Pearson Innovation - Innovation Consultants

Circles of Care

Mike Pearson MD of Pearson Innovation takes us through Ron and Sharon's lives and looks at how communications and a joined up approach to healthcare could help them change for the better.

Sharon is married with 3 children, her husband Ron is a bus driver and together they earn £26,000 pa. Both smoke and are overweight. When young they never got into the habit of exercise, and now, with children, find little opportunity for anything active. They both know that their lifestyle and diet are poor - Ron gets the same lecture when he visits the doctor about high blood pressure. Sadly this does not translate into practical help so there is little motivation to change. They began seeing things differently after watching Jamie Oliver’s ‘School Dinners’; it showed them how much is wrong with their diet. The programmes also made them angry; they may struggle to sort their own lifestyle out, but who is at fault if the school feed their kids rubbish?

Both are already costing the NHS more than average, and if nothing changes they are set to consume even more resources as medical conditions such as diabetes emerge. The problems of obesity and smoking cessation are hardest to crack in less well-off social groups. Primary healthcare services are hard pressed to do much more for Sharon and Ron. The dilemma is that huge savings follow a healthier population, yet would another doubling of NHS funding deliver this in face of rising demand? On the bright side, the Jamie Oliver effect has served to show how readily the public will engage in health improvements if presented in the right manner.

Ron has been taking days off sick with a bad back and blood pressure. This is leading to stress, although his employer is sympathetic Ron knows how much it disrupts bus services - Sharon takes the bus to work. Sharon is rarely ill at present, yet a series of minor obesity and smoking related ailments are starting to affect her. She is becoming aware that unless something changes, their quality of life will start to deteriorate.

So the issue of health, or specifically wellness, is becoming increasingly important to Ron and Sharon - and their employers. The recent Stress in the Workplace directive put the onus on the employer to support such employees. It recognises the cost benefit of avoiding just a few days absenteeism, per year. It is clear that whatever the Department of Work and Pensions can do in the workplace to support wellness might well reduce illness in the NHS.

Ron and Sharon have a mortgage. This needs life insurance, but the premiums are higher due to the health risk they represent. Reduced premiums however are offered as an incentive to lose a stone and give up smoking. Moreover Ron’s employer has a scheme that rewards reduced absenteeism. Neither Ron nor Sharon have considered doing home health tests, but the idea of monitoring health outside the doctor’s surgery in not new.

Their respective employers provide simple testing at work as part of a health MOT. Ron discovered that if he cycled to work he gets a new bicycle once his health grading rises from MOT 1 to MOT 2. What is more, his car insurance company has also offered to cut £60 a year off motoring premiums if he gets to MOT 3, but that will take a few years. Both Ron and Sharon spend a lot of time in the car, and were intrigued by an advert on the ‘telly’ for the new hatchback that monitors health while they drive. They can then choose to allow their employer or GP to share this information in order to support them in their efforts to improve their health.

In these examples the pressures on Ron and Sharon to become healthier are applied and funded by the commercial sector, based on opportunities created by a joined-up, cross-departmental state policy. The idea of a personal health MOT is not new (FT Weekend 8 January 2006) and is a simple way to set health thresholds and monitor improvements. It does seem important however to adopt a common standard for health, as in other areas.

Sharon has a preferred supermarket, they always have bargains if she uses her loyalty card. She recently saw a programme on the ‘telly’ showing how much fat there is in certain foods, and has a rough idea of what to avoid, but working out how best to change the family diet has been beyond her. The doctor has been asking to see Ron every month and usually gives him a prescription for stress and blood pressure. It inevitably means a morning off work in order to get to the surgery and then the high street chemist. The supermarkets have increasing role to play in improving the nation’s nutrition. Major food manufacturers are actively seeking ways to positively engage the public with a better understanding of diet, nutrition.

Retail chemists are under threat from supermarkets and need ways to strengthen their offer. It is an irony that pharmacists are trained as scientists and used as shopkeepers – more can be made of their ability to diagnose and prescribe. So whilst we see the need for effective linking of food manufacture, food retailing, pharmacy and the GP, we fear that acting independently, each will have limited impact.

Neither Ron nor Sharon would ever go to health clubs; they are expensive and filled with ‘beautiful people’. On the other hand they are keen on the drop-in sessions their GP recommended. Friends go, and together they prove a powerful support group. Needing no mirrors and showers these sessions are simple to set up at the local church hall or library. In fact it took a couple of weeks before they realised it was a professional package, the same as in top health clubs, put together by the same people, but only costs them £6 a session. What is more, for every five they attend, they get reward points for healthy option at the supermarket. They now hope their healthier lifestyle will rub off on the kids. The health clubs know they are appealing to a very limited section of the population, and seek ways to attract wider audiences. Research has shown how to attract Ron and Sharon, and what puts them off. To be really effective however, it needs coordination with local primary healthcare. GPs could benefit from these health groups, and from local supermarkets and pharmacies by collectively providing the support Sharon and her family with practical advice and help on diet.

The Electronic Patient Information Record (PIR) could prove key to these collaborations. To be effective however, some shared access is needed. This is a political hot potato, especially in conjunction with the debate on state record of DNA. Concerns over privacy are inevitable, but the information needed to help Ron and Sharon is only peripheral and related to what conditions they don’t have than those they do. Controversy could be further reduced if any such access is always overseen and approved by Ron and Sharon - the mobile phone operators already have the tools to do this. Focusing on the positive aspects of this sharing of information, how it could reduce Ron’s days off work and win a bonus for attendance, will help to convince them.

Ron and Sharon both use mobile phones - well everyone has one, it helps them keep tabs on the kids. They also have a computer at home that the children use mostly for homework. The internet has a mass of information to offer but it is hard to work out what is relevant to them and who to trust. They trust their GP but can’t go running to him every time they need advice. They have heard of NHS Direct, and Sharon called the freephone number a few times when the kids were ill, but without knowing more about her family, the advice they could give her was limited. Broadly they approve of the NHS, they trust it, and who else is there anyway?

Both land-line and mobile companies speculate on the huge opportunities in wellness, and look for ways that communications can provide the services Ron and Sharon would pay for. Few commercial applications however are emerging, as acting alone these companies recognise how difficult it is to create the environment in which opportunities may flourish. The services they could provide must be trusted. Information needs to come from a trusted source, in turn leading to advice Ron and Sharon can act on. This raises the issue of brand and many companies know it is a risky strategy to stretch their brand to support offerings in healthcare. The NHS, on the other hand, is an established healthcare brand, and one that is already trusted with personal and confidential information. We suggest this could be expanded to enable a number of public facing initiatives.

These examples are not intended to illustrate how increased health funding now will reap savings later. Instead the pioneering attraction is that in line with the recent health White Paper it allows the NHS to benefit from a health dividend with little overall expenditure. These examples show how effective it might be if top level health strategy creates a framework that allows commercial companies, across sectors, to work together and engage the public in a way they see beneficial. It draws on the latest technological opportunities to allow profit making services to tackle major health challenges and achieve a healthier population. But it will only work if it results in products and services that individuals value, see beneficial and crucially are prepared to pay for. Key to success is providing ways for individuals to understand and engage in their own health, through information and support, such that they feel in control, recognise improvement and are rewarded for it. This is not privatisation by the backdoor as these are services predominately outside of the NHS and beyond their current remit. From a commercial perspective the opportunities described are not imaginary but based on ideas and technologies under development in major companies. No hard sell is needed to convince them to engage, although having their trust and a long term understanding helps. What has been lacking is the vision to see how each part fits together – a task that design thinking is increasingly finding itself asked to perform. This is a unique point in time when governmental action has the opportunity to make parts of a jig-saw fit together within an agenda that is highly beneficial to the country. It may to help wean the public off overdependence on health providers and professionals, who exhibit a tendency to see their existence above that of the patient or consumer. Intrinsically it will reverse priorities and focus on the individual and their needs, helping educate a large section of the public who know more about the workings of their cars than their own body.

These ideas need to be explored and presented as scenario based illustrations, which show how state and commercial organisations fit together in a larger framework. We seek funding for a first phase consultation to expand and explore these opportunities. We will receive matched funding from number of industrial partners. The ideas will be discussed in more detail, confidentially, with individual organisations to ensure they coincide with their commercial strategy. Being outside the control of any commercial group it is possible to include examples of how different sectors may contribute, based on our broad understanding of the directions they wish to pursue. In this way we sidestep the issues of confidentiality that would normally arise, leaving companies to resolve such matters in their own time. At the end of this phase we propose the organisation of a conference at which the scheme is launched. The scenarios would be launched to the public through a series of TV documentaries. It will be necessary to set up a collaboration group consisting of representatives from leading multinational companies and health policy makers including DH and NHS.