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1 August 2019 by Terry Whalley

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I entered the NHS five years ago after spending 20 years in the private sector, latterly in banking. From finance to health is an unusual career trajectory but it helped me bring into the NHS some valuable insights, particularly about attitudes to change.

Before joining the health service I worked for Barclays bank and was there at the time the Office of Fair Trading cracked down on the banking practice of delaying payments to customers. You probably remember a time when cheques sat in the ether for several days before the payment arrived in your account.

The crackdown dismayed much of the banking industry, but my team at Barclays saw it as an opportunity to gain a competitive advantage by speeding up the payments process. That resulted in better service for customers, and we reaped the benefit.

As someone with a keen interest in bringing healthcare closer to home, and particularly point-of-care testing, I’m familiar with the anxieties that the pressure to change can bring about. But I should first say what I mean by point-of-care testing. In my view it’s the practice of accessing an accurate and meaningful diagnostic, wherever the individual is treated. That could be in an acute ward, in A&E, a GP surgery, even at home – in fact, especially at home. It’s the opposite of taking a sample and sending it away for analysis, and we don’t see enough of it.

We spend more than £4b on healthcare across Cheshire and Merseyside, so if we can truly capitalise on the benefits of point-of-care testing the savings could be huge.

Three key areas

And there are three areas that are particularly exciting on the care-closer-to-home agenda. The first is antimicrobial resistance. It’s difficult to overstate the threat posed by the growing resistance of microbes to the use of antibiotics. Imagine what it would be like to go back to a time when people were killed by common infections. Part of the problem is that GPs will often prescribe antibiotics to be on the safe side or because they come under pressure from patients. If we could introduce a reliable swab to test a patient in the surgery we could reduce subscribing levels and the benefits would be enormous. It’s something we’re keen to explore in Cheshire and Merseyside.

The second area is liver disease. The enzyme test we current rely on can only identify liver disease when it’s at a late stage. If we could introduce an ultrasound test – which is completely non-invasive – we could identify problems much sooner in the disease path and reverse the damage and certainly deliver better outcomes.

Finally, atrial fibrillation – an area in which I know the Innovation Agency is making significant inroads. This heart condition can lead to stroke – often the worst type of stroke - and we know there are thousands of undiagnosed cases in our region. A simple wearable device is capable of reading an individual’s data and matching it with another set of data to predict the likelihood of stroke. The benefits of this kind of technology are almost incalculable.

Reasons for resistance

The resistance to change is something that can be frustrating but doesn’t surprise me. I think there are a number of reasons for it. Firstly, there are legitimate concerns about the costs associated with point-of-care testing, so someone who wants to make the case for change inevitably faces an uphill struggle. The NHS is also a fragmented organisation and that leads to concerns about consistency, and fears that point-of-care testing may give different results in different settings. Then there’s the difficulty of actually connecting the results to an individual’s care record. There’s also the challenge posed by our tendency to work in silos and take an interest only in our immediate area of work. And, finally, there’s the very understandable fear of change. We’ve all felt it.

Huge potential prize

Without wanting to sound glib, I’m convinced that pressure to change – such as the pressure I experienced at Barclays – can be the spur to radical improvement. I tend to think of myself as a disruptor: when I worked in business I was willing to leverage different technologies and change the way the company operated. I have the same attitude now I’m in the NHS. There are, despite what some might say, plenty of people in the health service who share my outlook and lots of evidence that people are prepared to be early champions of change.

What’s required is for people to see the end-to-end patient pathway rather than focus on the narrow part of the patient journey they’re involved with. If we can do that – if we can unlock the potential in our most innovative talents - the prize is enormous.

Terry Whalley, Director of Delivery for Cheshire and Merseyside Health and Care Partnership

@TerryWhalley

Terry Whalley was a speaker at the Innovation Agency Eco19 event. You can catch up with all our speakers’ presentations and podcasts from that event here: http://bit.ly/2WsupgH

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