1. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Creative Tensions in Healthcare Provision Dr Lester Russell Chief Medical Officer, Fujitsu

2. © Fujitsu Services 2005 2 “I need someone expert in the art of extreme torture – do you know PowerPoint?”

3. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

4. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 What’s happening in England?

5. © Fujitsu Services 2005 5 What’s happening in England? “No, the computers are up. We’re down.”

6. © Fujitsu Services 2005 6 The Five Clusters The programme has divided the country into five geographical areas, or "Clusters". A Local Service Provider (LSP) has been appointed to implement IT systems for the NHS in each Cluster Key ClusterLSP Main Health Systems Supplier SouthernFujitsuCerner LondonCCAIDX North EastAccentureiSoft EasternAccentureiSoft North West & West Midlands CSCiSoft

7. © Fujitsu Services 2005 7 Southern Cluster 1 2 3 4 5 6 7 There are 7 Strategic Health Authorities in the Southern Cluster: 1.Kent & Medway 2.Surrey & Sussex 3.Thames Valley 4.Hampshire & Isle Of Wight 5.Avon, Gloucestershire & Wiltshire 6.Dorset & Somerset 7.South West Peninsula

8. © Fujitsu Services 2005 8 Basic Demographics The Southern Cluster includes: 81 primary care trusts 63 hospital trusts 35 social services Organisation TypeCluster Total Acute Teaching Trusts5 Large Acute Trusts12 Medium Acute Trusts17 Small Acute Trusts7 Acute Specialist Trusts3 Mental Health & Community 19 Primary Care Trusts81 Ambulance Trusts12 Total156

9. © Fujitsu Services 2005 PACS Deployment – Overall Status – 4 th November 40 Initial Engagement Meetings completed Live Services: West Dorset – PACS Salisbury – PACS + locally-hosted RIS Maidstone & Tunbridge Wells – CR / MasterPage / Printers Dartford & Gravesham – CR / MasterPage + Data Centre-hosted RIS Poole – CR Milton Keynes – PACS James Paget (EEM Cluster) – PACS PACS Cluster Data Store – fully operational (6,089,130 images at 4 th November) RIS Data Centre Applications and Databases – operational (4 SHA domains in use) James Paget – data centre connection 2 nd November Royal Surrey – RIS commenced service on 4 th November Poole – RIS 7 th November Gloucester – RIS 7 th November Dartford & Gravesham – PACS 8 th November

10. © Fujitsu Services 2005 Equipment delivered and implementation proceeding at: East Kent, Ashford & St Peter’s, Gloucestershire, Plymouth Academy, Royal Surrey, Royal Cornwall Equipment on order for: NOC, North Hampshire, Maidstone & Tunbridge Wells, Plymouth, Brighton & Sussex (frozen), East Somerset, UHCW (NWWM Cluster), Medway PACS Deployment – Overall Status – 4th November

11. © Fujitsu Services 2005 11 Service Status

12. © Fujitsu Services 2005 12 Mission The role of Fujitsu as a Local Service Provider (LSP) is to enable healthcare organisations to improve and maintain health.

13. © Fujitsu Services 2005 13 Health productivity – the critical quotient $ max

14. © Fujitsu Services 2005 14 Health productivity – the critical quotient € max

15. © Fujitsu Services 2005 15 Health productivity – the critical quotient ¥ max

16. © Fujitsu Services 2005 16 Health productivity – the critical quotient £ max

17. © Fujitsu Services 2005 17 Healthcare productivity The people of the UK should not be asking, “How many events for the pound?” but rather, “How much health for the pound?” Donald Berwick - President, Institute for Healthcare Improvement, Cambridge MA Measuring NHS productivity - BMJ Vol. 330 30 th April 2005

18. © Fujitsu Services 2005 18 Healthcare productivity “In five years’ time, you will be your data.” Prof. Martin Severs – Chairman, Information Standards Board

19. © Fujitsu Services 2005 19 Enabling change - achieving health benefits Smart deployment of IT systems Service redesign Realisation of health benefits

20. © Fujitsu Services 2005 20 Enabling change - achieving health benefits Smart deployment of IT systems Service redesign Realisation of health benefits Modernisation

21. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

22. © Fujitsu Services 2005 22 Future trends Standardisation vs. Localisation

23. © Fujitsu Services 2005 23 Future trends Localisation “Our National Health Service is also a very local health service – and therein lies one of its key strengths. …what works in one place may not necessarily work in another. The local challenge is to shape services to match the characteristics, needs and priorities of the communities they support….” John Reid, Secretary of State for Health Our NHS – Where Next? South West Peninsula Strategic Health Authority 2004

24. © Fujitsu Services 2005 24 Future trends Standardisation Patient confidence Medical risk Medico-legal risk Transfer of data Care across different settings and by different providers

25. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

26. © Fujitsu Services 2005 26 Future trends Interconnection vs. Fragmentation

27. © Fujitsu Services 2005 27 Future trends Fragmentation of providers Purchaser/provider split Paid-for (but not necessarily provided- by) the NHS NHS as a commissioner Increased competition

28. © Fujitsu Services 2005 28 “If you don’t like change, you’re going to like irrelevance even less.” General Eric Shinseki, Chief of Staff, US Army

29. © Fujitsu Services 2005 29 Future trends Interconnection Home-care, primary, secondary and tertiary care Scheduled and unscheduled Urgent care and planned care Healthcare, social care and education

30. © Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

31. © Fujitsu Services 2005 31 Future trends Personalisation vs. Commoditisation

32. © Fujitsu Services 2005 32 Future trends Comparative clinical outcomes analysis Away from block contracts Towards Payment by Results (PBR) - really payment by activity Through Practice Based Commissioning (PBC) To payment by outcome

33. © Fujitsu Services 2005 33 Future trends Commoditisation Robust measures of quality Quality comparisons Value-for-money approach to commissioning Personal health choices driven by quality

34. © Fujitsu Services 2005 34 Future trends Personalised care Away from secondary care organisations’ menu-driven approach Towards primary care organisations, as a proxy for patient-driven care To patient making choices – including out-of-hospital care

35. © Fujitsu Services 2005 35 National and regional healthcare The enduring functional unit of the NHS is the referral network which surrounds the patient.

36. © Fujitsu Services 2005 36 Key point summary 1.Standardisation – Consistency of service, transferability of data. 2.Localisation – Services which are responsive to local needs. 3.Interconnection – Care is deliverable in different settings. 4.Fragmentation – Competition amongst providers. 5.Personalisation – Care packages tailored to the individual. 6.Commoditisation – High quality, low cost, high modularity.

37. © Fujitsu Services 2005 37 Advances in technology Ray Kurzweil NewScientist.com 24 September 2005

38. © Fujitsu Services 2005 38 Advances in technology “We won’t experience 100 years of technological advance in the 21 st century; we will witness in the order of 20,000 years of progress when measured by the rate of progress in 2000, or about 1,000 times that achieved in the 20 th century” Ray Kurzweil, Inventor and writer

39. © Fujitsu Services 2005 39 “..and that’s why we need a computer.”

40. © Fujitsu Services 2005 40