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Technology adoption
in health – is the NHS
ready?

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Background
Martin Wakeley
 Experienced NHS Leader
 Lead CEO lead for SPFiT
 Part of the PwC team that introduced the independent sector to the NHS
 Executive Director of Circle – opened their award winning hospitals and led
the acquisition of Hinchingbrooke
 Siro of the largest NHS investment in BI in the UK
 Turnaround director across numerous hospitals and CCGs
 Co-founder of Nth Dimension
Nth Dimension are backed by Tech Mahindra
Set up to innovate and disrupt in Healthcare
Set to create joint ventures across the NHS and universities
Focus on interoperability and data exchange
Create new markets

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AI and Healthcare
Technology and AI is
growing at a rapid pace in
healthcare
AI spend in USA healthcare
is projected to increase
from $660m in 2014 to $6
Billion in 2021 and that’s
probably a gross
underestimation (Frost &
Sullivan)
The number of companies
utilising machine learning
algorithms in healthcare is
growing rapidly.

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The pace of innovation is exhilarating
Google Deepmind is collaborating with London hospitals
such as Moorfield's
IBM Watson and Medical Sieve are gathering significant
momentum
Sense.ly and Babylon are changing the face of AI
Atomwise is accelerating compound research
Zorprisma Publiek know more about the efficacy of clinical

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Worldwide healthcare demand is increasing
0 20 40 60 80 100 120 140 160 180 200
Africa
Rest of Americas
South East Asia
Europe
Eastern Mediterranean
Western pacific
Population and healthcare resource
Median Age % > 60 Doctors per 10,000 Nurses per 10,000
The median age in Africa
is 19, in Europe its 39
In Africa the % of people
over the age of 60 is 5%,
In Europe its 21%
The UK population is
projected to grow by 9.7
million over the next 25
years
By 2039 8% of the UK
population will be > 80 yrs.

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There are not enough qualified staff to meet growth
0 2000000 4000000 6000000 8000000
Africa
Rest of Americas
South East Asia
Europe
Eastern Mediterranean
Western pacific
Clinical Staff
Actual Nurses Actual doctors
0%
50%
100%
150%
200%
0
1000
2000
3000
4000
Per Capita spend growth
Per capita Spend 2002 $ Per capita Spend 2013 $ Growth
There are over 7 million nurses in Europe for
a population of 906 million
There are just under 3 million doctors in
Europe
The OECD reports that 36% of UK doctors
were born overseas
Spending in South East Asia grew by over
130% in 10 years
Spend in Europe grew by 98%
Western Pacific spend grew by 172%

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The NHS is under considerable pressure
The NHS faces a £16 Billion
shortfall in its funding by 2020
Existing productivity gains cannot
meet the gap
The deficit in 2015 was a
record £2.5 Billion and its not
improving

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Social care is in a similar position
To meet current demand the
budget for social care will
need to double in the next
15 years
The largest area of spend is
in physical support for the
over 65’s

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Interesting developments?
Artificial intelligence can automate significant elements of
how healthcare can be delivered
IBM Medical Sieve can triage thousands of images and
direct the radiologist to the image requiring their attention
Remote monitoring can observe patients and take action
more more effectively than a human being
Avatars can engage with patients and anticipate events and
take preventative action. Recent studies suggest that
patient are more open with Avatars than real people
Genomics and other initiatives are pushing ahead the
precision medicine agenda along with anticipatory medicine

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Where could AI help?
NHS 111 receives 33,000 calls a day
Each triage call takes an average 15 minutes
61% were directed to primary care
GP Out of Hours recorded 5.8m interactions in 2013/14
3.3m were face to face
Each patient cost £7.50
In 2013/14 there were 41.1m imaging examinations of which
22.6m were x-rays

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Off the shelf solutions
Solutions such as Sense.ly and Babylon can replace some
of the services provided by 111 and NHS Direct. They can
also link into OOH services, linking patients to providers or
services without the need for human intervention.
IBM Medical Sieve could provide on-line automated triage of
plain film x-rays 24/7, freeing up staff to focus on more
complex tasks
AI can provide routine follow up and monitoring services for
patients post operatively or replacing face to face follow up

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The NHS has to adopt new solutions
Demographic pressures and the impact of reduced
availability of clinical staff from overseas will force the
requirement to explore non-human modes of delivery.
The productivity requirement for the NHS to deliver against
its targets is at a level higher than any other comparable
healthcare system has ever delivered.
The process to schedule and deliver care is based upon a
model that has hardly changed since its inception in 1948

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However?
The NHS has a poor track record with the adoption of
technology
The current situation means that cash for transformation is in
short supply
There is a shortage of technology advocates pushing
solutions at a national or local level
Procurement often requires reference sites but where are
they in the UK?

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Why is adoption slow?
• Who is going to pay for the technology?
• Product or service?
• Who is going to benefit from the technology
• What are the procurement and governance and regulatory
issues that need to be addressed?
• Who is responsible for adoption?
• How do you identify and address professional
parochialisms?
• Identifying and managing across inter organisational
tensions
• Working with patients and getting their support

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There are emergent opportunities
GP federations are becoming new providers and they don’t
have legacy business models or investments that prevent
them from innovating.
Interoperability solutions will gather pace and will generate
longitudinal data sets at massive scale supporting AI
adoption and accelerated innovation
New care pathways are dependent upon real time data
collection and analysis to direct patients towards digital
solutions

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Rose doesn’t seem to be eating
Rose – We’ve been
alerted by the NHS to
your fall - We’ll send
someone to help make
your home safe for you
Shared Data
Rose – We’ve let our
colleagues know in
Social Care that there
could be some side
effects to your
medication...
Rose is anxious after her fall
Can you tell the Fire Service that Rose now stores oxygen bottles at home...
Can you alert your staff to the aggressive dog that lives next door to Rose...
Rose – The hospital has
alerted us about your
recent fall. Your GP will
be in contact soon after
your discharge.
Rose – The NHS have
alerted us to your
disability. We’ll issue a
blue badge and a bus
pass automatically....
Rose – Your daughter,
who lives in Australia is
now able to apply, order
and pay for services
directly for you...
Rose – your blood
pressure seems to have
gone up overnight – is
everything ok?
2
3 6
4 5
8
7
1
10
9
This is possible now

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What next?
Lets get doctors and nurses excited
Lets get patients and their relatives excited
Lets create business propositions that make sense to the
people who pay
De-risk failure but reward success
Identify the top 10 advocates and adopters
Be flexible

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Please contact
Martin.Wakeley@nthdimension.com

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