What is innovation in healthcare?
Innovation in the NHS is a tough gig. How do we proactively seek out new ways of delivering care which bring improvement, refinement and development, when we are so overloaded by current volume of work?
Why are we doing it?
The biggest reason for innovation in the NHS is the challenge of balancing demand and supply. Rising demand of patients coupled with reducing supply of staff is a testing combination – and all in the context of global economic uncertainties, the pressure on the NHS is greater than ever.
A challenging population growth
Census data for 2021 shows population growth for England and Wales has increased by 6%. Hounslow had growth of 14%. At the same time we have recruitment and retention challenges in primary care in Hounslow. Nuffield Trust showed a fall in GP numbers in NW London of 5% between 2016 and 2018. Help is on the way with an increase in Primary Care Network (PCN) staff, however, recruitment and retention is also challenging as there is a limited pool of staff and high demand for them. Working across a number of practices makes training and mentoring difficult.
How does that fit with innovation?
Managing demand proactively (patients) requires innovation. Finding new ways to reach patients, communicating effectively. Recruiting and retaining supply (staff) requires innovation. Keeping staff motivated and ambitious. At Hiyos we’ve been trying to innovate in our methods of servicing patients and staff for years. We’ve tried many things. some work, some don’t. That’s what innovation is about, trying new things until you find one which works.
Does it work?
So far so good! We found that finding proactive ways of providing care – for example by group consultation and proactive communication using platforms patients already use, we can reduce demand by 1700 appointments per year. We also found that offering staff protected time to work on interesting and relevant projects has improved recruitment and retention.
So keep reading to see what we have done at Hiyos. But first, let’s explore a bit more about who we are innovating for – patients.
NHS plans to recruit 50,000 more nurses, 6,000 more GPs and 26,000 additional clinical roles in the next few years.Kings Fund
High demand for workers with correct skill mix. Plenty of training opportunities.
Opportunities for clinicians and non-clinicians to be involved in digital health projects which are transforming healthcare.
Hospitals & Clinics
Work in variety of clinical settings, in the community. general practice or hospitals.
Who are we innovating for?
If we consider patients as customers rather than patients, we naturally move towards proactive, customer centred care. We go to them with our services before they come to us, when the costs will be higher.
Patient demographics – growing and youthful
The population of Hounslow is growing rapidly. It was forecast to have a population of 281,000 by 2043 but 2021 Census data shows a population of 288,000. Interestingly the percentage of population is significantly above average compared to England in ages 0-10 and 25-49 for both men and women. 81% of children are from low income families, compared to 66% for England.
The Asian population is 34% compared to 18% for London and 8% for England. There are 32,000 people who have ’South Asian’ and a further 15,000 people who have ‘other European’ as their main spoken language. Finally there has been a significant rise in the refugee and asylum seeker population.
What do they need – and how can we match that?
We need to ensure that healthcare services are aligned to the needs of this population. To that end we need to ensure that we proactively support those aged 25-49 who often are employed and ensure that they can access health quickly at times that are convenient for them. We also need to be more proactive with children and young people, when health behaviours are formed. Health needs to engage more with schools.
The Marmot Review 10 years on demonstrated that the determinants of health inequalities are employment, education and the environment. Healthcare working on these areas can help reduce demand whilst proactively improving health outcomes.
Data from the World Health Organisation shows the importance of early diagnosis of diabetes, which reduces costs by 18%. But even earlier intervention – preventing diabetes by identifying patients who are at risk of it i.e. with a HbA1c of 42 to 47, can reduce costs by 50%.
Early treatment is cost effective
Office for Health Improvement & Disparities data for Hounslow shows a falling trend in cervical screening for all ages, breast screening and health checks. Late diagnosis is a poor prognostic factor and likely to add to morbidity and mortality, whilst at the same time increasing costs. There is therefore a significant role for public health and population level screening. In section D which broadly is around vaccinations Hounslow is green in 3 of the 36 parameters and red in 17 domains.
The rising demand and reducing workforce has resulted in the NHS adopting increasing options for access. Often patients find it difficult to navigate the options. The perception of access is just as important as access itself. National GPPS data shows that those who rated the experience of making an appointment as ‘poor’ increased from 14% to 26% between 2021 and 2022.
The Fuller Stocktake report suggested 3 guiding principles. Access for acute illnesses in the community when needed, whilst at the same time offering continuity for those with more complex needs. The third element is wellness and prevention. These are tough asks. How can the system manage this? We feel the answer is working on prevention. This can help reduce demand for acute and chronic demand.
The health needs of the public are changing, however, there is also a change in the patient perception of health, as well as expectations. We’re fortunate to have a formal structure in NWL, which links practice Patient Participation Groups (PPGs) to their Neighbourhoods (PCNs), Places and the ICS. and they do a fantastic job. NWL has also led the way for co- production.
However, there is room for improvement. The demographics of PPGs are not representative of the population. Perhaps there is a role for social media. HIYOS has a social media project which involves ‘social listening’ around topics of interest regarding health inequalities. We are able to gather information on millions of conversations, on what is being discussed with word clouds and sentiment analysis. Also we can drill down to demographics of the people having those conversations. We gain behavioural insights and design our service to meet the need. Patient engagement by listening, without asking a single question.
What can we do to reduce demand and increase supply?
Demand – Beyond healthcare
Patient demand is high and getting higher, it seems odd to suggest that we address this by going beyond the traditional role of healthcare. However, HIYOS has identified a reduction in demand when running proactive patient group workshops – by 1,700 appointments per annum.
A patient survey during COVID with 2,000 responses, showed patients wanted group events on topics such as gardening and cooking. They also wanted to engage with us using social media and WhatsApp.
Our health inequalities work involves engagement with schools and supporting work experience.
Supply – Supporting careers
We found staff want to be a part of an organisation with a clear vision and purpose. They want to make a difference to their community.
At HIYOS, all staff have regular catch ups, to identify training and career opportunities. We help build a portfolio career which may be working on innovation projects, teaching or research at the practice. In addition we can help find work outside the practice with with Health Education England or the PCN.
We work in blended teams and appreciate each others roles. GPs work in reception. Staff work hard but have fun along the way, whilst developing their careers.
Finally! How does Hiyos innovate?
Demand – patients
Based on Marmot Review, we are running a webinar channel across NWL with support from our partners . We are partnering with YouTube & speaking to TikTok. The practice has made 380 videos on YouTube with over 700k impressions. Some of our social media posts have had 130k views. We feel that there is an opportunity to use social media and webinars to deliver fun, engaging informative content designed to reduce health inequalities. We have had over 3,000 people register for our webinars. The project is independently evaluated by Imperial College Healthcare Partners. We plan to have research publications with Imperial SCARU.
We recently ran a test 3 day work experience programme which was not actively promoted. There were 30k views of a social media post, 950 registered and 350 completed all 3 days including the submission of a project. We’ve had some amazing feedback.
We have worked with local schools and delivered webinars to thousands of children. In addition we have visited schools both in class and during careers fairs. We are running a series of webinars called Body Works – which is for kids aged 7-11 led by clinicians discussing how different bits of the body work in the Metaverse.
NHS Net Zero
Earth Works – NHS Net Zero. We are supporting clinicians and patients to meet the NHS Net Zero by 2045. We are working with Prof Griffiths, Director of Science of the Royal Horticultural Society to share the health benefits of gardening and supporting community projects. Over 650 people registered for his webinar, promoted by Eventbrite.
Having completed our trial phases, we will be running daily webinars which will be relevant to those who are interested in working in the NHS as well as those who are already working. We will actively promote these sessions with our partners and on social media.