North London Partners in health and care

Public health: Everyone's business (part 2)

In the part of London where I live and work, we are blessed in the field of healthcare and research. With Barnet, Chase Farm, Royal Free, University College and the Whittington hospitals – we have the highest proportion of ‘good’ ratings by the CQC in any sector of the capital. We also have some of the best mortality rates in the country. 

We have specialist services of national and international pedigree. From sickle cell and thalassemia services at the North Middlesex Hospital and transplantation, immunology

and amyloidosis at the Royal Free London to neurosciences at University College London Hospital, eye care at Moorfields and mental health services at the Tavistock and Portman. And of course Great Ormond Street – one of the world’s leading children’s hospitals. 

Our health sciences are second to none thanks to our close working relationships with University College London – consistently rated one of the best universities in the world. Not to mention the London School of Hygiene and Tropical Medicine, Francis Crick Institute, Wellcome Trust and UCLPartners. 

Population health needs

Despite the high quality of the healthcare and research infrastructure, we are still not appropriately meeting the health needs of the population. Two thirds of adults in Enfield are overweight or obese – as are 40% of children. One in five adults in Camden binge drink at least once a week and the same proportion in Hertfordshire smoke. 

In the part of London we serve, the average resident can expect to spend 20% of their life not in good health. Our assets and capabilities are clearly not translating themselves into better outcomes for our population – and the paradox is mirrored across the entire NHS. 

I see the burden these kind of statistics are placing on the NHS whenever I walk the wards with doctors and nurses. We need a seismic shift – not necessarily in the amount or quality of resources that are brought to bear, but how they are marshalled together. 

System-wide solutions

We are starting to see a change of emphasis with the work of the sustainability and transformation partnerships (STPs) which is refocusing our attention on system-wide solutions and on population health – helping people to achieve their maximum potential – rather than treating people when they get sick. 

In my experience, STPs are focused on achieving the triple aim of the Five-year forward view: transforming the quality of care we deliver, and working hard to achieve a clinically and financially-sustainable NHS – but doing this by taking seriously our responsibility to improve people’s health and wellbeing. 

In the past, talk about prevention has been cheap. The practical challenge of implementation will take effort, energy and a serious shift of resources. 

In our STP, the out-of-hospital care arena and primary care homes are bringing people together outside of traditional NHS structures. We are developing models based on populations of about 80,000 with health and social care collaborating on the best ways to meet the challenge. Affecting deep change in particular lifestyle factors is something we cannot achieve alone. 

Those of us who work in hospital settings need to ensure patients’ physical and emotional needs are provided for; those who work in primary care need to take the same approach, and ask: “is it clinically essential and economically sensible for this patient to be referred to a hospital setting?” 

The Royal Free London is one of four trusts across the NHS chosen to develop a group model, enabling us to share services and resources more effectively across hospitals to improve the experience of patients and staff. 

Our vision is of a group of hospitals which have the scale and partnerships to be commissioned to improve population health outcomes. If we can organise ourselves at a population-based scale then we stand a better chance solving our population health paradox. 

Key role of digital technology

Technology will also have a huge part to play, if we let it. 

The world has changed so much with technology pivotal to the way we all live our lives. There’s now an app for everything and we receive alerts on our phones with news and travel updates. Quite logically people now expect healthcare to take full advantage of the digital revolution. 

As a Department of Health global digital exemplar, I’d like to think we’re leading the way in this arena. 

We’re soon to be opening the most digitally-advanced hospital in the NHS – the new Chase Farm Hospital in 2018. And working alongside DeepMind, a Google artificial intelligence research company, our clinicians have developed an app called Streams which alerts our doctors to patients at risk of kidney injury in minutes. This is already having a huge impact for patients, who get better outcomes, and clinicians, who save around two hours a day from not having to trawl through paper notes. 

The big enabler for positive changes to health will be digital technology. We know that the expectations of our patients are higher than ever and in the digital age they want convenience, and expect data that’s bang up to date. 

We need more data and less intervention. Around 80% of healthcare data is currently unstructured, and digital technology can help us knit this together. 

We also need to have the vision to think about how digital can help us to afford our healthcare system in the light of rising demand. There are real opportunities to digitise many processes and drive out cost and inefficiency. 

But I think the biggest challenge for us all is to change our mindset. We have to move away from hospitals being the symbol of the NHS to a world where empowering people to look after their own health is our primary function. And we have to think of our role as being about public health and population health outcomes, not defining ourselves by the organisations we work for or the buildings we work from. 

Sir David’s time as chief executive has been successful in obtaining foundation trust status for the organisation and overseeing the acquisition of Barnet Hospital and Chase Farm Hospital. His career in healthcare management is predominantly in the NHS, although he worked in the private healthcare sector. He is among London’s longest-serving hospital chief executives.