By Tony O’Brien, Columnist and Former Director General at HSE, Ireland
With countless reports about the pressures on our health and care systems and with winter fast approaching there is a clear need to reconsider how we deliver care, particularly for those with long term health conditions or debilitating illnesses.
The concept of anticipatory care is not new – along with personalised care, it became a fundamental ambition of the English NHS’s Long-Term Plan published in 2019 and is a key feature here in Ireland within the delayed Sláintecare programme (a ten-year plan for whole system reform and universal healthcare). This model of care aims to prevent and delay chronic disease by taking a proactive approach. It identifies people who are living with long term conditions and helps them to manage their condition to reduce the risk of their health worsening, and to prevent them from needing to attend hospital.
I recently chaired a webinar hosted by HN, a predictive health company, which looked at anticipatory care, how it currently works and how we can achieve a successful approach to it.
In the webinar Dr Adrian Hayter, GP and National Clinical Director for Older People at NHS England, highlighted that supporting people to live well and for as long as possible is not just about healthcare delivery – it is much wider than that encompassing the wider determinants of health outcomes. Through looking at over 50 systematic reviews and randomised control trials between 2015-2020 NHS England has been able to outline an interventions framework and approach for systems. He suggests the first important point is to be data-driven to consider the needs of the population being targeted, including those people living with frailty or multiple long term health conditions.
Dr Hayter highlighted that population health intelligence, which is one of the core strategic aims within England’s Integrated Care System, enables systems to work out where to put resources (such as workforce), in order to have the biggest impact in terms of outcomes on that population.
It is also important to be person-centred in approach and consider what matters to the individual in terms of the care and support they need to manage their health condition(s) as this will vary between individuals. We know that a catch-all approach won’t work in anticipatory care.
The importance of digital and data
More is possible than people imagine. As Dr Hayter highlighted, general practice has the richest data source available. If we can use the analytical tools at our disposal, we can not only predict who might become a future user of unplanned care, but we can then prevent it from happening in the first place through an anticipatory care model.
Take for example the non-urgent visits to primary care and A&E - these not only create a strain on the system and are a poor experience for the individual. Taking a targeted data-driven approach to identifying who would benefit the most from anticipatory care has shown to be effective in preventing unplanned care activity.
As Creenagh Williamson from HN highlighted in the webinar, “what is key is being able to identify the right people at the right time” who could benefit from anticipatory services such as clinical coaching.
HN, a predictive analytics company, has proved that by using AI to identify rising risk of becoming a high-cost, high-need patients, and then provide them with the personalised support they need to improve their outcomes through a health coaching approach, they can reduce care consumption. So far this year, HN’s evidenced-based approach can prevent 1 in 3 unplanned care events.
The evidence behind how anticipatory care generates value
It’s relatively easy to deliver the same intervention to a group of people but in order to generate real value and deliver personalised care, it’s important to understand the differing contexts of that particular population.
This has been highlighted in HN’s delivery of clinical health coaching in Hertfordshire. HN began the service by understanding the population of the Primary Care Network (PCN) and what unmet needs its patients had. By using a data driven approach they realised that the 5% highest consumers of GP appointments consumed over a third of the clinical resource. As a result, they were able to reduce primary care use of supported patients by 39% and reduce their interaction with the clinical team by 41%. By taking a proactive approach to primary care, the PCN was able to make sure there was less unmet need which had a positive impact on the individual and the system by making more appointments available to others and releasing clinical capacity.
But there are barriers to spreading this model of anticipatory care – it has to be targeted and effective for resources to be allocated from already under-pressure reactive services. It is also a cultural shift, as Creenagh describes “for some patients during health coaching this is the first time they’ve been given permission to take control of their own health and it might be difficult to shift that way of thinking about managing their condition”. Health coaching gives patients permission to take control of their health. It can be difficult in a reactive system to shift to that way of thinking and allow the patient to manage their own condition.
How can we support wider spread and adoption in Ireland?
The NHS England Fuller stocktake report outlines a new vision for primary care and will be a key resource for how we develop and implement frameworks for the delivery of anticipatory care in the future. In time this is likely to become a key part of the Enhanced Community Programme in Ireland too. The report highlights the need for population health intelligence, which is having an understanding of what your population needs and using approaches like clinical health coaching to empower people to take more control over their health. Ultimately, we need a personalised care approach to prevention. As the UK Personalised Care Institute aptly puts it; ‘don’t ask what’s the matter with someone, ask what matters to them’.
The panellists compared not taking action now to embed personalised, anticipatory care as analogous to not acting to mitigate climate change. Every year we delay the transition the greater the challenge becomes. Heading into another winter our over-pressurised urgent and emergency care services in Ireland need change today as do our population who clearly need anticipatory, data-driven and personalised models of care.