Presentation by Terry Whalley, Director of Delivery, Cheshire & Merseyside Health & Care Partnership at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.

1. The importance of POCT
to
The Cheshire & Merseyside Health & Care Partnership
Terry Whalley
Director of Delivery
@TerryWhalley @C_MPartnership

2. Terry Whalley
• 20+ years driving technology enabled transformation in Private Sector
• 10+ years experience in Healthcare (private & public sector)
• 2014 entered the NHS as part of DH sponsored Exec Fast Track Programme
• 2015 Programme Director for Black Country Alliance, including Pathology
Consolidation
• 2017 Director of Strategy at North West Teaching Hospital
• 2018 Director of Delivery, Cheshire & Merseyside Health & Care Partnership
I offer my views on the importance of POCT as we seek to ensure long term
sustainability of services and develop new models of care

3. Context
A key enabler to our Vision ‘People in every community in Cheshire and
Merseyside are supported to start well, live well and age well.’
• Improving the health of the population
• Improving the quality of care
• Delivering care more efficiently
A simple ‘triple aim’ underpins this programme of work
• Reduce unwarranted variation
• Remove unnecessary duplication
• Standardise to maximise quality & value
Health & Care Partnership for
Cheshire & Merseyside

4. The world has changed since the NHS began 71 years ago.
As we approach next 70 years, we are facing 5 paradoxes;
1. We’re getting healthier, but we’re using the NHS more & more
2. Quality is up, but we’re becoming more transparent about gaps &
mistakes
3. Staff numbers are up, but the pressure upon them is increasing
4. The public are highly satisfied with the NHS, but concerned for its
future
5. We must change to future proof, but the ability to do so risks being
impeded and/or overtaken by today’s challenges
Health & Care Partnership for
Cheshire & Merseyside

5. NHS Long Term Plan
The Long Term Plan for the NHS contains many references that raise the
profile of POCT;
• The number of patients referred for diagnostic tests has risen by over 25% over the last 5 years
• By 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to
three-quarters of cancer patients….. ‘accelerate access to diagnosis’
• Immediate review of the current cancer screening programmes and diagnostic capacity ….
modernise and expand diagnostic capacity
• introducing a new faster diagnosis standard from 2020 ….. underpinned by a radical overhaul of the
way diagnostic services are delivered for patients …. from 2019, we will start the roll- out of Rapid
Diagnostic Centres to upgrade and bring together the latest diagnostic equipment service
• By 2023, diagnostic imaging networks will enable the rapid transfer of clinical images from care
settings close to the patient to the relevant specialist clinician to interpret. This open standards-
based infrastructure will enable both the timely image reporting, as well as the development of
large clinical data banks to fuel research and innovation
• By 2023, we will have introduced new diagnostic imaging networks, Pathology networks by 2021.
This infrastructure will enable the rapid adoption of new assistive technologies to improve and
speed up image report

6. Health & Care Partnership for Cheshire & Merseyside allows
a more robust approach to doing five key things;
1. Local leaders coming together as a team
2. Developing a shared vision with local communities and the broader
region
3. Programming a coherent set of activities to make it happen
4. Overseeing execution
5. Learning & adapting ‘In preparing for battle I
have always found that
plans are useless, but that
planning is indispensable’’
- Dwight D. Eisnehower
Health & Care Partnership for
Cheshire & Merseyside

7. Building Blocks
 Employment
 Environment
 Housing
 Education
 Family and
Friends
 Life skills
 Healthy living
 Healthy schools
 Social and
emotional
health
 Smoking
 Physical activity
 Balanced diet
 Weight
management
 Transport links
 Open green
space
 Communities
30/50k Populations
 Screening for BP /
AF / Lipids
 Nicotine
replacement
 BP Screening
 Management of
Hypertension
 Symptom
management
 Community heart
failure
 Cardiac
rehabilitation
 Diagnosis
 AF case finding
 End of life care
 Medicines
management
 Long term care
management
 Social prescribing
30 60 900 Time in Minutes
15
15
30
60
90
1/3m Populations
 Critical
Intervention
 Cardiac Surgery
 Decompensating
heart failure
 Aortic surgery
 Valve surgery
 Complex pacing
 All age congenital
heart disease
 PCI / PPCI / ACS
 Electrophysiology
 Cardio-oncology
 Endocarditis
250/500k
Populations
 Invasive Cardiac
Diagnosis
 Planned
interventions
 Acute care
 Primary stroke
medial
thrombolysis
 Thrombectomy
 Primary pacing
 Cardiac Imaging
 C.T.
 MRI.
50/100k
Populations
 Invasive cardiac
diagnosis
 End of life care
 Radiology
 Syncope (TLOC)
clinics
 Home I.V.
 Phlebotomy
 Stroke services
 Sleep services
 Oxygen therapy
 Genetic
screening for FH
Left Shift Models of Care
PREVENTION DETECTION MANAGEMENT
HOME COMMUNITY HOSPITALS
JOINED UP LOCAL POLICY MAKING (min unit alcohol/sugar) / MECC / HAPPY HEARTS WEB SITE / DIGITAL

8. Primary
Community
Social
Care
Secondary
Care
Self
Care
Complex
Patients Tertiary
Care
Making every contact
count
Social
Prescribing
Pharmacy
First Contact
Asset based community
development
Improved Job Opportunities
Health Coaching
Pharmacists
ANPs Mental Health Workers
`Hospital` specialists
working in the
community
Integrated Team
Working
Outreach support from
tertiary to secondary
care
Prevention
Risk
Stratification
Placed Based Care
`CVD` and Other Boards
Standardised Pathways / Configurations
Acute Sustainability
Reduce duplication and un-warranted variation
Managing Care in New
Primary Care Networks
Prevention / Detection and Improved
Primary Care Management
Care Navigators
New housing
Economic Growth
Same Standards / Same Care /Same Services
Healthy Living Pharmacies Cardiac Rehabilitation Expansion
Fire and Rescue Service
Health apps / technology
Community Heart Failure Expansion
Thrombectomy
New ACS Pathway
Endocarditis Pathway and MDT
access
Configuration of Pacing Services

9. Health & Care Partnership for
Cheshire & Merseyside
• In 2019/20, The HCP is investing more than £2m in improving our diagnostic
capability
• We spend more than £4b across C&M on health care, so the prize associated
with POCT transforming models of care is immense
• We are looking at POCT through a new patient value lens, looking at the end
to end pathway rather than the isolated cost per test
• We want to enable more rapid clinical decision making in the process of
diagnosis (rule-in or rule-out), treatment choice and monitoring, prognosis and
operational decision making
• This is fundamentally about enabling better outcomes, better experience and
better use of resources, recognising the value of diagnostics at the heart of
new models of care
• POCT can enable diagnostics to become a value based proposition at the heart
of new models of care
• This in turn will help us to improve the quality of care and so improve the
health and care of the population. Enabling benefits of genomics and big data
and the ability to enable diagnostics closer to point of care where possible.
‘’You get the best efforts
from others not by lighting a
fire beneath them but by
building the fire within
them’’

10. Cheshire & Merseyside
Pathology Network

11. General Theory of Pathology
Delivery*
Tier 4
Tests:
National
Centre(s)
Tier 3 Tests:
Regional Network
Hub(s) covering
population of c2m+
Tier 2 Tests:
Essential
Service Lab(s)
Tier 2a: ESL+
Tier 2b: ESL
Tier 1 Tests:
Point of Care Testing
(POCT) in any Location
Informatics Integration
Governance Integration
Financial Integration
Workforce Integration
Risk Integration
Laboratory Leadership
Selectively Coterminous, meaning
that tier 3 & 4 tests could either be
centralized in an isolated unit or
distributed among existing selected
laboratories
*Credit Martin Meyers

12. Why Point of Care Testing is
important
Telling the story of ‘Why’ to win hearts & minds
1. Sustainability
2. Resilience
3. Fragmentation, ‘tests done anywhere are available anywhere’
4. Unwarranted Variation
5. Unnecessary Duplication
6. Infrastructure
7. National Imperative
8. Big Data
9. AI / Machine Learning
10. Future Vision for value based proposition v volume based commodity

13. How does POCT enable value in
Health Care?
• An Australian study found that opportunistic, community-based screening for undiagnosed
AF, using a pocket sized ECG monitor and smartphone app was cost effective.
• Medicines Adherence Testing evidence for patients with hypertension shows prevention of
518 heart attacks and 305 strokes in 10,000 adult male patients
• Rapid Molecular Testing for Flu and CPE enabled 95% reduction in bed-days lost as a result
of IPC related issues
• Detecting evidence of scarred liver enables patients who would not be identified via
traditional enzyme tests to be routed into interventions that can halt or reverse CLD.
• Smart Assistive Technology with real time information gathering could enable crisis
avoidance and better management of disabilities and long term conditions
• Wearables, connected to provide ‘big data’ with the application of ML/AI could enable
rapid, effective, early diagnosis in ways we have not even started to imagine

14. Thanks for Listening
Questions?
Terry Whalley
Director of Delivery
@TerryWhalley @C_MPartnership