problems. And it's expensive and we haven't got enough people. And the people that we've got are tired. And if you can't throw people at it, the next thing to do is throw technology at it. And there are enormous, enormous opportunities for things like automation, for artificial intelligence, for data-driven redesign, and for other technologies such as Cloud, which can strip an awful lot of the waste and drive up more efficiency and mean that we stand half a chance of keeping up with the level of demand that we've got. If you don't believe me, cast your mind back to the height of the pandemic. And some of the ways that we used data.- Yeah.- And some of the ways that industry partnered deeply with the NHS. In fact, the army part partnered deeply with the NHS. And indeed, we managed to break down the slightly weird artificial distinction between university life science departments and the service as well as part of the recovery trial. So that's what I kind of mean by sacred cows. There were a whole bunch of artificial silos that were literally just swept aside as part of that. And it came out of a crisis. But I think we are in a similar, we were in a similar crisis at at this point. So what what gives, yeah, what gives is a what gives, what gives is a reluctance to think creatively. What gives is a perception that technology is a cost, rather than an asset to transform. And what gives is that the sacred cows that we've, and the vested interest that we've hidden behind for decades have any place in our kind of revisioned form of health and care.- I think using the pandemic's a great example. So I sat in the command team for the local system, we had the army and coast guards and the council and industry sitting around the table saying, well, how do we fix this then? As opposed to how do you commission us to fix it? Or how do we convince you the thing we've got, which fixes things that you will take it and use it to fix something? It suddenly became, the purpose was a unified purpose. And my reflection of what you've just said is quite,'cause I think we're in a chronic crisis, the NHS is very good at responding to a crisis. So give me a crisis and I'm very happy with that. Give me something a bit more chronic or a little bit more investible long term. I'm a bit less, my world is 12 months and that's a long way out. And this week and this list is currently the focus. So we're in, I wonder if we just redefine it as a chronic crisis because that will, 'cause that's that mobilisation. It feels like it's that mobilisation that we need to do. We facilitate now groups of commercial organisations, pharmaceutical and MedTech companies, who want to talk above brand. They don't want to talk about their products anymore, who want to talk about being part of helping solve it. How do we just practically do that? How might we do it? I'm not expecting one answer 'cause I know it's a bit more complicated than that, but how might we do that?- It's a bit more complicated. I think a, I think a really important thing is, is what do we focus on? So I'm not sure I'd describe, it as a kind of chronic crisis, but it's.- I'm trying to provoke a are we in a constant emergency? That's was just my sense really of what you were talking about.- Let me rebrand it as an ongoing opportunity. So, okay. Very good, ok. You can tell I worked in central government for a while, can't you? So honestly, I think one of the key things is where we marshal those resources. So, if you look at any, process or any kind of organisation, there'll be a whole bunch of things, we're really good at explaining what's wrong and describing all the challenges and talking about how difficult it all is. And we're often very good actually at describing where we'd like to be. We've started off this conversation actually talking about kind of world and population based delivery, which is kind of clearly the destination where people really struggle is how do I move from what I'm doing today. To what I'm doing where that vision is, what's the first thing that I should be focused on? Where is the priority? And I'll give you, so I talked about the use of technology. And I just want to give you a concrete example. So when you and me were younger, we did a lot of process mapping. We would've gone into a room, we would've covered the walls in sticky bits of paper and interviewed people and created a kind of model of the process. And it works really well in terms of lean thinking and Six Sigma and things like that. It's good methodology. The problem is, it takes a long time. You've got to take a lot of people out of delivery. And the very people you want to provide the insights in order to do that, or exactly the people who are treating people so that it's difficult to get them away. So as we have run the system hotter and hotter, and my goodness, it's running hot at the moment, actually, traditional things like process mapping just become harder and harder. It's too expensive an overhead. What many other industries have done is they don't use process mapping, they use process mining. And what that means is that you look at the digital footprint of processes rather than interview and map, it's in an analogue way. Now, if you do that, and there are very good bits of kind of software that do this, you can create a highly dynamic view around not only what you think is happening, but variation, how it varies from what should happen. And indeed, where those unexplained variations and what the impact of them, some of them will be good, some of them will be negative. And using that kind of process mining methodology, what you end up with is a kind of, do you know what, in this big complex process, you should be focused on there, there and there. Because they're the things that are going to have the biggest impact and the biggest improvement. Now I think that's really exciting. And then what you do is you think what partners in the broader ecosystem can contribute there, there and there. And then you reach out to industry, academia, life science, the community or whatever assets you've got to answer a specific, now that, the nature of that conversation, I think is genuinely transformative.- Yeah, I think that's a brilliant way of looking at it. I'd like to complicate it a bit more and hopefully you'll be able to simplify it for me, but I'd like, the last time we met physically, okay. I met you in South Bank and then we talked about quite a few of these things and how things could be done to help move the story forward. And then on the way out, you introduced me to your quantum computer set up in the lobby and I think it was minus 273, it was something like, it was a Kelvin type number of cooling and a lot of very sophisticated copper pipes. But the actual processor was just a tiny dot in the middle. so if I could just create that quantum space and then look at the date, the process mining that you've talked about, which is the, where's the opportunity type question. And then overlay with AI more broadly, which says, but what could a better one be? Where are the gaps and how do we fill the gaps? And how do we model out and scenario in something? Does that all come together in a way which you can just gimme a sentence or two to say, oh, well, all that stuff you just talked about, really what at the heart of it is, what is the heart of it?- I won't give you a sentence, I'll give you two letters. It's QI. so we all are very well acquainted with the concept of quality improvement. And I think that's all we are talking about here. It isn't terribly complicated. It is looking at an as is scenario, an established process. It's doing some analysis around kind of what the opportunities are for improvement, the impact of improvement. It's doing a analysis on how easy or hard it is and what assets we've got in order to address that. And then it's creating that change. And that change might be process redesign stuff obviously, it might be the application of some technology, some automation. It might be some emerging technology. So we've talked a lot about generative AI. Have we not, it might might be something else. But you end up then with a kind of transform system, but critically one that is underpinned by metrics. So you understand the impact of your changes and you create a closed learning system, which is kind of imperative to this. So I think that's how it comes together. I think that's the kind of, that's the sort of loop. And in that regard, things like quantum or generative AI or process redesign or whatever are just tools that you plug in to those opportunities. The critical thing is knowing which opportunities to go for first and which is going to have the biggest impact. I mean, stuff like quantum, I mean, it's properly exciting. I mean, for listeners who might not be particularly acquainted with it is a pivot from classic computing to harnessing the particular physical characteristics of quantum mechanics. So this is how subatomic particles operate as you get close to zero and allows you to move from a language that's zero and naught to one that is multi dimensional and where zeros and naught can operate at the same time. Let's not go into too much detail 'cause A, you'll get confused and I'll run out of knowledge, suffice it to say it is a C change in compute power. And it's often been used as something of a research project and a long way off. But I can tell you there are organisations IBM is one of them that has quantum machines now used in anger, used for very specific things. So used predominantly around cybersecurity and model encryption for the most safety critical systems in the world. But in the next couple of years, imagine if you start to apply that compute power to understanding the relationship between genomics for example, and disease or how you start to link population based more ability data, more population-based genomic data, say for example, to inform precision therapeutics, precision medicine as is or dare I say it, risk-based screening or risk-based health promotion, or you can imagine a much more personalised view of the experience of receiving both prevention and healthcare delivery and wellness. That actually with classic computing is quite difficult still. It's expensive and it takes a lot of impact on the environment to run that level of compute. So relatively, in my working life, I think we are going to see quantum start to have an impact probably initially around security moving into bioinformatics, and then I suspect then I suspect genomics in the of time.- Yeah, and if I just overlay the generational story of earlier, so your parents and then you and your children, and then obviously, Davies line will continue into the future to ensure that we all can continue with insight, whichever generation we subsequently end up in. There is a bit where the dynamics have changed massively, haven't they? There's a dynamics which is reasonable predictability. We've got into now where the ageing population, I was talking to the Wessex Cancer Alliance, Sally, who's going to be coming to an event we've got later in September and she'll be talking about the three tumours you'll have in your lifetime, not whether you'll get a tumour or not, based on the dynamics of the way things are going. Just listening to you talk about it feels that we'd have a much better handle on things if we were working in that data enabled decision making, modelling looking forward as much as we are recording historically what has happened.- Yeah, no, I think that's right. And one of the sort of frustrating things is the data that we are describing here, we've sort of described it as kind of secondary use data. There's the really serious business around prescribing people a drug, but then there's the secondary importance of data that allows you to kind of understand how disease and populations work. And of course nothing could be further from the truth. In our language, we don't do justice to the kind of primary importance of things like research and the primary importance of population health management analytics, which is as intrinsic to the delivery of care as it is someone giving a prescription. We have kind of really sort of muddied the water in people's thinking around the importance of data. I was on record not that long ago about a campaign to change the name of secondary use data to foundational data.- Yeah.- Because in many ways, healthcare is a knowledge industry and the foundations of that knowledge and the decisions that you make to treat people don't come from, they don't come out of fresh air, they come out of that data around research and understanding populations. I think you make a very strong point. But there is I think an important comment, and we talked about the mature discourse with the public around this. I think this is an area that we need to be talking more openly and honestly and a more transparent way.- Yeah, and I think the link through to data is fascinating if we open it up to more than just the health services data capture model. And I've had conversations with wearable organisations who more broadly have it and one particular which had what in our population could be 400,000 different data sources that could flow into a model. And you talked earlier about, no point looking at the summary care record or patient record and prescribing any sort of solution from that. But if we knew everything about everybody all the time, subject to consent and all of those things, and we really had our finger on the pulse and we overlaid with what you talked about, about what we could then do for evidence and real world evidence suddenly stops becoming a sort of an adjunct to clinical trial data and it suddenly becomes, no, no, I mean the real world evidence, that would really unlock things, wouldn't it if we were in that state?- Yeah, I mean, it would in two regards. What one is real world evidence becomes real fill evidence. So we get personal, personal information. so in my career I would prescribe a drug or embark in a therapeutic plan based on the results of randomised control that involves hundreds of thousands of people often, and the patient sit in front of me and say, well that's fine, but how's it going to affect me? And of course the answer to that is, I don't know. So that's getting closer to real fill evidence rather than real world evidence, is an important pivot for this, and one that isn't, it's not a pipe dream. This is real. And the other one however, is at the other end of, in many ways the spectrum, it's understanding our responsibilities to the whole population. So one of the kind of cruel facets of our current situation is that the experience, access and outcomes of healthcare and indeed people's life expectancy between the richest and the poorest in our country is getting worse. It's not getting better. And understanding that clearly kind of 90% of the things that determine our health and our wellbeing are outside the delivery of healthcare. The so-called broader determinants of health and the opportunity of having a more inclusive and a wider view around data that matters. A, enables us to track health inequalities.- Yeah.- And understand the distribution of health inequalities across our population on a fairly granular level, but also for us to be able to, and I talked about data mining, for us to be able to point sophisticated data modelling techniques to understand the impact of those things on people's health income outcomes for different cohorts in the population. So what is the relationship between leisure facilities and housing situation for a particular cohort of the population? So we should be able to do that and make allocative resource decisions based on getting the best bang for our buck, the population. Rather than, and this is where the conversation goes back to the beginning, I guess, rather than arguing which hospitals should get the new modern scammer.- Yeah. That is really core to this is changing, we talked about narrative earlier, but it's changing the narrative to be that. And I agree with you, the ICS role has to be, I in the past, you and I don't see quite the same view of this about, you know, I think there should be a chief patient officer, somebody in charge of the patient because nobody really has ownership because it's a shorter shared ownership. And I know you have a slight different view to that. But I think the essence of maybe our compromise is we could agree the ICS is the Chief Patient Officer in that role, but repopulate Chief Population Officer for want of a better phrase. I do like making names up and things like that to try and explain what we're looking at. But, it comes back to the, if we've got a pound to spend, if you've got a Hampshire pound or a Dorset pound or a Manchester pound to spend, the system has to say actually, building a car park slightly further away from the hospital'cause we'll increase step count. That is better than investing in yet another subspecialist clinical pathway because overall, the population has benefit. But then of course you've got the tension with the personalisation down to the individual, but I lose out now because you are doing that. So is that the world you think we're heading towards?- Well, I think it's a world of politics now with a small P, it's into a political discourse at the community level around kind of making decisions at the kind of trade-offs that I was describing. And if I light it up with a concrete example, so you will be well acquainted with the reconfiguration of spoke services across London. A decade or so ago, and I have commissioned the national stroke audits at that time, so was responsible for all of the analytics and the data that underpin some of those decisions. But quite literally, London was, had had some of the worst mortality in Europe for strokes because the lack of hyperacute stroke units and urgent scanning, and there was a reconfiguration, very painful and highly politicised reconfiguration that led to the creation of hyper acute stroke units and a subsequent reduction in mortality. And we ended up one of the best in Europe of places to have a stroke. And I was talking, presenting this, some of the data to some analysts and a relatively junior analyst in the audience put his hand up and said, Dr. Davies, it's great to hear that that London's one of the best place to have a stroke in Europe. How do we get to a point where it's one of the best places not to have a stroke?- Yeah.- And I just, he nailed.- The actual exam question really?- He nailed the exam question completely. I subsequently got to know him very well actually. He actually is that bright. But it was, yeah. It was one of those moments where people were like, yes, we do have to carry on treating people, but as we start to think around kind of operational efficiency around the things that we're doing, we have to not lose sight of the allocative efficiency debate at ICS level that says, okay, do we get more bankrupt bucks in terms of health outcomes by the prevention agenda rather than building another hospital or having another scanner. And the trade off there is difficult, but it has to be done in the full glare of public discourse. Yeah, as I say, I feel optimistic that the dialogue is moving in that direction.- We covered a huge amount in the hour has sort of zoomed by and I love talking to you and there's, I mean, there's loads more I'd love to over time and maybe we could think about how we could keep the conversation going. But if we look at the audience who are interested in listening to what you have to say today and listening to the story, which is a very compelling one, but they're sitting operationally in their organisations, with a I have to achieve this by the end of this quarter. I have to make this thing happen and I have to do something. What is the call to arms to help connect what effectively is the industry's operating frontline, which is the health strategy effectively that we have been talking about? What would your advice be to those listening?- Well, I'm not sure proper advice. I think that would be a bit too bold, the offer, and I think the call to arms, if that's what it is, is two twofold. One is to accept the offer, that's out there. Many people from other industries, bluntly are patients or their parents are patients or their children are patients. They have lived experience. Every one of them of healthcare in this country and they work in industry. There is an open offer for those industries to reach out and partner and find ways of supporting people in and co-producing solutions. So the kind of spirit of cooperation and partnership that we saw during the pandemic, I think we should be recreating across academia and across industry. And I think that's important. I think the second one is, and we've talked about this a little bit, to think about the assets that we have in our communities and to not see patients as a drain on the system and a burden, but to see them as a resource and a source of not only wisdom, but also capacity and organise ourselves for that purpose. And the third is to frankly be brave enough to take those kind of, to have those design conversations where you've take an anthropological view of kind of what's going on and user centred, design specialists in and think really creatively around kind of unlocking the opportunities for efficiency, using things like AI, using things like automation, using things like Process Mining, as I've described. So I think they would be my top three.- Yeah, yeah. Brilliant, well as ever, that really helped crystallise out the 'so what' part of the discussion, what are we now going to do? That was brilliant. Well, our time's up, I want to thank you, Mark, that has been absolutely fantastic. Better than expected, and I had high expectations. So that is always good. It's all always an absolute pleasure to talk to you about what really we're trying to focus on, what really matters and how can we really do something about it. It's getting to grips with a real thing. Thank you very much for your time today. What I'd like to do just for our audience listening in, just to thank you all very much for listening in today, for joining me and Mark in this conversation around population health. So you may already be aware of it, but we have an NHS symposium happening on the 26th of September. We'll do a follow up after this. Just message everybody who's been listening in today, let them know more details about that. And if you've got any questions that we didn't get to, we will endeavour them. And I work with Mark, anything that we haven't covered today and we'll just get an answer out to everybody. So thanks again, Mark. Thank you very much. Thank you everyone for listening. All right, thank you very much, goodbye.- Bye-bye.- [Narrator] Thank you for watching. If you'd like to find out more about our work with the NHS or how we could support your market access goals, please email info@mtechaccess.co.uk or visit our website at mtechaccess.co.uk.