Modelling an Alternative Future Economic …

1 1 Modelling an Alternative Future - Economic evaluation of a Digital NHS in London Healthy London Partnership 04 July 2017 2 Table of Contents 1 Introduction .. 5 2 Summary Impact 6 Financial View - 5 to 10 years .. 6 Financial Impact .. 7 Workforce Impact .. 9 Estates Impact .. 10 Overall Workflow and Workforce Effects .. 11 As-Is and Can-Be Scenarios .. 11 Workflow .. 12 Workforce .. 13 Impact on Primary Care .. 14 Impact on Secondary Care .. 15 Admitted Patient Care .. 15 Outpatient Care .. 16 Urgent Care .. 18 Interconnections and Principal Initiatives .. 19 3 NHS Priorities .. 21 NHS Five Year Forward View .. 21 Next Steps on the NHS Five Year Forward 21 Wachter Review .. 21 NHS Big Data .. 22 Genomics .. 22 4 Population and Demand Pressures on London .. 22 5 Technological Challenges for London.

2 23 6 Route to Change .. 23 7 Channel Shift .. 24 Outside Healthcare .. 24 Within 25 8 Imminent Programmes Facilitating Digital Initiatives in London .. 26 Gateway .. 26 NHS Digital Apps Library .. 26 London Health and Care Information Exchange (LHCIE) .. 27 Methodology Polulation Health Management .. 29 Commissioning Opportunity (COP)/Diagnosis Stratification (DST) .. 30 3 9 Unwarranted Variation .. 32 10 Key Digital Opportunities for London .. 33 The 48 Initiatives in Seven Themes .. 34 Triage .. 34 Primary Care: Artificial Intelligence Triage - Initiative 2 .. 34 A&E Reduction through AI triage Initiative 24 .. 36 Image based Triage for Dermatology Initiative 3 .. 37 Virtual General Practice Initiative 6 .. 38 Health Information Exchange (HIE) supported Electronic Patient Records (EPRs) .. 41 Access to Patients records during NHS 111 calls - Initiative 1.

3 41 Transfers between Hospitals in - Initiative 20 .. 42 Transfers due to Patient - Initiative 21 .. 43 Calls related to patient enquiries in Trust Initiative 15 .. 44 Calls to seek Missing Discharge Letters and confirm OP Appointments - Initiative 16 .. 45 Calls due to Missing or Illegible Test Results - Initiative 17 .. 46 Patient Records Retrieval due to change of Address - Initiative 39 .. 46 Reduction in paper handling time fax - Initiative 14 .. 47 Time Saving in A&E due to Electronic Patient Record (EPR) Access Initiative 25 .. 48 eOBS Digital Task Observation and Handover System - Initiative 42 .. 49 Supported Self - Management .. 50 Diabetes Self Management and Self Coaching Initiative 32 .. 50 Arts on Prescription Initiative 46 .. 51 Exercise on Prescription Initiative 47 .. 52 Expert Patient Programme Initiative 48.

4 53 Guided Rehabilitation Initiative 38 .. 54 Digital Self-Care and Care Planning in Care Homes Initiative 4 .. 55 Channel 56 Mobile enabled Community Nursing Initiative 44 .. 56 e-Prescribing Initiative 5 .. 57 Referral Support Services Initiative 10 .. 58 Pre-and Post-Surgical OP Attendance for Assessment .. 59 Outpatients Pre-operative - Initiative 33 .. 60 Outpatients Post-operative Investigation - Initiative 34 .. 61 Postage Savings by e-Referral (eRS) and emails - Initiatives 13 & 29 .. 62 Discharge to Assess - Initiative 35 .. 63 Virtual OP Clinics - Remote Follow-up Initiative 43 .. 64 e-Referral from hospital to community pharmacy Initiative 41 .. 65 4 Care Plans and End of Life (EoL) .. 66 Savings by Avoiding Re-Entry of Care Plans Initiative 22 .. 69 Implement care plan sharing in care homes Initiative 27.

5 71 Digitally Shared Care Plans Initiative 28 .. 72 Digitally shared Care Plans for patients with LTCs North Lothian Initiative 26 .. 75 Diagnostics .. 77 Remote Communication of test results in Primary - Initiative 8 .. 77 Pathology Improvement Programme - Initiative 12 .. 77 Pathology Tests Duplication Avoidance - Initiative 18 .. 78 Radiology Tests Duplication Avoidance - Initiative 18 .. 81 Alerts .. 84 Asthma - Inhaler Sensor Initiative 84 Non-Invasive Heart Failure Monitoring Primary Care Initiative 9 .. 85 Non-Invasive Heart Failure Monitoring - Secondary Care Initiative 30 .. 86 Remote monitoring of Drug - Initiative 19 .. 86 DNA Reduction in Primary Care - Initiative 7 .. 89 DNA Reduction in Secondary - Initiative 40 .. 90 Mood Monitoring Initiative 45 .. 91 Clinical Decision Support Systems (CDSS).

6 92 CDSS GP on-line support from Secondary Care consultants Initiative 11 .. 92 CDSS and Adverse Events Initiative 37 .. 93 CDSS for Case Finding - Initiative 23 .. 94 CDSS for Photographic Image Analysis Initiative 36 .. 96 Once for London 97 Opportunities as aligned to steps in the Patient Journey .. 98 Appendix 1 Link to Tables .. 99 Appendix 2 Link to Dashboards .. 100 Appendix 3 Social Prescribing .. 102 References .. 102 5 1 Introduction The London Digital Programme, which is part of The Healthy London Partnership (HLP), commissioned the analysts i5 Health to produce an Economic Modelling tool to support implementation of digitally enabled new models of care. The result is a package of 48 evidence based technology solutions which are explored in detail in this document in terms of releasing efficiencies. In addition, this data is plugged into a dashboard tool configured to the 5 populations of the Sustainability and Transformation footprints across London.

7 The explicit intention is for Sustainability and Transformation Plan (STP) leads to use the tool to work through how to transform the traditional face to face and paper heavy workflows across primary and secondary care into digital workflows, by implementing, for example, virtual triage, e-consultations, artificial intelligence, decision - support, electronic alerts and notifications, use of big data and self -management tools This document considers in detail how the 48 technology enabled initiatives could release financial values annually totalling over 700m for the capital s NHS and the associated impacts on workflows, workforce and estates. The initiatives fall in into two basic categories: 1. Those that replace a face to face events with a digital Alternative , generally known as channel shift 2. Those that replace a human process with a digital one or create a new digital process where there was previously no human equivalent All of the 48 technology initiatives have an existing evidence base and hence provide solid data on what can realistically be applied in practice today and thereby not misleading the viewer with exaggerated claims of benefits /cash releasing savings claims.

8 STP leads can select from the 48 initiatives the combinations that best suit their local context together with the scale and pace of implementation. Some will want to go further faster. In addition, it is anticipated that STPs will continue to innovate in order to create and add to this evidence base. As set out in the Summary Impact Analysis (Section 2) the data in this document has been modelled in four different ways, as follows: Financial Impact Taking a realistic view based on the historic rate of adoption for technology solutions, the paper suggests that, in five years time, the implementation of the 48 digital services will be providing recurring annual savings totalling over 700m per annum in gross value. The paper further proposes that this sum, fuelled by additional initiatives, could then grow exponentially thereafter to reach nearly 3bn recurring annual savings in the tenth year.

9 Capacity Impact The estimated at-scale adoption of the digital services and digital channels could increase available capacity by 25% in primary care settings, 20% in A&E settings, 5% in hospital outpatient settings provide a reduction in hospital admissions and, for those people who are admitted, a 4% reduction in bed days. 6 Workforce Impact Digital services if fully adopted could release 20% of the GP workforce, 5% of the nursing workforce and 15% of the consultant workforce Estates Impact Estates includes GP practices, OP clinics, Beds, Desks and (percentage of) A&E department. Effects are such that single initiatives could create capacity equivalent to a typical London hospital A&E department. The 48 initiatives are capable of being categorised in a range of different ways depending on the approaches taken by the users.. Three are included in Section 10 Key Digital Opportunities for London.

10 These are: 1. Seven Themes: Triage, HIE supported EPRs, Supported Self-Management, Channel Shift, Diagnostics, Alerts and Clinical Decision Support Systems. (This subsection details all the 48 initiatives which are numbered accordingly) 2. Once for London Opportunities 3. Opportunities aligned to steps in the Patient Journey Appendix 1 provides a link to a Table that summarises all the 48 initiatives studied in this section - showing the Financial, Workforce and Estates consequences for London as a whole and then for each of the 5 STP areas. Appendix 2 provides a link to all the Dashboards for the above organisations. Appendix 3 is a link through to similar Economic Modelling work that i5 Health produced on Social Prescribing which has already been delivered to the London STPs. It is recommended that this document and the accompanying tools are used in conjunction with that Modelling work.