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>>Richard Vize (host): OK so welcome to our final keynote session, I'm sure you found
it for many of you being in the room for Sir Bruce's speech, what an inspiring discussion
it was, that sort of journey through the last ten years, the extraordinary change that has
been delivered by the NHS and also that discussion of the many challenges to come. Very inspiring.
So I'm now delighted to invite for our final keynote of Expo 2017, the Health Secretary,
Jeremy Hunt. You’re most welcome
>>Jeremy Hunt: Thank you Richard, good afternoon ladies and gentlemen, it is a great honour
to follow Sir Bruce, and of course Sir Bruce steps down as NHS England Medical Director
at the end of this Year after ten years in that post and I just want to use this moment
to thank Bruce for truly remarkable service to the NHS, I have had a particular interest
in patient safety and Bruce has always been there for me in the many difficult challenges
we have faced.
But I would just like to use this moment publicly to recognise his contribution to the NHS and
thank Bruce. [Applause] This is actually the first speech that I have
given in Manchester since the horrific bombing at the arena in the summer. And I just want
to also start by saying how incredibly proud I was of the NHS response when that happened,
I was privileged to meet a number of the doctors, nurses, paramedics involved and it was incredibly
impressive and I think all of us in the NHS were incredibly proud of what happened then
in Manchester.
And I also want to congratulate everyone here, because this is our biggest Expo yet, 5,000
delegates, 150 stands and that matters because when we think about the NHS I want something
very simple, I just want our NHS to be the safest, highest quality healthcare system
in the world, we all want that. And we often talk about the challenges of funding, the
challenges of quality, the challenges of safety, but we also need to talk about the challenge
and the opportunity of technology and this is a unique occasion to do that and I want
to congratulate Matthew Swindells and his team at NHS England for pulling this together.
And it's very timely, because next year the NHS is going to be 70. It will be a moment
of reflection and the whole country seems to be coming 70 at the moment with the ageing
population. But it will be a moment of reflection. I think we will conclude that despite the
many challenges facing the NHS we have an enormous amount to be proud of. 7,000 people
alive today who wouldn't be alive if we had the cancer survival rates of just four years
ago. We have, according to an independent report from NHS England, dramatically better
outcomes for nearly all major conditions than we had five or ten years ago. And big improvements
in the safety culture, all of which have happened under a time of great pressure on the frontline
and great financial constraint.
But I want to ask what we will be talking about not when the NHS is 70, but when the
NHS is 80, by which time I will have been Health Secretary for 15 years. Don't worry,
I don't think that's going to happen! I think that the reason we need to think about that
is because the changes in medical innovation are likely to transform humanity by as much
in the next 25 years as the internet has in the last 25 years. So what might medicine
look like when the NHS is 80?
Well the first thing is we may well not be going to doctors for a diagnosis. We might
be going to computers instead, who will be looking at the 300,000 Biomarkers in every
single drop of blood, mashing that with big data information about everyone else's Biomarkers,
and when we do go to a doctor, he or she may well be comparing our medical record with
our fully sequenced genome and giving us much more accurate predictive information, we may
well be in a world where if we show any symptoms of a disease we consider that a sign of failure.
Because the name of the game will be to catch diseases when we are asymptomatic and we have
a much better chance of being able to nip illness in the bud.
And accompanying all of that is likely to be a big shift in power from doctor to patient
as patients use technology to put themselves in the driving seat of their own healthcare
destiny, in the same way that we use technology to give ourselves much greater control over
every aspect of our lives. And I want to suggest to you that the NHS is much better placed
than we give ourselves credit for to actually lead that revolution.
Thanks to our GPs, who studiously ignored Government wishes for national IT systems,
we have the best longitudinal, medical records of any health economy and those are forming
the basis of a single electronic health record that is now starting to be shared across the
NHS.
We also have four of the world's top ten medical research universities and we have the incredible
tradition of innovation and the values that sit at the heart of the NHS. And that gives
us great opportunities. But we also have some big weaknesses, and a year ago at Expo, we
were very honest with each other about our single biggest weakness, which is the state
of our hospital IT systems and we have Professor Bob Wachter, from University of California,
San Francisco, who did an honest appraisal and he told us that we needed to do three
things and a year on let's just look at how we are doing.
The first thing he said is that we needed to back our best hospitals when it comes to
IT and digital, to become as good as the best anywhere in the world and we set up the global
digital exemplar (GDE) programme, we have 16 GDEs, and there is some extraordinary work
happening with all of them. We have, for example at Imperial now, automatic entry of routine
data in 25% of their wards that is already saving 4,000 nurse hours every year. At Royal
Liverpool they have sensory monitoring of people's heart conditions that has led to
a 46% reduction of cardiac arrests. And at Alder Hey they have got a revolutionary new
paediatric portal. So these are really significant steps forward and all of our global digital
exemplars are buddied with partners in other countries ‑ that really are the best in
breed, often in the United States, but not exclusively in the United States.
What we said last year was we wouldn't just back the very best Trusts but we would also
have a group of fast followers who would be given grants of up to £5 million each, which
they will be expected to match, a very significant investment. And today I can announce who those
fast‑followers are. So I’ve put the list up there. Of course this is a fluid list and
if you are not on the list just yet that doesn't mean to say that you won't have the opportunity
to get on the list, but congratulations to the fast followers who we are hoping are on
their way to becoming global digital exemplars.
And then we also said we wanted to have some mental health GDEs. The Prime Minister announced
seven in January, and we are going to have another seven. I can announce today another
seven fast followers in the mental health sector, they will have grants of up to £3
million each. And again there is some fantastic work, Birmingham, and Mersey have got some
really extraordinary technology helping to reduce self-harm and suicide and we see that
exact same potential for technology.
So that was one thing that Bob told us. The other thing he said is that we needed to have
an NHS National Digital Academy because he said that we needed more digital expertise
in our Trusts and we needed in particular to have chief information officers and chief
clinical information officers in all our Trusts. And so we have now awarded the contract for
our NHS Digital Academy, it is a consortium of Imperial, Edinburgh and Harvard. And the
first cohort of 50 people will start in January, mainly coming from our GDEs but we are today
opening it wider than that. That will help build up our skills in the IT space, again
a very, very important thing that we need to do.
He said we needed to have a chief clinical information officer for the whole of the NHS
and we were delighted to appoint Keith McNeil to that role after his fantastic work at Addenbrookes.
Unfortunately for family reasons Keith has decided to desert us and go back to Oz, but
I do want to use this moment to recognise the fantastic work Keith that has done and
indeed the fantastic work that he did at Addenbrookes before that.
Finally just looking back to previous Expos, three Expos ago we launched My NHS which was
part of our plan to make the NHS unquestionably the most open and transparent healthcare system
and we put on that a huge amount of information that is not available in most other healthcare
systems that allows NHS patients to find out an enormous amount of the quality and safety
of their local health provision and today we are putting another 90 datasets on My NHS
for people to access and we are also launching £100,000 My NHS open data challenge for the
best apps and ideas that harness that information for the benefit of NHS patients.
So I wanted to give that by way of a follow‑up.
But I want to look forward to some of the things that we want to make happen in the
medium-term and even in the short‑term in the NHS. Again thinking about that 70th anniversary
that we have next year. And I believe that historians of the NHS will look at the first
three decades of this century as being highly significant in very distinct ways. I think
they will say that the first decade was really the decade when we decided to sort out access
and waiting times. The Government at that time deserves huge credit for bringing down
the waiting times both for urgent and emergency care and elective care and those are under
pressure at the moment but we must be very, very clear that we are not going to sacrifice
the hugely important progress in what was, I think, the access decade for the NHS.
Then I believe that this decade, perhaps born of some of the tragedies we have had to deal
with at Mid‑Staffs, Morecambe Bay and Southern Health, will be seen as the quality and safety
decade, the decade that we decided in the NHS that quality and safety have to be at
the heart of everything we do. And again, there is much more to do but I think that
we are making some progress.
What about the next decade? I believe, because of technology, it will be seen as the patient
power decade. The decade when the master‑servant relationship that existed for three millennia
between doctors and patients will be turned on its head and patients will use the information
that becomes available at their fingertips to exert real control in a way that will transform
the prospects, particularly of people with long‑term conditions, but actually of everyone.
And so what can we do to set up the NHS for this patient power decade? Well I have set
my friends in NHS England eight challenges which I want us to deliver for all NHS patients
by the end of next year. And I just want to run through what those eight challenges are.
The first challenge is to make sure that there is a fully functioning version of 111, available
through apps or online to all NHS patients by the end of next year. Now we know from
pilots that we have done in North London, Leeds, West Midlands and Suffolk, that when
you transfer NHS 111 services online it is safe. We also know that there is a channel
shift of around 6%, so around 6% of users switch to online, they prefer to use online,
we think it may be greater than that, there are of course some people who find it easier
to be open online, if you have got questions for example about *** health, there are
obvious advantages with an online service.
But we want this to be available to all NHS patients. And, in particular, we want people
to be able to access symptom checkers online. But there is something particularly exciting
that this can unlock, which really would be a world first for the NHS. That is if we can
marry an online version of 111 with people's GP medical records, obviously with their consent,
so that a 111 symptom checker can ask you smart questions. So if you are a diabetic
it can ask you questions about your diabetes. If you have long-term conditions it knows
about those. It can ask you age‑specific questions, sex‑specific questions and so
on.
And that would mean that you could have a smart Q&A service which would mean much more
accurate diagnosis, much quicker diagnosis and a much better service for patients. Also
of course a cheaper service for the NHS. So 111 online for all NHS patients.
Challenge number two. We made huge progress in giving people access to their GP record
online. And when I became Health Secretary five years ago we didn't have any sharing
of GP medical records, now the summary care record is available in most hospitals. That
is a great step forward. We want people to be able to access their own medical record
in a meaningful way, their full medical record, through an app. And why is this? It is partly
to help people who want to learn more about their own conditions. It is partly because
we know from parts of the United States where this has happened that medical records become
much more accurate when this happens because patients actually notice mistakes in medical
records. But it is also partly from the simple patient safety benefit of having a record
of all your interactions with the NHS in one place. So that if you turn up in an A&E department
on your holiday in Cornwall or the Lake District, you could actually show a doctor what those
interactions are.
Now initially those interactions will obviously only be your GP interactions but what we want
to move towards is everyone being able to look at all their interactions, as simply
as you can look at your entire order history on Amazon for example. And that's something
that will have enormous patient safety benefits.
Challenge number three is to make sure that we really make it easy for people to book
GP appointments online. At the moment we book about one million GP appointments a month
online. We want to double next year the number of online appointment slots for GPs. And part
of this is to link into the new models of care that are increasingly being offered by
GP surgeries. Part of it is also to reduce administrative pressure on GP surgeries where
a number of tasks that are currently done by administrators could actually be done online.
The next one is to really ramp up the booking of repeat prescriptions online. We have about
two million of those every month and we want to increase that dramatically. This of course
has huge patient safety benefits, but also huge convenience benefits for people with
long‑term conditions and will tie into a big new campaign that we are putting together
in the next few months to reduce medication error. So that's the next challenge.
Then something that I think will make a real difference to the sometimes very challenging
debate about use of data and people's data sharing preferences. So at the moment we have
a big debate about whether we should have an opt-in or opt-out system in terms of people's
anonymised data being used for medical research. We want to transform that debate for NHS patients
by saying that whatever your preferences are, can you go online at any time, access your
medical record and through an app change those preferences, in one direction or another.
But it is your decision and we’re going to make it very easy for you to do that. We
will be only country in the world that does that.
I think it will make people feel much more comfortable that we are respecting their wishes
when it comes to data sharing.
Something else that this gives us an opportunity to do is transform the debate on organ donation,
where there is also a big debate about opt‑out and opt-in. We think it should be as easy
as loading up an app on your smartphone to change your organ donation preferences. And
that's something that we are uniquely positioned on, and we are very keen to take steps to
boost the number of organs available for transplant. We think this is a very easy to way to do
that. It gives us also the opportunity to prompt people to express a preference actively
through technology that they might not otherwise do.
And then, and this is going to take us a bit longer to get absolutely right, but this gives
us also the chance for people to express their end of life preferences online. And in particular
that crucial piece of information which is whether people would prefer to die at home
or in a hospital setting. Which if we can get that information early enough and get
it agreed early enough then it means we can give a much, much better end of life experience
to our patients and that's something that we think we can do and will make a big difference.
And then finally and perhaps the thing that will make the biggest practical difference
is for people with ongoing conditions who are the biggest users of NHS services. Through
the work of Matthew Swindells, Juliette and the NHS England team, we are developing a
suite of apps that are not built by the NHS but they are checked and approved by the NHS
as being relevant to the whole panoply of long-term conditions from dementia to diabetes
to COPD to whatever. And what we want to do is to allow apps to quiz people's medical
records, so that, for example, if you have diabetes and you are put on an exercise programme
by your GP, if you give your consent then information from your Fitbit can find its
way through an app on to your medical record so that you can have a discussion with a doctor
and maybe a more honest discussion you would like about how much exercise you are actually
doing.
But this I think will be very transformative, all these things obviously have to happen
with the consent of patients.
Two final things to mention, first of all, if the NHS is not there for everyone, it is
nothing. That is what the NHS is about and we recognise that not everyone is comfortable
using a smartphone. So we will always make sure that when we introduce new services there
is a face‑to‑face or telephone alternative for people who don't use smart phones, but
we also want to recognise how many, particularly older people, actually do want to get online.
We have already trained up 400,000 people to help them get online and I can announce
today that we will be rolling out over the next three years another 20 digital inclusion
hubs to further support that.
Something else we will be doing to help people go online is making sure that people can use
Wi‑Fi across the NHS estate. That's been rolled out across primary care this year and
secondary care next year. And so that will make a difference, and then
the second thing I want to mention is this of course was the year of the NHS cyber-attacks.
I want to thank NHS staff who did a fantastic job in limiting what could have been potentially
catastrophic damage when that happened. But, we can never be complacent. We have to recognise
that we still have a lot of work to do to earn the public's trust that their patient
data is safe with us.
So in July the Government announced its response to the National Data Guardian and CQC report
on data security, we have announced ten new data security standards, a £21 million investment
to protect our trauma centres from cyber-attack. And some new national support for unsupported
Microsoft systems that were part of the original problem that caused the cyber-attacks. But
that is a very important final point to make.
Let me just wrap up by saying this - it is really exciting. I think everyone who is here
at Expo is excited about the potential of technology. But in the end technology always
has to be our servant and not our master. And what is it that we are all trying to do,
we are trying to build the safest, highest‑quality healthcare system in the world. And as we
grapple with the challenges of resources, the challenges to improve patient safety,
the challenges to improve quality, the challenges of changing consumer expectation, technology
can be our friend if we recognise that it is a means to an end and not an end in itself,
and that end is safer, healthier patients.
Thank you very much. [Applause]
>>Richard: Thank you very much indeed Jeremy, we have got time for just a couple of questions
which I will take them together. Yes, please. One, two. And can we have a mic heading your
way please.
>>Question: Mr Hunt.
>>Richard: Can we bring the microphone up please.
>>Question: My name is Aysha, I'm the Commissioning Manager for continuing healthcare for Greenwich
CCG I know you have talked about all the eight online things that you are...
>>Richard: Can you speak into the mic please?
>>Question: How do you think people will, especially poorer people would access telephones,
and also how would they access training on using all these apps and those technologies?
>>Richard: So just to paraphrase the question, so how would people who are from more disadvantaged
parts of the community be able to access the new services that Jeremy has outlined today
and second question please.
>>Question:, Hi again Mr Hunt, it’s Marsha, I have complex physical and mental health
needs and I have just got this digital thing that I'm trialling for diabetes, it's really
good because instead of pressing, you know having to take my sugars I just scan it and
it is really, really good. However it is still trial, it is not available yet on the NHS,
yet I'm doing it all the time and it is actually monitored, I'm really conscious of it where
I was always forgetting to do it and thanks for all the good work you are doing by the
way.
>>Jeremy: Thank you very much. Let me just do those two and maybe I couple do a couple
more after that Richard. But first of all, one thing to be absolutely clear, and this
is of course our great USP is that all these services are available, and will be available
completely free of charge to all NHS patients. So that is why it is so exciting, because
lots of other countries are doing aspects of the things that you have seen here but
I'm not aware of any other country that is offering them universally to an entire population
of 50 million people. But of course there is another reason why it will help all NHS
users, which is that get this right and it can actually save a lot of costs, so the 6%
of people who use the 111 app rather than speaking to the call handler save the NHS
money, that is more resources for more doctors and nurses and that is where the benefit is.
Marsha I'm really pleased that your diabetes device is helping you. I think we have a failure
in our information, which means that we don't commission as smartly as we might. Because
I'm sure that, I don't know the exact device, but if we gave all diabetics in the NHS devices
like that it would probably save the NHS a lot of money because they will stay healthier
for longer and in the end, as you know what we’re trying to avoid with diabetes is amputations
of which we have shockingly high levels. But we don't collect as CCGs enough lifetime information
to be able to actually prove financially that's the case. And that is what we are in the process
of doing, so that we can start to invest. And I think that this is the underlying purpose
of the Five Year Forward View, to start to be much better at investing in prevention
rather than cure, which is what this is about.
>>Richard: I’m afraid we do have to bring it to a close there and finish on time. Can
I very much thank the Secretary
of State for Health, Jeremy Hunt.
>>Jeremy: Thank you very much.