How Leeds is improving care by breaking out of 'NHS-only systems'
Leeds digital chief Dylan Roberts tells Gill Hitchcock about how the city is joining up records and trying to help 10,000 Loiners get online each year
Could shared digital systems make or break the government’s proposals for more multidisciplinary healthcare teams? In the Long Term Plan for the NHS, it promises fully integrated community-based healthcare for first time since the start of the health service in 1948. Backing this up will be £4.5bn of new investment.
Digital systems have the enormous potential for multidisciplinary teams. They can enable GPs, pharmacists, district nurses, community geriatricians, physiotherapists and podiatrists, along with social care and the voluntary sector, to work together effectively.
But here’s the rub: many national NHS systems will stop that happening. Dylan Roberts, chief digital and information officer for Leeds City Council, says: “One of our big challenges is to penetrate what are NHS-only type systems.”
Roberts should know. His digital responsibilities extend beyond the council to Leeds’ clinical commissioning group. “If you want multidisciplinary teams, you need integrated care records,” he says.
“You need the ability to get into each other’s calendars and organise appointments, to use tools to see the presence of people around an individual’s care, to be able to use common directories to get hold of them.”
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Fortunately, he has good news too. In Leeds, they have been finding ways around the barrier. Sometimes this means creating bespoke solutions, but ones which could – and should – be standard, national offerings by the NHS.
What Roberts describes as “the most famous one” is the Leeds care record. For the past six years, it has been used by all healthcare professionals. Whether patients are in a mental or community hospital, visiting their GP or social services, the profession will have access to the same record about that person.
As a result, decisions about an individual’s care are considerably improved, according to Roberts. Building on this, Leeds council is now working with an app team in the NHS to pilot a person-held record. The idea is that people will not only have access to information held about them, but the opportunity to capture their own data and share it with public services.
“The real innovation about this platform… is that it’s being developed to open platform standards,” says Roberts.
“That means that other people can develop products on top of it. By way of example, and this is the intent, we might get people who have diabetes or blood pressure monitoring solutions, and those solutions would record data and it would be transmitted and made available straight away to clinicians.”
Roberts is keen for health and care services to be joined up around the needs of individuals. He talks about the importance of a shift in care away from the acute sector: “Imagine a care system whereby the more expensive acute end is on the right. On the left are community and locality-based services, which might just be services around wellbeing.
“It’s about making that left shift, so there is an earlier intervention which costs less and is a lot better for the patient or the citizen.”
When it comes to early intervention, Leeds’ vibrant third sector has an important role to play. This is why the Leeds Community Cloud is being developed. It will integrate frontline capabilities by providing IT services across public sector organisations, such as the council, more than 100 GP practices and numerous voluntary organisations.
Roberts has long recognised the health risks of social isolation. According to Age UK, loneliness among older people is as harmful as smoking 15 cigarettes a day.
With funding from NHS England, Leeds City Council is collaborating with Fish Percolator, a local software developer, on Careview. This is an app which allows people in a community – perhaps police officers or Royal Mail workers – to report neglect. The reports are aggregated on a heatmap to help frontline services identify people who are socially isolated.
“What we are trying to do is identify properties where there might be people who are socially isolated and require someone to go around and knock on the door,” says Roberts.
Meanwhile, thousands of adults in Leeds lack basic digital skills. Many people who are already at a disadvantage, because of age, income or disability, are at risk of digital exclusion. This is where 100% Digital Leeds, a scheme delivered by Leeds public libraries and charity the Good Things Foundation, comes in.
“Each year we want to engage with 10,000 people who have never been online,” says Roberts. “We have funded four coordinators who are engaging with community and locality-based groups to get them to act. For example, we have trained Middleton Elderly Aid to do digital inclusions courses.
“And what we also do is to provide a tablet-lending scheme. We have the biggest tablet lending scheme in the UK.”
Returning to the national picture, while the Long Term Plan has ambitions for multidisciplinary working and technology, does not it seem to separate the two? “I think you are right, the focus for me does tend to be too much towards how can we use technology to improve existing service provision,” says Roberts.
"What we want to do is to try and make IT delivery redundant. We should be playing an assurance and governance role."
“In other words, how can we make the current broken system more efficient, as opposed to looking at new interventions on a community or locality basis.
“Nevertheless, I’m heartened by the new Long Term Plan. To be fair, Matt Hancock does have a clue about technology and chapter five is a massive step forward from previous health secretaries and previous plans.”
As for his own plan for the next five to 10 years, Roberts would love to see a vibrant marketplace offering solutions to help people live better, be more connected and even manage some of their health conditions. These would include apps and devices which capture data about conditions. They could be prescribed by GPs, or purchased patients.
“What we want to do is to try and make IT delivery redundant,” says Roberts. “We should be playing an assurance and governance role, but when it comes to us delivering solutions, I would like a scenario whereby there is a mass of those solutions which are shared and re-used across the country.”
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