Background on Telestroke Over 4,000 people suffer a stroke in Cumbria and Lancashire each year, but thanks to Virgin Media Business this particular NHS trust is hoping to save patients lives by giving specialist doctors the tools to deliver quicker care, by consulting with patients remotely, using digital video conferencing. Patients across Lancashire and Cumbria showing signs of an acute stroke can now be assessed by any of the 15 specialist doctors working in the area, using a video conferencing facility. Patient records and scan images can also be instantly accessed, as part of the virtual face-to-face consultation. The video conferencing solution called Telestroke , allows the NHS trust to harness the power of our technology to take the stroke specialists to the patient, rather than moving the patient long distances, around rural areas, to where the specialists work. This new and speedier way of consulting, increases the chances of early diagnosis and ensures stroke victims are treated with specialist medication, as quickly as possible. It is estimated that with the increased opportunity for early diagnosis: 24 more patients in the area will survive a stroke each year than without the new service 40 more patients are expected to recover with no symptoms or significant disabilities 30 less patients per year will require full-time care As a result, there will be an annual estimated cost saving of £6.6 million in local social care This change in technology is also expected to save the NHS over £8 million a year . The new service will deliver standardised care across eight hospital sites in Lancashire and Cumbria, enabling patients in smaller hospitals to access the highest quality care, regardless of location. Dr Paul Davies, Consultant Stroke Physician, North Cumbria University Hospitals NHS Trust said: “For some patients who have a stroke, treatment with a clot busting agent, called Thrombolysis, can be very effective and can lead to reduced levels of disability. “Thrombolysis treatment can only be given to patients within 4.5 hours of the onset of their stroke so time is core to this treatment and Telestroke will help improve the speed of patient diagnosis .
In 1993, around the same time that Windows looked like this...
...and the state-of-the-art in mobile phones was this Nokia 1011..
… and this man was creating...
...this tool which would eventually bring (the new) world wide web to so many...
… this company ran an add campaign described what it perceived as the future. That campaign...
...was called the “You Will” campaign. And as something of an introduction to this talk I thought it would be interesting to show you a couple of add from that campaign. Remember this is from 1993
So that’s six pieces of the future that AT&T envisaged back in 1993. I’ll leave it up to you to decide if the predictions came true or not or weather AT&T did bring them to customers.
Today, I’m not going to talk about six things, I’m only going to talk about one thing
In fact, when I think about it, it won’t look like one thing...
… it will look like three things...
...but it’s really just one thing.
And the first of the three things (which is really one thing) is Telephony. Now you may think you already have telephony - and you would be right - but only up to a point.
And that point is that the telephony you have right now works only in context of your corporate PBX environment, the PSTN, or more commonly, both.
To remind us of why this pattern is so common lets remind ourselves of some of the key elements. Arguably, the most important element is the one that says zero - that once you have paid for the PBX calls that remain “on net” are essentially free
So, what if you want to to make a pan-public sector call? In theory - because everything is “on net” for the PSN - does that mean that you can make “esentially free” calls across the PSN? Unfortunately not (although there have been trials in Hampshire and Kent). Well not yet, anyway.
Today, whenever you make a pan-public sector call you break out to the PSTN. Clearly - and this may sound odd coming from a Telco - this is less than ideal.
Which brings me back to my first point. We - the PSNGB and the Cabinet Office - are going to make telephony work across the PSN. This will be done by...
Once that’s complete it will be possible for suppliers to deploy telephony solutions that stay “on-net” within the PSN. When that happens your intra-public sector call minutes vanish into your bandwidth (the capacity you have deployed to the site). The economics of which are more favourable. That’s point one.
The second of the three things (which is really one thing) is Video Conferencing. Now you may think you already have video conferencing - and you would be right - but only up to a point. Now instead of putting another picture of the PSN up, I am (in the interests of time) just going to talk about the dependencies and what we are going to do about them.
Once that’s complete it will be possible for suppliers to deploy video conference solutions that enable conferences right across the public sector - and stay “on-net” within the PSN. That’s point two.
The third of the one things is mobile working. When most people think of mobile working they think of remote access - and you probably have that already - but you are missing a trick (and you may not even know it)
Once that’s complete it will be possible for suppliers to enable mobile working environments across the PSN. That’s point three. So… in summary...
Well, that’s the goal. NB: “Everything Everywhere” was already taken.
Hand back to Neil
Local authority ICT functions responding well to conditions of severe austerity Twin challenges of doing more for less while playing a key role in transforming their organisations and deploying technology to allow services to be maintained while budgets are falling. Four key priorities for ICT managers: Protect ICT’s budget share by promoting the role, achievements and credibility of the ICT function - technology is key to public services surviving austerity without significant service reductions Focus on reducing total costs of ownership. Different procurement practices mean variations in ICT costs remain very wide. Review insourcing vs outsourcing. Long term contracts can inhibit change, including the ability to exploit opportunities like cloud computing and shared services. Review information and technology strategies. These must align with and support the corporate strategy, and the corporate strategy should take advantage of the potential of technology
PSNGB Innovation Workshop PSN Summit September 2012
PSN Innovation Stuart Higgins Howard Inns Neil Mellor Keith Smith
PSN Innovation today“Innovation is theprocess of identifying,testing, implementing “Innovation is oftenand spreading ideas that given complexadd value” definitions. We prefer the simple- Dept of Business Innovation one: new ideas that& Skills work” – Geoff Mulgan
PSN Innovation todayCategories Savings Efficiencies (sharing) TransformationNetworks Regional WAN Extending WAN to partners Mature PSN Departmental WAN Aggregation Service provisionInfrastructure Sharing data centre from/with Making data centre Mature PSN services neighbouring Authority services available via PSN Using infrastructure to and/or G-Cloud assist local businessesApplications and Using local partner instance of Making hosted applications Mature PSN servicesprocesses i.e. CareFirst or voice available via PSN and/or User centred services application G-Cloud Incubating local growth Using local partner voice or Streamlined processes hosting service Common front/back end Reinvented services
ExampleCambridgeshire PSN• Significant savings through a different way of delivering services, working together and economies of scale through aggregation• Savings of 50% for the county council, >£1m pa on networking costs• “A significantly enhanced service for less money… also facilitates further savings, because fewer circuits are needed”• Other savings: up to 30% on telephony and 20% on perimeter security services• Not just about saving money, also better services by joining up agencies and sharing assets including buildings• Issues: Migrations sometimes been slower than planned, overall transition went well, no unplanned outages, minimal disruption• Learning: • Takes time to build trust and align intentions. “You cant set up that… to work positively in a couple of weeks” • Bringing organisations together is catalyst for new and challenging ideas, “Getting together and sharing requirements is a very good way of saying ‘weve not thought of doing it that way before and challenging that."
ExampleSurrey PSN• Surrey County Council will save more than £5m after agreeing a deal to connect at least 20 public services in the South East• Annual saving of up to £750,000 adding up to £5.25m• Replacing up to 40 separate networks in Surrey and Berkshire with just one• Scope: internet, telephony, WAN, LAN, contact centre and UC• Savings of up to 20% on current contracts expected for other public services. These include Surreys boroughs and districts, Berkshires councils, fire and health services and a university• Will expand to include libraries and schools, with potential for other organisations, such as more emergency services and voluntary groups, to join• "We firmly believe public services should be seen as a single team co-operating to make taxpayers money go further wherever possible”
ExampleInnovation in Governance – Dorset PSN• Governance remains a primary concern for those considering a PSN approach• A ‘lead partner’ is required• Decisions and innovation strategy need to be driven by the partnership• Formal structure helps incoming partners understand how their voice will be heard
ExampleWhittington Hospital NHS Trust• Speeding discharge rates and saving about £150,000 a year• Savings in bed costs and penalty charges for discharge delays• Freeing up more than 400 bed days a year• Moved from being one of the worst performing trusts in London for delayed patient discharge to one of the best• Spreadsheet and teleconference - 15 people from patient discharge, hospital social work and community services teams• "Initially there were a lot of sceptical people, but I championed it and people who were sceptical in week one were no longer sceptical in week two, because it was very easy to use."• Hosted ‘cloud’ audio-conferencing service costing £6,000 pa
Example Innovation case study: Telestroke The Cumbria and Lancashire Telestroke Network is a collaboration between six Acute Trusts and seven PCTs in Cumbria and Lancashire whose aim is to deliver 24/7 stroke thrombolysis for patients with acute ischaemic stroke in a rural area.• Over 4,000 strokes in Cumbria and Lancashire each year• The solution allows the trust to harness the power of our network technology; patients showing signs of an acute stroke can be assessed by specialists, using a video conferencing facility. Patient records and scan images can be instantly accessed, as part of the virtual £8m consultation. expected• 24 more patients in area will survive a stroke each year savings• 30 less patients per year will require full-time care• Annual estimated cost saving of £6.6 million in social care• Anticipated NHS savings of over £8 million a year.
What’s coming“The future is already here, itsjust not very evenly distributed”- William Gibson
Definition: To work from potentially any office in the public sector. To be able to sit down at a random desk, plug in and have access to your usual corporate services (including the phone on the desk) plus any local services that you may be entitled to - but not those local services that you are not entitled to.
Dependency StatusJoined up networksAgreed interworking standardsFully functional pan-PSN IPTelephonyCommon federated authenticationCommon model for networkadmission control
Dependency StatusJoined up networks ✔Agreed interworking standardsFully functional pan-PSN IPTelephonyCommon federated authenticationCommon model for networkadmission control
Dependency StatusJoined up networks ✔Agreed interworking standards ✘Fully functional pan-PSN IPTelephonyCommon federated authenticationCommon model for networkadmission control
Dependency StatusJoined up networks ✔Agreed interworking standards ✘Fully functional pan-PSN IPTelephony ✘Common federated authenticationCommon model for networkadmission control
Dependency StatusJoined up networks ✔Agreed interworking standards ✘Fully functional pan-PSN IPTelephony ✘Common federated authentication ✘Common model for networkadmission control
Dependency StatusJoined up networks ✔Agreed interworking standards ✘Fully functional pan-PSN IPTelephony ✘Common federated authentication ✘Common model for networkadmission control ✘
Innovation in public services • Innovation is essential in public services • Improvement - better for less • Transformation - radical approaches to major issues • Technology key to surviving austerity without significant public service reductions (Socitm, Sept 2012) • Balancing needs • Multiple stakeholders • Rising expectations • Rising cost of delivering services • Potential of new technology • Risk, reward and reliability“If it fails, admit it frankly and try another. Butabove all, try something.” Franklin Roosevelt
Innovation - some lessons learned• Collaborate. Forget the normal boundaries and bring together talented people inside and outside your organisation. Most public innovations are initiated by middle management or front line staff• Create an active support system. Develop a culture that supports, nurtures, and develops innovation in a systematic way.• Change agents are needed. Senior leadership support for innovation is important but you need specialists throughout the organisation.• Use new technology. Forward-looking organisations should identify and embrace new technologies. Disruptive technology may look sub-optimal today, but can rapidly overtake established products.• Open up the innovation process. Attract talent and ideas from people everywhere, across geographies and sectors.• Provide a full range of support for innovators. Innovators often need more than just capital. Deploy a wide range of supports, including mentorship, information and advice, connections and networks, and public visibility.• Tap the creativity of “lead users”. Lead-user innovation encourages consumers and end users to modify existing products and services or to create entirely new ones that meet their specific needs. http://www.monitorinstitute.com/downloads/IntentionalInnovation-FullReport.pdf
Barriers to public services innovation• Motivation and incentive – lack of rewards for adopting/adapting• Lack of market test/competition – high degrees of monopoly• Risk, reward and reliability – need to balance but may pull in different directions• Demand side weak – driven by low reward for success and high negative impact for failure• Multiple stakeholders – often unable to articulate what they want• Supply side weak – sources of knowledge there but little help to use insights from learning (Bessant, Richards, & Hughes, 2010)
Perceived constraints - that aren’t• “Standards stifle innovation”• “Standards force a lowest common denominator approach”• “You can’t buy a solution until the standards have been defined for it”• “It’s too complex - complex systems tend to fail”• “I’m different”