Civil War, Heart Failure, Sex and Big Data

The World Economic Forum report published earlier this year sets out the issues  affecting healthcare across the globe over the next few decades. At it’s heart are three assertions. To become sustainable, health systems are going to have to focus on:

  1. The use of “big data”
  2. The way places affect the health of people
  3. Seeing  patients as assets not problems

These are themes close to my heart. You can see the full report here.

Today’s blog focuses on the first issue data and using “Big Data.”

I was lucky enough to be asked to open Big Data Week in Leeds a couple of weeks ago. This was a great intiative looking at how different groups can bring data they have together to drive insights about how healthy Leeds is. A sort of Joint Needs Assessment with a twist. Details here. My talk covered the importance of transparency, the power of data to bring clarity, insight and intelligence; and big data and the future of Leeds.

The importance of transparency. In 2006 I was leading a review of the Department for International Development on behalf of the Cabinet Office. Part of the review required trips to areas of conflict. We ended up in Nepal, where a “low grade” conflict based on ethnic lines was rumbling along. At a remote school in the Himalayas, we were greeted by the headmaster and local officials. The school was part of the aid programme. Along the walls were details of the children, their cultural roots, their attendance and grades. This was transparency in action, if a bit hard on the kids not doing so well. I asked the head about the approach. He talked about the importance of transparency and accountability to the local community. It was powerful stuff.

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“The rebels came to see us one day. They asked for a contribution to the cause. Violence lay behind the threat. I pointed to the walls. I told them that their children were in school as much as anyone. They had as much resource and the same books. And that they were getting good grades too.

I asked whether instead of us giving them money, perhaps they would make a contribution to the school.”

“That was brave!” I said.

Yes. I had also called  the army so knew they were on their way. Data are strong but a contingency was essential”

Data can be presented to bring clarity and impact. Chris Bentley’s work on health and primary care undertaken in 2010 showed clear and stunning disparities in health. He looks at how access to primary care and the support for chronic disease management affects patients.

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In Birmingham, for example, you can see that according to GP lists, the prevalence of heart failure was higher in the outer areas of the City. (See map on the above left)

If you look at mortality data, you can see that mortality from heart failure was highest in the inner city (Seemap on the right). The data reveal that we need to look at why patients are not accessing primary care until too late.
This then requires us to look at the insights – is it the way services are designed? The attitudes of patients? Doctors? Similar analysis appear in other parts of the country and link to the inverse care law – I am not picking on Birmingham, justusing it to illustrate a wider point!

Using multiple data sources, real insight from patients, segmentation and analysis we can begin to make a difference.

Intelligent data can bring insight. Patients can make very rational decisions. We often just don’t like them.

As a commissioner, one of my targets was to reduce teenage pregnancy. The long term trend was down and numbers were small. However, the were a few areas of hotspots. The public health team analysed a range of data. These suggested that the hotspots clustered around a couple of schools. They also found that access to pharmacy was limited around those schools, particularly on a Friday evening and Monday morning. Insight from teenage girls suggested that they needed to be able to access prophylactic and emergency contraception at those times as they knew they may end up drinking too much and taking risks. We might not like this but by looking a pharmacy access first, then attitudes to sex and relationships, we could consider how we further reduce teenage pregnancy.

Big data are the future – as set out in the World Economic Forum Report. The multiple factors of innovation, economic problems, demography and expectation need data, intelligence, insight. We certainly believe this in Leeds and are placing this at the heart of our Leeds Innovation Health Hub. More details here.

All health partners, the universities, the council, local industries and the national bodies based in Leeds have signed up to our ambition to make Leeds a global city for health informatics. We believe the conditions in Leeds make this a unique place to make this a reality. The blurb on the press release says, we have:

  • More focus on clinical leadership in the NHS will drive up quality, improve health outcomes and enhance the patient experience
  • The city is in a unique position as home to academic expertise, public and private healthcare organisations, national NHS infrastructure and wider city technological and business sectors
  • Patients will be empowered to take increasing control of their health through better access to their own data to inform their decisions
  • Healthcare investors to Leeds will be able to test concepts to ensure they are widely deliverable
  • The ecosystem will support a focus for inward investment leading to economic growth and to become a partner of choice for local, national and international businesses wishing to innovate in the health sector

And why not. Leeds has more health informaticians per square foot than many cities in the World – a function of having the national programme for IT, the NHS Information Centre, NHS England, Health Research in health institutions and the two universities, the two largest providers of primary care  IT, insurance companies….. Marry that to a city leadership that is trying to focus on communities; that has good progress on risk stratification of patients, supported self care and integration; and wants to be the Best City in the UK; and we may just get there.

So, big data are the future. Our lives are already shaped by this in how we shop, eat, travel, communicate…..industry is ahead of us in this regard. We need to catch up, overtake and use big data, place and people’s assets for a sustainable NHS.

As the Chief Executive of Leeds Community Healthcare NHS Trust, I want us to be a part of these changes. For my organisation and for the people we serve. Because the realities set out in the World Economic Forum Report will come all too soon.

Thanks to Peter Laflin for the invite and everyone at Big Data Week 2013.

2 thoughts on “Civil War, Heart Failure, Sex and Big Data

  1. Some great examples shared here around data, its value and how it can sometimes be conflicting.

    The NHS is well known in the research world as being data rich and insight poor. Events like Big Data Week in Leeds demonstrates two significant steps forward, 1 is that data is being seen by more as valuable to effect change and 2 that many different services, teams, providers need to work with each other and each other’s data to get an effective patient outcome.

    My above comment leads on to 2 further problems, you must be geared up to change once you know what needs changing and that data ownership and lack of willingness or policy to share is a far greater barrier than the technical ability to create the valuable view/insight in the first place.

    With experience of working with Teenage Pregnancy management information I’m not sure how this new drive to utilise data can stop history repeating itself having taken 4 years to go from 18 counties in Wales eventually using a single system for a truly Big Data view of the needs, best practices, hotspots and training needs to ensure the young people had best access to knowledge and contraception.

    Once again thanks for the laying out your thoughts in this way helping us see the thirst for data and its value that many of us striving to ensure improves the healthcare that is on offer…

  2. Thanks Nick. Yes – data sharing and information governance issues are paramount. Legitimate concerns around these must be overcome. That is often a big hurdle….we then need to act. That’s where Leadership comes into play, backed by a clear startegy and action. That’s what makes Leeds such a good place – we have the commitment of leaders to act.

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