Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Speakers:
Dr Srikanth Bellary†, Clinical Director for Diabetes, Heart of England Foundation Trust
Farid Bidgoli, Associate Director of Market Access, MSD
Panel:
Hanno Ronte, Partner, Deloitte
Peter Pigden*, Patient Representative, Insights for Care
Declaration ofInterests:
Noneof the aboveparticipantshavereceived an honorariumfor thispresentation
†Honorariumsand expenseshavebeen provided previously foradvisory servicesto MSD butnotin relation to Insightsfor Care
*Expenses havebeen provided to supportattendanceattheInsightsfor Caregovernanceboard meetings
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2. For over 150 years, we have known that data can be used to transform
care
“The proposed [data gathering] would enable the mortality in
hospitals, and also the mortalityfrom particulardiseases,injuries
and operations,to be ascertained with accuracy, and these facts,
together with the duration of cases, would enable the value of
particularmethods of treatment and of special operations to be
brought to statisticalproof”
- Florence Nightingale,1860
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3. Nightingale identified that poor health, and not wounds, caused most military
deaths…use of her data reduced all-cause mortality from 42% to 2%
Evidence BasedPolicy‘
RoyalCommission on the
Health of the Army’
Reducedrates of
Infectious disease
All-cause
mortality
decrease : 42%
to 2%
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4. The Five Year Forward View identifies that data are central to achieving better
care in a financially sustainable way
• “Flat” fundingwith a need for transformational, disruptive change
• Evidence-based approach to future planning
• Newforms of care provision
‒ Evaluativecomponent fromestablishment
• Data assets to support systemfocus on integrationof care
‒ Quality improvement / audits
‒ Research
‒ Risk stratification
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5. Why Insights for Care?
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6. Diabetes is an escalating national problem1
- 3.4 million patients to 5.6 millionpatients with Type 2 diabetes by 2035/36 in the UK
- 9.8Bnto 16.9Bnof direct costs to the NHS by 2035/36
- 10% to 17% of NHS Expenditure
2010 2015 2020 2025 2030
5m
4m
3m
2m
1m
0m
9.5%
9.0%
8.5%
8.0%
English Diabetes Prevalence2
1. Estimating the current and future costs ofType 1 and Type 2 diabetes in theUK, including direct health costs and indirect societaland productivity costs,DiabeticMedicine,2012
2. AHPO Diabetes PrevalenceModel , November 2012
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7. A pseudonymised data asset to provide a holistic view
of the whole pathway
Primary careSecondary Care
Pathology (LIMS)
E-prescribing
Nephrology
Diabetes
Imaging
Retinopathy
Solihull Community
CDS  Administrative data
– Inpatient, outpatient,
A&E
 Pathology results
 Imaging activity and
scans
 Retinal screening and
results
 Community services
 Inpatient prescriptions
 Diabetes clinic specialist
database
 Dialysisand other renal
specialist information
Other providersof care*
 GP data
 157 indiv idual
practices
– Indiv idual
engagement
and data
agreements
with each
practice
Pharmacy
Celesio
 Retail pharmacy
data
HEFTInformatics-Pseudonymisation
BCHC
Birmingham
City Council
Digital Health
ProviderSystemPseudonymisation
GP1
GP2
GPn
*On goingdiscussionsinrelation to organisational participationin Insightsfor Care
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8. Contributes:
 Data access
 Independence, scientific
researchcredibility
 Cross-setting relationships
 Service redesign
implementation
Contributes:
 Project funding
 Pharmaceuticalexpertise
 Publication support
Contributes:
 Technicalexpertise &
capability
 Information governance
compliant trustedthird party
 Analysis & intellectual
property
 Project management
Insights for Care is a three-way Real World Evidence partnership
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9. Commissioner
MSD
Hospital Trust
Pressing
Issues…
How can I manage the
burden of an aging
population with LTCs?
How can I reduce A&E
attendances of the most
seriouslyill patients?
…demand novel solutions
Which Patients?
Remote Monitoring / Digital Health
Which Model of Care?
Observational Research
Innovative contracting
Evidence
Insights
Partnerships
Innovation
…required to improve
outcomes
PatientOutcomes
Business Model Innovation
Collect PROs
Vital signs
Analytics can provide
the insight…
In which patients can our
medicines have most
impact?
How do my business
models need to adapt e.g.,
‘Beyond the Pill’?
What new public sector
partnerships are possible?
Integrated Modelsof Care
Patient Adherence programmes
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10. Insights for Care can enable clinicians to do more by unlocking the
value of Real World Evidence
• My frustrations as a clinicianindelivering care without adequateinformation andinsight?
‒ What does mypatient populationactually look like? What is the local burdenof disease and
demographic mix?
‒ How are my patients managedin primary care?How oftento they visit their GP? What are their
diagnoses and prescriptions?
‒ Who are my most vulnerable populations?
‒ Where can I make the biggest differenceto my patients’diabetes outcomes withnewservices?
‒ How canI demonstrateto my Trust andCCGthat my new service interventionactually works?
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11. Real World Evidence has the potential to address several key
limitationsof classicalclinical trials
• Currently,there are severallimitations with clinicaltrials:
‒ Inclusion/ exclusioncriteria create anunrepresentative patient group(e.g.,age groups,co-morbidities,
etc.)
‒ Cannot capture factors suchas health professionalbehaviour,adherence to guidelines,etc.
‒ Limitedability to understandimpact on long term outcomes
• Real WorldEvidence canaddress manyof the above limitations:
‒ Provides insights into practicalaspects of clinical care
‒ Allows design of care models that are appropriate for local communities (e.g.,Retinal
screeningfrequency,benefits of new therapies,hypoglycaemia,etc.)
‒ Allows resource investment to drive betteroutcomesthroughongoingevaluation
and improvement
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12. It can help ensure patients living with diabetes have access to the most
appropriate treatment pathway…
• Risk stratificationunderpinnedby analysis of patient demographic and clinicaldata canbe usedto
ensure that treatment pathways arealigned with the current burden ofa patient’s disease andits
likely evolution
0%
5%
10%
15%
< 6.5 6.5 -
7.5
9.5 -
10.5
8.5 -
9.5
>10.57.5 -
8.5
Five-YearMortality by baseline HbA1c
2008 2009 2010 2011 2012 2013 2014
0%
100%
98%
96%
Quartile 2
Quartile 1
Quartile 3
Quartile 4
Survivalby IMDQuartile
Hypothetical data,for
Illustrative purposes only
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HBA1C
Year
Survival
Mortality

13. …And that vulnerable groups of patients do not ‘slip through the net’
0%
25%
50%
75%
100%
45 +40 - 45
15%
35 - 40
20%
75%
30 - 35
40%
25 - 30
50%
20 - 25
53%
15 - 20
54%
< 15
60%
Attend Education
Programme
Structured EducationAttendance versus Index of Multiple Deprivation
• Attendance at structured educationprogrammes drops off sharply forhigh-deprivationpatient groups,
identifying areas where newinterventions have the potential to significantly improve outcomes
Key Target forNew
Interventions
Index modelleddeprivation
%ofPtswithDiabetesaccessing
structurededucation
Hypothetical data,for
Illustrative purposes only

14. Insights for Care also has the potential to quantify the benefits of new
interventions
6
7
8
9
10
11
12
13
36302418120-12-18-24-30-36
HbA1c(%)
Median
Treated with single OAD Treated with multiple OAD
Q3
Q1
• We cantrack glycaemic durability insimplifiedRx pathways – potentially allowingus to quantify the
benefit of more intensive monitoring
Time to Transition to Insulin (Months)
Hypothetical data,for
Illustrative purposes only
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15. The IfC programme can also provide a range of organisational benefits
for Heart of England NHS Foundation Trust
• The Trust recogniseskey benefits forits community anddevelopment of servicesfromthe partnership:
‒ Deeperunderstandingof the community we serve
‒ Maximising the value ofexistingpatient data to inform best care
‒ Tailoring of servicesto improve patient outcomes
‒ Improvedfuture capacity planningandoperationalefficiency
‒ Greaterresearch outputfor wide dissemination
‒ ImprovedManagement against KPIs/ targets
‒ Supportingprofessionaldevelopmentandattracting/retainingtalent
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16. The programme is underpinned by a robust governance framework…
• Insights for Care’s InformationGovernanceprocesses andpolicies have been approved bythe HEFT Caldecott
Guardian and Board, andreviewedbyBirminghamCrossCity CCG
• Our research protocol has beenreviewedandreceiveda favourable opinionby HEFT’s and MSD’s internal
researchethics processes andby the HRA South East Coast Surrey ResearchEthics Committee
• We have also receivedpositive feedback onproject InformationGovernance fromthe HRA Confidentiality
Advisory Committee (CAG)
‒ The CAG confirmed “the data disclosed to Deloitte was not consideredto constitute
confidential patient informationas the identitywould not be ascertainable bythose
in receipt of and processingdata”
• The CAG also gave positive feedbackonthe level of patient engagement in IfC,and
the general governance arrangements inplace
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17. …And a multi-channel approach to external communications
• Patient awareness posters displayedinall HEFT clinics commonly visited
by diabetic patients,communal areas inHEFT and in participatingGP
surgeries
• Patient awareness / opt-out leaflets (withfreepost envelopes)displayed
all HEFT clinics commonly visitedby diabetic patients andin participating
GP surgeries
‒ Available in English and five most commonmonoglot languages in
HEFT catchment
• Patient helpline at HEFT to answer enquiries
• Presence onHEFT and CCG websites*
• HEFT and CCGs communicatingIfC to allGPs (participatingandnot) to
provide awareness shouldtheir patients make enquiries
Note: * Inprocess
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18. Lessons Learnt
Have a shared vision!Drive each other!
Early engagement across
all organisations
Underpin the
collaborationwith
strong governance
Strong project planning
and communications
• Build broadstakeholderrelationships
• Align benefitsto addressingorganisational challenges andobjectives
• Organically growfromone disease areaof interest
• Governance bydesign
• Identify externalexpertiseto support Caldecott guardians andIT
• Patient and public engagementandinvolvement
• Strongproject management withweekly progress calls
• Strongclinicalengagement
• Resourcingcommitmentfromall parties
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19. Thank you!
Questions for the Panel
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