Social Prescribing – what are the practical issues for NHS England

Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.  the KingsFund have a helpful article here
I am the Founder and CEO of BriteLives.  BriteLives is about providing activities and connections that help people avoid the NHS and its expensive statutory services. For us, it’s all about staying fit and well.  If someone does become unwell then, of course, they should go and see someone at their primary care practice.  But there are other options that the NHS could offer and signpost.
A comparison between current models of prescribing and treatment in primary care and how social prescribing might work shows some stark practical challenges.
Let’s take the example of someone feeling depressed, it’s common mental health issue that people feel increasingly able to acknowledge.   A doctor could prescribe antidepressants, (64.7 million were prescribed in 2016, 31million in 2006, that’s106% growth)  in fact, the Pharmaceutical companies profits are predicated on this behaviour.
It’s easy for the GP to do so, the workflow is found in the GP System, the Electronic Prescribing System,  the paperwork of the NHS and its Green Prescriptions forms, the Pharmacy systems and NHS payment systems.  All pretty much automatic and easy for the GP and patient to follow.
But, if the Doctor wanted to refer the patient to a BriteLives service; like a wellbeing course such as  http://www.britelives.com/listings/growing-wellbeing-6-week-course/ (this is a practical course that helps people address their depression without the recourse to drugs).   How might the Doctor go about that?
  • There is no listing of local services in the GP system.
  • No method of auto referral, it’s “not at the touch of a button”.
  • No reporting system telling the service provider someone is on the way
  • Not even a referral letter that can be printed or emailed
  • No Payment method for the service provider.
  • No system to make sure the final payment is only taken on the delivery of the service.
  • No Copayment system should the patient want to do more or add services
  • No way of innovating new ideas such as:
    • A reward split, GP pays £20 for service,
      • £1 goes to GP to encourage use of non-pharma
      • £15 goes to the provider for the service
      • £4 goes to the patient for completing the course (it can be seen as covering transport costs or the like if you don’t like the “bribe” aspect of this)
I believe that NHS England needs to become serious about centring social prescribing care around the individual and the local community. Developing an effective social prescribing policy and strategy would be a good start.  At present, there isn’t one and progress will be slow.

Cyber Security in Healthcare – a primer for the Board.

What should  CEOs and boards understand:

  •  Protection of key information assets is critical
  • How confident is the Board that the hospital’s most important information is being properly managed and is safe from cyber threats?
  • Are you clear that the Board members are likely to be key targets?
  • Does the Board have a full and accurate picture of:
    • The impact on the Hospitals reputation, if the existence of sensitive internal or patient information held by the Hospital were to be lost or stolen?
    • The impact on operational services if our online services were disrupted for a short or sustained period?

Exploring who might compromise information and why

  • Does the Board receive regular intelligence from the Chief Information Officer/Head of Security on who may be targeting hospital information and IT, their methods and their motivations?
  • Do the Board encourage the technical staff to enter into information-sharing exchanges with other organisations in the sector and across the economy to benchmark, learn from others and help identify emerging threats?

Pro-active management of the cyber risk at Board level is critical

  • The cyber security risk impacts public confidence, reputation, culture, staff, information, process control, brand, technology, and finance.  Is the Board confident that:
    • They have identified the key information assets and thoroughly assessed their vulnerability to attack?
    • Responsibility for the cyber risk has been allocated appropriately?
    • Is it on the risk register?
    • Does the Board have a written information security policy in place, which is championed by the Board and supported through regular staff training?
    • Is the Board confident the entire workforce understands and follows it?

Buidling the right thing

This week we will be focussing on understanding in more detail what our customers actually want.   Too many startups build stuff that no one wants.  It usually happens for one simple reason – they don’t get out of the office enough and speak to customers.   You can help us by filling out this short questionnaire. And there is a chance of winning an Amazon voucher.

There are two important hypotheses that startups need to test:

  • Their Growth Hypothesis-how are we going to attract customers and partners?
  • Their Value Hypothesis  – does what we build meet the minimum needs of our customer?

Last week we had the opportunity to talk to the CEO of AgeUK Lambeth, as an important partner of BriteLives we felt we needed to understand their challenges.   But we also wanted to discover if they can help us find local services for the BriteLives platform.   In doing so we were able of capture a little more understanding of the data to support our Growth Hypothesis.

 

Too many unchecked assumptions in NHS Information Technology.

How many assumptions do we make when setting out a plan to change or build something?  It’s OK to make assumptions but it not OK if we don’t check that they’re correct.   Looking back on my time in NHS England I can now see that very few of the assumptions made were ever checked.   Here are some questions you might think about asking before you set out to do anything.   This one checks some assumptions about searching for such services.

This set checks some assumptions we might make about people  searching for services.

Do you look for local services?

  • How often do you look for local services?
  • Where do you look?
  • Why do you bother?
  • When did you last look for a service?
  • What service did you find?
  • Where did you find that service?
  • When you found a relevant service did you book or use  it?
  • When did you last book a service?
  • What are the implications to you personally of not finding services?
  • When was the last time you failed or ran out of time to find a service
  • Where or what else have you used to find services?
  • Who else shall I talk to and is there anything else I should have asked?

What to avoid

  • Talking about your idea and getting compliments about it
  • Don’t get caught up in their ideas for your product/service or change idea
  • Generic Claims, “I always/never…
  • Future Claims – “I could/would…
  • Hypothetical feedback – “I might/could…

 

The bottom line of this one, if people aren’t looking for services don’t build a service that provides a look-up service.

So, three things for any Senior Responsible Officer (SRO) in the NHS  to do before a Project kicked off:

  1. Make sure the assumptions of the Project are identified.
  2. Test those assumptions with a number of audiences, users old and young,  organisations and specialists etc.
  3. Make sure you have validated any learning from tests you make.

If you can’t do these three things; then don’t start.

Quick thought:  Did anyone test the assumptions made before the Electronic Prescription Service was built?

BriteLives.com

Hello, we’ve had an idea that may change the way older people access local services. It stems from the challenges I faced caring for my Mother, but I guess you may have spotted that.   We  have been at it for eight weeks now and we have learnt a thing or two.

Lesson 1:   Read The Lean Startup and once you have done that, read it again.  It’s not about Startups it’s about constant innovation.  It will save you time and more importantly money.

Lesson 2: Work out, as concisely as possible, how to describe your idea.

We started with:

The leading marketplace to make the provision of personal, household and community services easier and more accessible, helping older people and their families live happier and more connected lives“.

We are now:

BriteLives.com is the place where you can find and review local and personal services for older people.

Cutting out those words was a great deal harder than writing them in the first place.

Pitch it to friends and to yourself.  Make sure you do it slowly, accent the name of the Business. Something like:

BriteLives.com  (pause) is the place where you can find  and review (pause) local and personal services (pause) for older people.

Lesson 3:  Join an innovation accelerator.  You may be sceptical about the value, don’t be. You can’t think of everything, so let someone else force you to think about the relevant things and set some deadlines for you. It will accelerate the development of the idea more than you could imagine.  We are part of BGV and wow what a difference they have made already.

Quick Test: Can you guess what BriteLives.com does?