Pharma Market Access Insights - from Mtech Access

NHS winter planning 2024–25 – Engaging with NHS decision-makers through Autumn to Christmas

• Mtech Access - Powered by Petauri • Season 7 • Episode 21

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How is the NHS preparing for winter? Which challenges are the most pressing for NHS decision-makers? How can industry best engage and support NHS decision-makers in the next few months?

In August, Karen Cooper (Senior Consultant – NHS Insight & Interaction, Mtech Access) was joined by Jo Turl (Former Director of Commissioning, Devon ICS) to explore these challenges.

Jo and Karen discuss:

  • How ICBs and Directors of Commissioning prepare for winter pressures
  • The current key areas of focus at Place and ICB level
  • Specific challenges and pressures facing the NHS now and in the run up to winter
  • Immediate and long-term impact of (expected) new government policies
  • How industry can best support the NHS as it plans for winter and beyond
  • How your field teams can engage with NHS commissioners over the next few months

This episode was first broadcast as a live webinar in August 2024.
Learn more at https://mtechaccess.co.uk/nhs-winter-planning/

For support with your UK market access and NHS engagement strategy, visit: https://mtechaccess.co.uk/strategic-uk-market-access/ or email info@mtechaccess.co.uk

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- 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 to this Mtech Access webinar on how the NHS is planning for winter and what the key area to focus are in the back end of the year. My name is Karen Cooper and I'm a Senior Consultant in the NHS Insight and Interaction Team at Mtech Access. And it's my pleasure to extend a warm welcome to our speaker for today's session and participants that have joined us today. For those of you that don't know us well, Mtech Access is a specialist market access consultancy. We provide strategic solutions to help pharma and medtech companies bring interventions to market, both in the UK and globally. We also work as a collaborative partner to the NHS. In these webinars, we invite speakers from our connections across the NHS to share their insights on the key topics on the day. Today we're speaking to Jo Turl, who's worked in the NHS for over 20 years, holding several senior commissioning roles over her time there. So I'm going to come straight to you Jo, and ask you to introduce yourself and tell us a bit about your background and experience in the NHS.- Great, thank you very much Karen for the warm welcome and thank you for everyone who's listening today as well. It is a real pleasure to be here. So as Karen says, I'll just tell you a little bit about myself and my experience. So I've been in the NHS for over 20 years. Started off actually in internal audit and business intelligence, which was quite a good grounding'cause I worked across really all sectors of healthcare at that time, both in acute hospitals, in the community, and also from a commissioning perspective as well. I moved on though to work in performance and planning. So got really good understanding of how the operational plan works every year. Also the strategic planning cycle, the funding cycle as well and setting and reviewing performance on NHS contracts to move throughout the year. Then as Karen says, I've held quite a few positions in commissioning, so I moved completely across into the commissioning then of NHS services. I started off commissioning acute services and mental health services, but then moved on into commissioning what we call out of hospital services. So very much focusing on community services, both in hospital and out of hospital in people's own homes. Also general practice. So I've probably spent about the last 10 years I think commissioning general practice services. So I've seen quite a few changes from during Covid, post-Covid to the new network DES that came along, the direct enhanced services which brought about primary care networks but also the enhanced support that community pharmacists provide as well. I also more laterly worked in commissioning dentistry services as well, which is certainly a hot topic from a minister perspective and a local perspective at the moment. And as I mentioned previously I worked in commissioning mental health services but also learning disability and neurodiversity services as well. So spent quite a lot of time understanding those services. We implemented at the time first response services, also the community mental health framework as well as services to support the assessment of autism and ADHD as well. Just in terms of just understanding my role, particularly as the Director of Commissioning over the last probably four or five years in various roles within NHS Devon. So part of my team's work would be really to understand the needs of the population. So we would undertake needs assessments to understand what was needed for a population as a whole, but also really understanding specific areas in terms of geography, in terms of deprivation. We would then work with our clinical teams, operational teams on the ground to redesign services. Also including working with members of the public and some of our private sector providers as well. So first that involved for me, very much focused on elective pathways. So some of those pathways were trauma and orthopaedics, ophthalmology where we designed things like referral advice and guidance, physio first pathways. And I moved into much more of a focus around urgent care. So laterly particularly since Covid, very much focusing on the out of hospital offer. So my team commissioned and put in place virtual wards across Devon and also the urgent community response teams as well, which you might hear referred to as UCR teams. Also was involved in commissioning several LD and mental health services as well, both inpatients and in the community as well. As well as also commissioning and consulting with public on developing community services that wraparound primary care as well. So I was involved and led couple of some of our commissioning programmes around health and wellbeing centres. So health and wellbeing centres, very much focused on how can we have community services working together geographically centred in the populations that they need to be. And then just a couple other areas as well I'll touch on. So I was involved in writing and working with others to develop any of the strategies for NHS Devon at the time. So we developed a general practice strategy. We also developed a community first strategy, very much around how we increase the focus and support around out of hospital services and also developed a mental health strategy as well. And I've also been involved in and led many significant improvements, sorry, procurements I should say, in Devon. So for community and mental health services, we procured those across one of our localities within Devon. Procured health wellbeing centres, GP practices as well, involved in putting in place new GP practice contracts and also 111 and out of hours contracts as well. So hopefully that just gives you a little bit of a snippet into some of the things that myself and my team were involved in.- Absolutely, what a vast amount of experience you've got. So don't know what to zoom in on today. So that's what you've been involved in, what are you currently involved in?- Yes, thank you and apologies, anyone who's getting a little bit of crackling, I'm going to try to stay still, I think when I move my headphone crackles a little bit. So I'll try and do what I don't usually do, which is stay still when I talk. So at the moment, Karen, since I've left the NHS, I still work very closely with the NHS. I work with NHS providers, NHS Commissioners, NHS England, but also independent and private providers as well. I've been mainly focused over the last few months in working in primary care. So I've been supporting primary care networks who are really interested in developing their services and how they can work with other community services in a more collaborative way. Some of that is involved in understanding better how they can implement multidisciplinary teams, how they can really understand their population and use population health management data, but also use some of the technology that's coming along as well, like point-of-care testing for example. I've also been working with some of the community interest companies and dental providers to really understand again how they can improve their services, how they can work with commissioners to make sure that patients in Devon get the best services possible. And I've been working, as I've mentioned, with some private companies, whether they're medtech companies and other NHS or providers of NHS services as well to really understand how they can work with the NHS and really deliver a service that meets the priorities of the NHS as well as obviously is good from a business perspective as well.- Brilliant, so you've seen both perspectives, haven't you? A lot obviously the NHS perspective but also through working with industry. So you've talked to us about a lot of, you know, the things you were involved in as Director of Commissioning. What were your main challenges at that time? So what kept you awake at night?- Yes, so that's a really good question, Karen. Quite a lot actually. So no, in all seriousness, so I mean we go into work in the NHS'cause we want to do a good job and we want to improve services and we really care about the services that our population receives. Particularly when for most of us, that's a place that our families and our friends live. In a minute, I'll come to some of the things that kept me awake at night because actually they're different things than the challenges interestingly. So I think in terms of the challenges, I think the conversation that kind of we have time and time again and every year and at the beginning of every year and through the winter every year is how are we going to cope with these competing priorities. And I think that's a challenge for anyone working in the NHS particularly now. I think it's harder than it's ever been, I have to say it, it genuinely is. We've got long waiting lists, we've got people whose conditions have exacerbated over Covid, we've got workforce challenges, funding challenges, increased demand, and you know, estates is, you know, sort of crumbling around us if you like. So I think trying to work with those competing priorities and trying to work out what you can not do or not do at the moment and what you need to focus on is a real challenge because it's really difficult if I'm honest, to put anything on that not yet pile. Particularly of course when you've got regulators, when you've got ministers, when you've got local counsellors who want to see in progress in all of these areas. So you know, anyone working in the NHS now has my huge sympathy in terms of how they cope with those competing priorities. I'd be remiss not to mention resources and that's twofold. So one is funding. So you know, I genuinely believe funding has been really difficult in the NHS over the last five years. That's been extremely difficult apart from the additional money that was pumped in for Covid that, you know, then we've had to go back to our baselines. That is a huge challenge. But the resources evolved in being able to now try to strategically plan long term but firefight some of the challenges we've got, they've become exponential and on the back of just recently ICBs being told that they need to reduce their running costs by 30%. You know, that really a moment came then where I think we all took a sort of gasp and thought on earth are we still going to do all of this but with less people than we've already got? And we already feel that we probably haven't got the resources we need to be able to adequately cover off all the things we are being asked to improve. Workforce is a huge challenge. So in some places of the country it's different for different clinical groups but somewhere like Devon that is remote, that geographically is difficult in terms of distance, et cetera. Workforce is a huge challenge. I mentioned funding and it's not just about the funding, it's about how you free up funding to do new and innovative things is really difficult. So most of the money in the NHS is all tied up in existing contracts. Now that does not make it impossible, it absolutely doesn't. And you can absolutely demonstrate a case for change, which as long as you do that properly and it's well evidenced and benefits are really clear, I strongly believe that those areas can still be pursued. But being able to demonstrate how you do one thing which takes money out one part of the system, which is generally the acute part of the system, but then be able to get that money to reinvest it into the community is a really difficult thing to do. And invariably it requires a level of being able to commit, you know it's the right thing to do without necessarily being to definitely being able to evidence that you know exactly what the outcome will be. And that's really difficult for both commissioners and operational teams to sometimes be able to make that leap and make that decision. I think we know we're in a world where we have to collaborate now we have to collaborate and that's not just within the NHS but we need to collaborate with our partners and I think it was really refreshing to see that Labour in its manifesto does explicitly talk about partnering arrangements and innovations, et cetera. But it's difficult. Everyone's got their own targets. Even within the NHS, you've got NHS Trust, they've got their own targets, you've got commissioners that have got their own targets and budgets. You've got independent providers like GPs who traditionally we feel are part of the NHS but of course they're independent businesses that need to run at a profit. So it's really difficult sometimes to make sure that that collaboration actually happens. And then probably the other real area of challenge I think that has felt really prominent since Covid is patient expectation. And it does feel like, so in my experience of feedback from clinicians both within acute hospitals but also within general practice is that patients have a very high expectation in terms of what they want to expect and when they want to expect it and how they want to receive it. And I think, you know, there are some, you know, there are I'm sure some difficult conversations coming along with the public about what that needs to look like. Just briefly because you said what keeps me awake at night and the reason why I say Karen, they're sort of different things is those things are the challenges that we face on a day-to-day basis. But those things that keep you awake really go back to those, the real kind of root, I suppose of the NHS, which is are services safe and are they available? And we are getting to a point now where actually things that you thought were absolutely stable, like GP practices for example, being able to access your GP, your practice being open, we're getting to the point now where GP practices are saying actually we need to hand our contract back because it's not viable for us to do this anymore. And that's a real kind of keep you awake at night moment. As are those, as we go into winter now just sort of thinking about my NHS colleagues, they will be on daily escalation calls, they will be on escalation calls which might happen, you know, all throughout the night. Might be happening every several hours when it gets really into the heights of winter and they're the things that really not just physically keep you up at night but they really keep you up at night in terms of making sure that patients are treated and patients have a bed to go to if they need one.- Yeah, brilliant, lovely answer. I'm just, I'm going to throw in here, we've I had a question from one of the audience,'cause you mentioned there about prioritising and how you prioritise the different areas. Moving into winter specifically, are there any areas in the NHS that are deprioritised so to speak, in order to kind of cope with the demands of winter?- Yeah, actually that's a really good question actually because, so whilst I will always say it's really hard to put anything on the back burner, genuinely it is, we make choices about where we put our resources, we absolutely do. And during winter the absolute focus will go to that urgent care pathway. So absolutely, I mean they will already have been planning over summer, what are the plans for the winter. Those plans will already be very well forming, but absolutely everyone's focus will be, let's make sure that we get flow right over the winter. How do we make sure we are making the best use of those out of hospital services? How do we make sure we're not conveying ambulances if we don't need to? How do we make sure we don't admit patients if we don't need to? So what you will find happens is just although nothing officially might be put down, what you will find though is that's where the resource gets shifted to and some of the other areas will get slow streamed. We also find of course that sometimes elective activity gets, you know, gets sometimes paused in various different ways just because of the sheer amount of urgent care demand. Now there's a real want not to do that and actually hospitals planned quite well last year to try not to do that as much as possible. But you will find some things around development, some things that more long-term, the strategic long-term planning, unfortunately the prevention work, unfortunately that's the sort of stuff that will take a backseat over that kind of four or five month period.- Okay, thanks, you mentioned there the planning. We all know there's an awful lot of policies that come out within the NHS. Can you talk us through what the key NHS policies and strategies are that will be being looked at at ICB and place level that will be driving activities for that group of stakeholders? There's a lot of them out there and I remember from my time in the NHS, you just can't do everything or read everything or know everything. So what are the key areas that people will be focusing on?- Yeah, absolutely, no, really good question, Karen. So I mentioned earlier on the operating plan. So the operating plan is basically the yearly Bible of this is exactly what you will commit to do this year. You have to submit targets to NHS England, you have to say how going to perform against very specific targets. You have to write a narrative every year to say this is exactly what we're going to do to design our services so that we can hit those targets for the population in our area. So that's the overarching if you like, for the year, this is what we are going to do. In terms of what sits below that though there are three kind of at the moment and of course very well aware things might change now quite rapidly with new government. But there are three overarching areas of kind of strategic recovery if you like. The first is elective recovery and there's always a focus around elective recovery throughout the whole year. And of course Labour have made the commitment around an additional 40,000 appointments and have said that's going to be mostly achieved through over time and and things like that. And there's a real concern I think from the top that that's going to be quite difficult to achieve. So there'll absolutely be a focus around making sure that the NHS trusts are sufficient as they possibly can be using the GIRFT. So getting it right first time information, which helps kind of benchmark and gives kind of good practice to hospitals, but also utilising as much as they can the private sector as well, in terms of reducing waiting list backlog, but also finding new ways of working as well. So any ways that we can find that mean patients don't need to go to hospital, don't need an outpatient appointment, don't need a follow up appointment, again that will be a real focus. The secondary is urgent care recovery. So this is always going to be really important again within the NHS. So particularly focusing on waits in A&E and handover delays. But also more and more over the last couple of years we've seen a real focus on out of hospital. So what can we do out of hospital that means we don't need people to get to the hospital to start with. So what support can people like paramedics, GPs, communities teams have, which means they can make really well-informed clinical decisions either through guidance, speaking to a clinical professional or through using technology, which might help them either make a decision about that patient's management or might help the ongoing management and remote management of that patient as well. And then the third area is primary care, so GP, general practice recovery. And we've heard again from Labour, this is going to be a real area of focus. They've talked about the return of the family doctor. So that's really code for people who have long-term conditions who need ongoing management. They get to choose and see the same person if they need to and if they want to. But also there's a real focus as well around neighbourhood services. So this is very much here, it feels like the meat isn't on the bones at the moment, but it feels like this is very much the return of the integrated neighbourhood teams, which Fuller talked about, which never went away, but just the focus was put very much on the kind of access for urgent care. Also feels very much like the work that Lord Darzi did previously. And of course he's coming back in to do a review of what's wrong in the NHS and then on the back of that we'll see a new long-term plan. So I expect neighbourhood services to focus really, really clearly within that. And then of course the Cavell Centres that were a project at the time a couple of years ago for NHS England, which are very much focused around geographically siting general practice services with other community services as well. And then the other area that particularly is hot at the moment is dentistry as well and access to urgent dentistry services as well. But as you say, Karen, there are lots of policies out there, there are lots of things that then sit underneath this. Just this week they launched an operating framework for virtual wards, which I know we'd been discussing earlier in the week as well. And this is really important because it really signals that virtual wards are here to stay. They came in on the back of Covid, they were funded through the service development fund, but that funding has been put into mainstream baseline funding. Now the expectation is they are here to stay. As a minimum that there need to be virtuals for respiratory heart failure and (indistinct), but the point of the operating framework is that they will be more standardised than they currently are. It'd be true to say that, you know, we've let areas develop based on what workforce they had, what facilities they had, what remote monitoring they had. And this is much clearer that these services need to be standardised and they are here to stay as well. Then the other piece of policy that came out, which the guidance but is around single point of access as well. So an area which the NHS focused quite significantly on last year was called care coordination. So it's very much how do those health professionals on the ground get the advice they need and you know, where to refer into if they want to avoid a conveyance to hospital or an A&E attendance. And this guidance around single point of access gives a very clear foundation for what every healthcare system needs to have in place this winter. But what that should do hopefully is that will increase the level of referrals for things like virtual wards and urgent community response teams, which means we can keep people out of hospital hopefully this winter.- Brilliant, me taking notes here, there's a few things I've wasn't aware of. You've mentioned a couple of times out of hospital care and we know that's a big driver at the moment. I'm pretty sure some of the audience is sitting there thinking we have solutions that can actually pull patients into the community and get them treated in the community, keep them out of hospital, but actually implementing that is really difficult and it's often a funding, a historical funding attitude that gets in the way of that. Have you got any thoughts on how, because you said it is possible if you can make the right case for change. Have you got any thoughts about how to make that easier? Because hypothetically the funding should flow that way now, shouldn't it? But is that happening in reality or not?- Yeah, no, brilliant question. And if I could absolutely solve this for everyone, I'd be rich by now.- That's why I'm asking the question.- Yeah, in seriousness, in seriousness. So I do have some experience and advice in that regard. So I think really clearly, I think, you know, the NHS is, you know, it is creaking at the seam in terms of capacity and people who work within NHS are more than ever really up against it in terms of the level of work that they need to do and the competing priorities and the resources within which they've got to do that. So I think my experience particularly over the last few months or so is that we need to make it as easy as possible for the NHS to be able to make those right decisions and they don't want to, you know, like I said, everyone who works in the NHS is there because they want to improve services, but they are so up against it in terms of time and resources. We need to make this as easy as possible. And my experience is actually that coming to the NHS with a really fully worked up business plan, business case that really clearly links back to the national policy, national priorities, really focusing it on what they need to do, being really clear about the evidence base is really important and how that evidence base demonstrates value for money. So that value for money isn't just about, you know, isn't just about the money, it's absolutely about quality, it's absolutely about patient experience. So it needs to demonstrate that triangle if you like. But I think being really clear about how you think the innovation or service helps to deliver those benefits is going to be your kind of ticket if you like. And I think there are real opportunities for partnering with NHS organisations, whether that's general practice, whether that's acute hospitals to do some of that research, do some of those clinical trials. And in fact Labour talks about that in its manifesto, is the one to engage with more clinical trials and partnering with and making it much easier to partner with private sector, which we absolutely need to do. And I think that is the real way to be able to get in is that you can demonstrate or at least work with to start demonstrating what that benefit will be. But you're absolutely right, Karen, the money should be flowing that way and I've got some, you know, I've got some hope at this time that that is what Labour are talking about, you know, we'll have to wait and see. But certainly there's been a commitment, there's been increased funding into general practice, which is great. We've just seen the virtual ward guidance come out this week, so that's great. So it really is a focus on those out of hospital services. So I've got confidence that we're heading the right direction, but I think don't get despondent and don't think that the NHS doesn't want to engage. Because it does, it's just about time and it's about demonstrating the evidence and the benefit and the outcomes that will be achieved for those patients.- Okay, so we've talked about, alluded to the Labour government and the impact that's going to have on the NHS. What are your thoughts on that? What are the key manifesto promises that they've made and which do you think will actually happen and will any get dropped and not?- Well, wow, yeah, no really good question. Well, I come with no political, you know, bent to this at all, you know, keeping the politics out of it at all. I suppose the first positive thing to say is that Labour have come in and recognised and, you know, you can cause a tactic but, you know, they've recognised that things need to change in the NHS and that there are things that are really not working well and you know, that has to be a good thing. So we don't understand the problem is, Wes Streeting says, you know, you don't understand the problem, how do you know what the cure is? So I suspect we're, you know, lots of people sat there saying we know what the problems are, but you know, let's agree on what the problems are, let's document them. It seems as if that is what is going to happen, we hope. You know, certainly they've come to the table very quick in terms of dealing with strike action and pay. So, you know, that's positive. I think the focus on the family doctor and the neighbourhood teams I think is a very positive one, and I think, you know, the first thing that Wes Streeting did when he was announced as minister was his first place he went to was a GP practice. So he didn't go to a hospital, didn't go to a specialist hospital in London, he went to a GP practice. So the signs are good and certainly we've been saying for a very long time now, neighbourhood teams, multidisciplinary teams, co-location, it's the right thing to do. But we've been woefully poor at doing it. We've been saying it probably for 20 years and it doesn't feel like it's really happened. It's happened in pockets and there's some brilliant examples. So I really hope that we get some focus, but it will need funding, I'm absolutely sure about that And there are already some moves around the additional roles that are being funded in general practice that suggest there is some willingness to do that. I think they've come out clearly and said the new hospitals programme, they will continue to support but it does look like it'll be scaled back and that is good news for everyone because actually the estate out there is a real issue for everybody. I think still mental health will be key. I don't know whether it'll get the focus it has had over the last sort of 10 years with the mental health investment standard, et cetera. But certainly they've been really clear that they want to have more boots on the ground, particular focus on children's mental health and this government does seem to be talking very much around prevention, around children, early intervention, which is really positive. Also the mention of AI I think is really important as well and technology and I was really pleased to see that they want to bring in innovations and adoption plan and that will take into account how things are procured but also how approvals can be made easier, to partner with organisations outside of the NHS as well. So I think that's really positive. And as I mentioned earlier on, they're talking about how they can get involved in more clinical trials and do things like develop the NHS apps. So it seems there is quite a heavy focus there on tech, what that can do, clinical trials and that, which I think is all really positive. So as to how it'll happen and how much will get funded, you know, that's the million dollar question isn't it? But I think there are some very positive signs there.- Oh brilliant, does sound very positive. Going back to winter planning, putting your previous hat on, can you talk us through some of the initiatives you implemented in Devon as part of your winter planning that helped to alleviate the additional pressures that are faced through the winter?- Yeah, absolutely, yeah, I'll talk about last winter. so I suppose I'll start from the top in terms of sort of strategic and then sort of try to work down through that. So there was actually approaching Devon last year that we would work as a system and very much completely relooked at the way that we did system escalation and control centre. So really tried to bring providers together every day on a call and that's all providers to really understand what the pressures were in each part of the system, how different parts of the system could help support each other, what protocols needed to be put in place to do that, how we could help support when demand was more pressurised in one area than another. And that will continue that kind of way of working that control system at system level will continue to happen in Devon and in other parts of the country as well. We also mentioned earlier on, Karen that we put in place care coordination sort of service if you like. So that care coordination service would take calls from healthcare professionals, whether that's paramedics, GPs, community teams and they would get advice, clinical advice on the phone which they would be able to take and hopefully either not convey a patient or be able to keep a patient at home or they would get very clear referral route into a new service. Now that service was very much in its infancy last year and with the new single point of access guidance coming out and being really clear that every system needs to have that this year, I really expect to focus on ramping that up this year. And there was some good evidence in Devon last year that that was really starting to work and that the majority of calls that were taken from an ambulance stack were actually being able to be diverted away from hospital, which is really positive. We also implemented, we very much wanted to focus on proactively monitoring patients to keep them away from A&E altogether to keep them away from 999 if of course clinically appropriate. So we invested in primary care, so in general practice services, to ask them to proactively identify people that they thought were at risk of hospital admission and actively contact those patients, make sure that they're on the right meds, making sure they were linked up through the right voluntary sector supports that they were being case load managed if they needed to, multidisciplinary team support. And that was really effective last year. The other area that was very much focused in primary care as well was the acute respiratory illness hubs as well. So again, this is in national guidance so they're called the ARI, because some people might know them as the ARI hubs. So this was very much about anyone with acute respiratory illness coming to the GP practice or the primary care network and being assessed and then hopefully managing those patients. And actually I think we found that over 95%, it probably more actually of those patients could be managed and kept in primary care. So that is something again that I expect be happening in most areas again for this winter. And I mentioned earlier on of course the work we did around virtual wards and the urgent care response team. So that's absolutely here to stay. So there will be absolute focus. What we did last in Devon was made sure that we had services for respiratory frailty and heart failure developing in all of the hospitals. There was real focus at the time in making sure that we could get the bed capacity that we committed to, which we did, but also be able to make sure that occupancy was as high as it could be. Sometimes we found that not all of those beds were used, generally speaking because of staffing issues, but sometimes it was felt by the wards or the services that they couldn't find the patients to go in those beds. So the focus then is very much, but how do we change that much more into a step up rather than a step down. So rather than finding patients in a hospital bed that could be discharged early, if they could be remotely monitored at home, how do you actually stop patients getting into hospital in the first place? So how can a GP, community team, 111, the ambulance service then use the care coordination centre to be able to refer those patients into a virtual ward or all through a UCR team if they needed that sort of urgent response to prevent those patients needing to be admitted to hospital. So that will continue to be a big focus in this winter. But yeah, I mean we found it very successful last year in terms of virtual wards. Probably didn't get quite where we wanted to in terms of occupancy. Certainly saw a big improvement from where we were the year before. And then same day emergency care as well. So sometimes called SDEC are services that acute hospitals run. So if a patient does end up in hospital at the A&E department, come via paramedic, they can then be straight referred to what we call an SDEC service, which basically a kind of a quick turnaround service so a patient doesn't need to go into a bed, but they do need clinical assessment and triage and diagnostic tests and then hopefully can be discharged at the end of that. So they were the big areas that we focused on in Devon last year, they will be very similar again. I think that there will also be a big focus on what general practice can do and what community pharmacies can also do as well to help support and keep patients out of hospital.- Yeah, perfect, but one of the questions from the audience is, and as you were talking then I was thinking are these just winter problems or does it just, I mean especially considering we've not really had a summer, are these problems that happen and are there and challenges through the year but these services are ramped up in the run up to winter or is it continuous through the year?- Yeah, it's a really good question, Karen, because I mean I can think back to when we used to do our winter planning and it felt very much like a winter event and we would absolutely feel more pressure over winter, but it does feel like that is continuous and I think the demand has just got so significant. The population's growing, living longer, multiple long, you know, morbidity et cetera. And that's great that people are living longer and we're keeping them alive, et cetera, et cetera. But we've still got predominantly, we've still got very similar number of beds that, you know, that we had before. Similar levels of staffing. Yes, some staffing has increased absolutely, but there are a lot of vacancies as well out there. So every year the system is just under more and more and more pressure. So actually it feels like these are continuous issues now. So there is a continuing, where at one point in time we were very much focused on what can we do differently this winter? It's now how can we embed those services to make sure that we've got them all of the time? So virtual wards, UCR, 111, how do we make sure they are fully used and occupied all the time? Because you're absolutely right, Karen, it doesn't feel that similar. I think what's different about winter is yes, of course we get periods where demand does increase'cause we've got more infections both out of the hospital but also in hospital, which means beds are closed, you've got more staff away sick, taking holidays, you've got more bank holidays, which means then you have peaks and troughs and it's really hard to get over those peaks. So practically speaking it is still really difficult during the winter, but actually the solutions are probably the same. Predominantly, apart from maybe where you might deal with things like flu and respiratory illnesses and things, which do definitely ramp up over that winter period.- Hmm, okay, thinking about who's listening today, have you got any thoughts about how pharma companies and medtech companies can contribute or could contribute to NHS's efforts in reducing hospital admissions, particularly for chronic conditions that are exacerbated through the winter?- Yeah, absolutely, absolutely. So I mean one of the areas, specific area we've mentioned is respiratory. So I mean that's a prime area where medtech can help support in terms of point-of-care testing for example. We've got to make sure, I think the key for me is is how does it, and I'll go back to what I said earlier, I suppose how does it deliver the priorities of the NHS if the priorities of the NHS are around keeping people out of hospital, stopping them attending A&E, stopping them phone 999, meaning they don't need to be admitted. They are the outcomes, they're the measures that pharma, medtech need to really focus on. As I said, things around point-of-care testing, but it needs to be, you know, the NHS have to perceive it as value for money. So there is the cost of that, but also the time it takes to train people, the time it takes to do that. And particularly if that's in a different setting. So if it's in primary care instead of in a, you know, in a hospital, that will take then additional time in general practice. And that needs to be thought through in terms of how that's funded. But also other areas as well in terms of where medtech can particularly come into its own is around virtual wards as well. So virtual wards, as I've said absolutely here to stay. It's really specific in the what good looks like section in the new operational framework. That point-of-care testing should be in the kind of kit bags if you like. So it should be available to those front line clinicians, healthcare professionals that are trying to keep people out of hospital and trying to deliver those virtual ward and UCR services as well. I think it's interesting because I said you know, over winter some of the things that do get put on the back burner and more of those preventative areas. But of course the areas where you've mentioned that's where we really need prevention to come into its own. So if we can better manage these patients and we can think about, and maybe pharma in particular, we can think about how it works with general practice, how it works with the rest of the NHS to make sure that actually things are available, which really helps to support people in reducing their risk, reducing exacerbations. But it needs to be something that's affordable to the NHS but also doesn't take up lots of time in terms of training, in terms of administration, in terms of review or at least think about how partnering arrangements could happen so that we can trial some of those things. Try to understand the evidence is and what benefit it can derive for both the patient, the NHS but also the organisations as well that are providing these services.- Yeah, yeah. Brilliant. So if you worked for a life science and if you worked for pharma or me medtech, who are the customers you'd be going to see to support you with adopting new products or new technologies? I mean, so nowadays who makes the decisions?'Cause it's changing isn't it?- Yeah, I think it's a really, really good point, Karen. It's really interesting 'cause as I said, I speak to many sort of small to medium sized organisations and they'll be run by different people who have different backgrounds and I think, you know, if you're a medic for example or clinician that's, you know, working on something particular that they're really passionate about, I think that's great and they're the sort of people that you want to put up in front of the clinicians and the medics and the nurse, you know, they're the people that you want those people to engage with, but they're not really the people that hold purse strings anymore. They're not the people who can make those decisions, but they're really important'cause they're hugely influential in terms of whether they will then engage with it and use it. So you need those clinician to clinician conversations. They are really important. But in terms of where the decisions are made, because of the funding constraints in the NHS, more and more so those decisions are being made higher up the chain and you really do need to be getting around the table with the medical directors, the finance directors, the operational directors, the directors of commissioning, the chief executives to be making those, you know, to be having those conversations and being able to evidence what you think the demonstrable benefit is. The other area I suppose I would consider as well is how do you engage with NHS England as well, both at regional and national level because NHS England is hugely influential in terms of what their regions will do, what their regions will focus on. Yes they need to focus on the national picture but they will have their own view on kind of what best practice is as well. And I think there is something well about engaging with patients and engaging with local authorities as well because don't underestimate the power of the patients and the councillors and the MPs as well in terms of where they really want to focus. But yeah, those decision makers really are those board tables, whether they're within the trusts or whether they're within the ICBs and more and more so they will be joint system decisions now. So really I think, you know, being open to having those system conversations at that high level is really probably where you need to be thinking about how you pitch it.- Okay, I can almost hear everybody shouting at the screen saying,"Yes we understand that. How on earth do we get to see people like that?" And I think accessing that level decision making is the difficulty. So it's thinking about what messages you're taking and how you're approaching them.- It is, yeah, it it's, and I get that and I do understand that because all of these people are busy people and I'm not suggesting that you don't engage with their teams because the teams could be a really good in in terms of actually if you can demonstrate something that you think is really good then you know, I could say, you know, I was in this position only four or five months ago, if my team came to me and said, "Actually do you know what, I think I found something that's really interesting." I'd absolutely always be open and most people would. So, you know, it's not that you shouldn't engage with those people, but they won't be making decisions anymore. So don't fall into the trap of thinking,"Great, they said it's good idea. They want to go ahead to think that's a done deal."'Cause it won't be, and it can be a fairly laborious process sometimes as well. But I think you're absolutely right, Karen, it's what are your key messages, keep them really simple and keep them really focused because it amazes me sometimes how people don't get this right but if you keep them simple and keep them focused on what it is the NHS are really focused on in terms of their priorities and that will absolutely, as I said be about reducing waiting lists, reducing outpatients, reducing mental health waiting lists. How do you stop people attending A&E. As long as you focus on those things and be really clear about how you can demonstrate that it does that, then people will want to listen.- Perfect, I'm just looking, actually one of the questions from the audience was around how industry can improve their working relations at that level, at ICB level, and I guess by aligning to the NHS's agendas are really good. Well probably the main thing but can you think of any other ways that industry can improve the working relationships with the NHS?- Yeah, I think it's really interesting. Some people are really scared about partnering with industry and the NHS does seem to be. I've got a recent experience actually with where the NHS are really worried about partnering with industry and there was, you know, there was no risk. There really wasn't, but it was still very sceptical about doing it. And I think, you know, Labour coming out and saying actually we want to make it easy to partner with industry, we want to make approvals much quicker and easier. I hope that starts to filter down because I really believe that partnering and working alongside each other is the only way that we'll get through some of this really, and I think as I mentioned earlier on, but I think really trying to engage in that sort of clinical research, the trials, really trying to evidence the product you've got is actually going to have benefit that's going to make the difference for where the NHS are really trying to focus to meet the targets is the main thing. I think yes, it might have all these other side benefits and no one's ever going to say quality isn't important and clinical outcomes aren't important. They absolutely are going to say that, but we've got to be realistic that the focus is around those waiting times targets and the money at the moment. And that's where it is. Yes, things will come along that are really good clinically that will just have to happen because they absolutely should happen. But mostly people will be focusing on where they can derive those benefits in terms of meeting those targets.- Brilliant, I'm keeping an eye on the time. We've got about 10 minutes left. So we've talked about planning for the winter, but looking beyond the winter, what are some of the longer term innovations or strategies that the NHS is considering to improve resilience in general but also in urgent and emergency care?- Yes, I mean we are kind of coming towards the end of like the long-term plan cycle in some ways. So in some ways I think we'll be very much waiting to hear what comes from the Lord Darzi review and then the new strategic plan. But I think the government is very clearly as I've mentioned, focused on several things. So as I mentioned they've talked really clearly about neighbourhood services and I do think that's an area really where medtech, pharma, industry can really, really add value. So keeping patients at home, how do you keep them in their own home? How do you make sure that they're safely monitored? How do you make sure they've got the right technology, that they find that technology easy to use? How do you make sure you're monitoring their vital signs? How do you make sure that the information is easily transferable, that people can access that information? How can we keep people home? How can we prevent illness? Whether that's through pharmacology or other services that can be provided for patients. So I think that neighbourhood services is going to be here to stay. I think we'll see a big focus of that in the long term strategic plan as well. So that would be one area. I've mentioned virtual wards specifically, so I think that will absolutely be here to say and be here to increase. I think the other area is around AI as well. So lots of companies, lots of NHS trusts are looking at their digital strategy, at their clinical strategies and thinking about how they can use AI particularly in scanning, particularly in diagnosis. So that would be a real area I think people should be thinking about how they're making sure whether that's either developing your own or partnering with organisations who do AI really well already, that feels like a real key area. I think in terms of kind of bigger strategy if you like, I think it'll be really interesting to see what comes out about general practice. There's been lots of talk about whether practices should be run on partnership basis, whether GPs should be salaried, should that be brought into the NHS. I think it's too early to tell what this government's view of that is at the moment is my view. But I think something we will need to significantly change. It looks like primary care networks and here stay at the moment. So that is very much about at scale working. Definitely ICBs are looking at at scale, general practice. So I think that could be a really interesting area. So if practices are looking to start to buddy up, become bigger practices, practices at scale, actually then they can really think about investing in their own technologies as well, their own medtech, their own point-of-care testing if they get that, you know, that level of at scale. I think as I mentioned out of hospital, definitely here to stay in terms of the focus on, you know, keeping people supported at home, as I mentioned before. specialised services we know are coming out to ICBs. I'm not sure about any specific changes in that regard, but we know through the delegation of dental and pharmacy and optom to ICBs, that's been quite difficult just in terms of having the resources et cetera to do that. So I wouldn't necessarily assume there would be any big shakeups initially. We're expecting some interesting policy announcements around dentistry at some point of time as well. So that will be interesting as well in terms of how you manage those patients because actually a lot of patients who phone for urgent dental care, don't always need actually a dental treatment. So this is also about how people manage pain and things like that as well. So I think there were lots of opportunities, but I think, yeah, I think we need to wait and see what comes out after the Lord Darzi review.- Yeah, that's really interesting what you said there, in terms of POD or you know, pharmacy and optometry being delegated down to ICBs, how was that? You know, you said it was a struggle in terms of resource and stuff. How was it? Did the resource and capacity come with the delegation? Because you are right, that will, you know, be similar to what's going to happen with spec com. How did that work?- Yeah, yes, and it's similar conversations are happening with spec com. So basically ICBs were delegated pharmacy, optom and dentistry. And at the time ICB said,"We're not really ready to receive it." Most did because the due diligence was quite tricky to do. It required a lot of work. Not all the information was there from the existing teams that undertook the commissioning of those services. No additional resource came with it. So we've got teams that were currently doing it for in the NHS England teams, but they're generally quite small and probably in their own right weren't big enough to be doing what they needed to be doing. And of course the pressure is so much more significant and the demand is such an issue now with the issues around funding and the contracts that there is probably a lot more work to do than there ever was as well. So I think ICBs felt that they were taking something that, you know, they hadn't, you know, they hadn't necessarily done all their due diligence. They weren't getting any extra resource to do it in terms of bods on the ground. They didn't have the expertise and it was just another thing to do on top of the already existing priorities as well. And I think it would be true to say that strategically not much has happened with things like dentistry in particular, maybe more around pharmacy, but it's kind of just been left, it kind of feels over the last 10 years or so, really with contract that's not really fit for purpose. So whether specialised commissioning will be better or not, I think it remains to be seen. But you know, there's a clear timeline out there at the moment. Obviously there's some areas that are progressing with that quicker than others and they've also been really clear that there were some things that will stay at that NHS England level as well.- Yeah, okay, It's definitely one to watch, isn't it?- Yeah, absolutely.- Okay. Just thinking, I know this is a topic that's close to your heart in terms of point-of-care testing. I'm trying to think, have you got any examples of the kind of work that you've done in Devon or elsewhere around how point-of-care testing can actually support patient care and all the support the priorities that the NHS are focusing on?- Yes, absolutely, so for me some of the work I've been doing is really around how you can better point-of-care testing in both community teams, also in general practice in primary care networks as well. So increasingly GP practices are working more at primary care network scale, which I think makes point-of-care testing a bit more scalable. And particularly I think the big opportunity for me is if Labour really move forward in terms of their neighbourhood services, really thinking about how they are, because they've specifically mentioned about geography and co-location and having services together, you then get a critical mass. So rather than every GP practice needs to have its own point-of-care testing and needing to have people trained on it, I think there's a real opportunity with those neighbourhood teams to have enough of a critical mass that you can have that point-of-care testing there with the community teams working with general practice to make sure that you've got enough trained staff that can undertake that and really understand then how you manage those patients, where you refer those patients to, to avoid hospital admissions. The other area of course, which I think is already more prevalent probably, but as SDEC services really enhance, so the same day emergency care services in the acute hospital. So those sort of 24 hour services where they undertake those diagnostics and turn the patients around within a day, there's an opportunity there for point-of-care testing as well to really embed that, to make that quick, so actually not waiting for path labs, et cetera, et cetera, to give results. So I think that's another key area for me as well.- Okay, and what about CDCs, community diagnostic centres?- Yeah, actually make, yeah, sorry, go on, Karen.- No, no, I was going to say what sort of role, and this is a question from the audience, you know, what's the CDC's role in supporting the backlog and how much are they being directed from a very strategic level at ICB level?- Yeah, it's a really good point, so initially when... And I should have mentioned CDCs in the point-of-care testing because absolutely there's an opportunity there to then co-locate that within the CDCs. But you're absolutely right, Karen, when CDCs initially came along, the idea was to completely strategically look at diagnostics differently and look at those patients who traditionally don't have access to diagnostics. So how can those diagnostics be put in the areas of deprivation where people don't access services, et cetera. But what's happened is because obviously there's been a need to get them in place to hit a certain target, it has hit a certain deadline, they've had to probably go quicker than we might have wanted to in terms of embedding some of those services. And because of some of the restrictions around workforce, around estate to put these centres, they've had to build on what they've already got, which has meant A, they're not necessarily in the right places to answer some of those questions around inequalities and access. But also workforce has never really been tackled as part of that. So generally speaking, you're talking about workforce that already work in hospitals and what unfortunately they have become to hit the target around waiting times is a place where you can really get through that backlog of what's already on the waiting list rather than thinking a bit more innovatively about how could you do some of that point-of-care testing, which means patients don't get to hospital to start with. So that is absolutely sort of hamstrung, I think local ICBs and be able to do what they want to do with those CDCs.- Okay, hopefully, potentially moving forward. So that could change and they could be developed into. Yeah, okay, right.- Yes, absolutely, but it would need workforce and it probably does need some consideration around estates as well.- Yeah, okay, we're at time unfortunately, Jo. I could talk to you forever, so thank you very much.- Yeah, gosh, it's gone very quickly, so thank you.- It has, hasn't it? So thank you very much for the valuable insights. So as we bring the webinar to a close, it just remains for me to remind all participants that we're here to help at Mtech Access. So if you'd like to have further discussions with Jo,'cause she's absolutely fascinating do reach out to us, I'd be remiss not to mention our upcoming symposium, which is in-person, in Manchester on the 5th of November. So we've got an absolutely superb lineup of speakers and the focus on the symposium is around how to implement change in the NHS. So it's around transformation in the NHS. And I know that's a topic that a lot of us battle with and keeps us awake at night. So thank you once again for joining and we look forward to seeing you at our next webinar. Please do sign up to the newsletter so you don't miss out on these valuable events and have a brilliant rest of your day. Alright, so bye Jo, and goodbye everybody else. 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.