Binita 2

Health Innovation Manchester (HinM) - a blueprint for an integrated and innovation driven health service?

Wednesday, April 15, 2020

We spoke about the Health Innovation Manchester initiative with Dr Binita Kane, the consultant leading the respiratory programme of this ambitious city-region-wide partnership.

We know that Manchester is a slightly special case. Could you explain a little more about how HInM works with the other systems in Greater Manchester (CCGs, Clinical Network, Trusts etc.)?

In 2016 Greater Manchester became the first City Region to gain devolved control of its health and social care budgets - a sum of more than £6 billion annually. This has provided the means and the opportunity to do things differently to meet the needs of our 2.8 million residents and drive forward integration of health and social care.

Health Innovation Manchester (HInM) was formed in October 2017, by bringing together the former Greater Manchester Academic Health Science Network (GM AHSN) and Manchester Academic Health Science Centre (MAHSC) under one single umbrella, which also represents Greater Manchester’s wider research and innovation system.

In practical terms what this means is, that previously disparate bodies including; commissioners & providers, government bodies, research bodies, industry and wider partners, are now working together to improve outcomes for nine shared priorities, including respiratory, meaning the system is working as a ‘whole’ on the same problems. 

 

We also have a memorandum of understanding with the ABPI (the body that governs the Pharmaceutical Industry) meaning that we can work with industry partners in an open and transparent way to work towards our shared goals. This has been one of the biggest advantages in my view and it has transformed my opinion of working with industry, as I now work largely with the medical/science arms which are non-promotional. I have seen the huge advantage of having a symbiotic relationship. One of my roles is to ensure that any projects done in collaboration with pharma are promoting best practice and are focused on improving patient outcomes. I have learnt a great deal and can give many examples of the benefits of working in this way.

And what are key objectives?

Our goal is to take innovation, which could be anything from a new drug, a workforce solution, a model of care to the latest in digital technology, and drive it at pace and scale into healthcare systems across Greater Manchester. We know that the average time for an innovation to currently be embedded in the NHS is around 17 years, which is wholly unacceptable. How often have we seen fantastic examples of care with good outcomes in one place, to find a short distance away patients experience different standards with poorer outcomes? We are keen to revolutionise this through a carefully designed pipeline approach, aimed to rapidly scale and spread good practice and reduce variation in outcomes.

What is the staffing structure like at HInM?

HInM has a board with executive representation from the all of the main organisations across Greater Manchester. Staffing is made up project teams including clinicians, project managers, data analysts and administrative staff. Clinical leadership is key, our CEO, Professor Ben Bridgewater, is an ex-cardiac surgeon, we also have a medical director who is a GP and Consultant Physician leads for the various projects.

What have been some of the biggest challenges you’ve faced in getting HInM up and running and achieving your goals?

I can only speak of my experience in setting up the Respiratory programme, this is spread across a large geographical footprint. We have spent a significant amount of time engaging with and building relationships with the 10 local CCGs, clinicians and other local organisations. The main challenges are no different to what is experienced elsewhere in the country; having the infrastructure to deliver transformation, including IT, data management, workforce and project support, having clinical leaders in each locality who can champion and drive forward innovation and integration of care and ensuring that the system (rather than keen individuals) are driving change. The advantage of working with HInM is that we are enabling change in all of these areas, particularly intraoperability between IT systems, but progress can be slow and some areas are outside of our circle of influence. However, we have made great strides since 2017 and are starting to see some really positive change.

And what do you think have been the biggest achievements?

From a respiratory point of view, embedding virtual clinics into the Manchester locality (across 80 practices) and having this approach adopted by Greater Manchester is a huge achievement. I can’t tell you how difficult it has been to co-ordinate primary and secondary care diaries, prove the value of the project and influence its adoption at scale. It has taken 3 years of hard work but we are getting there!
Establishing a digital platform for severe asthma services in the North West, working with Pharma to roll out third party pharmacy COPD reviews, adoption of PINGR (a quality improvement tool using machine learning for Primary Care) and roll-out the MyCOPD app across 7 CCGs, have also been great achievements.

Is there anything exciting in the pipeline that you can tell us about?

We are embarking on a project to reduce the inhaler carbon footprint across Greater Manchester, we are in discussions about an expansion of MyCOPD technology to include other disease areas including asthma, heart disease and diabetes at scale. We are exploring the concept of ‘digital motivation’ to onboard patients onto these sorts of apps and encourage self-management. We also have an exciting project in the pipeline looking at community pharmacy-led reviews for high risk asthmatics, so there is a lot going on.

What advice would you give to other areas trying to reduce variation across a large area?

We are lucky in Greater Manchester to have had incredible civic leadership. The high-level buy-in and the whole system approach to improving health outcomes is essential. Engagement of the front-line and building relationships between organisations is also essential, one can have high level strategies, but without engagement at ground level nothing will change. My advice is that one needs both top-down and bottom-up support to enable change on this scale. It’s also vitally important to pay attention to and invest in infrastructure to deliver change including IT and project support.