New technology can improve the health services delivered to millions of people

Rachel Cashman, Head of Collaboration for Excellence, explains how NHS England will deliver the 3millionlives programme:

As we all know, we have a growing elderly population, a growing number of people with Long Term Conditions (LTCs), and growing numbers of people with multiple LTCs.  That is putting an increasing strain on already stretched NHS resources.

One in three people are living with at least one chronic condition, such as asthma, heart and lung disease, arthritis, hypertension and diabetes – and half of people over the age of 60 have one. 

One in three of the population in England amounts to just over 15 million people with an LTC – and it’s estimated that by 2025 this will rise to 18 million.

People with LTCs are the biggest users of the NHS, accounting for around 50 per cent of GP appointments, 64 per cent of inpatient appointments and 70 per cent of inpatient hospital beds – meaning 30 per cent of the population accounts for 70 per cent of the spend.

If we continue to manage care in the same way as we do now, we can expect to see an estimated £4bn of additional cost on the NHS in five years.

In the new NHS and social care landscape, we need to find new approaches and service delivery models that will deliver more efficient and effective care.
We need better health outcomes and innovations that support people to live more independently, and we know that technology enabled care services can transform peoples’ lives. 

The challenge we face now is integrating these technologies into the NHS and wider health and social care services, so they become a mainstream service, not a side-line proposition.  And this is where the 3millionlives programme, delivered in the right way, can really make a significant difference.

So, what has NHS England done since taking over delivery of the programme on April 1?
Our first action was to conduct a rapid review of 3millionlives implementation to date, as there was a significant risk the programme as previously delivered would not hit the interim ambition of 100,000 new users in 2013. The review resulted in a need for a significant shift in strategic direction for the 3millionlives programme, including a redefined vision, mission and objectives for delivery, and bringing on board strong clinical and technological advocacy and a reframed partnership with Industry.

An early outcome from the review was an agreed change in governance arrangements, so that 3millionlives will be delivered going forward through a matrix approach of clinical advocacy, service improvement and technology strategy – making it a true partnership and synergy within NHS England.  This is articulated in the vision statement for 3millionlives, which NHS England published over the summer. 

There is now tri-partite accountability for the successful delivery of the programme at Director level, with co-ordination for delivery and implementation of the programme residing with my team, the Collaboration for Excellence Team.

Another early action from the review was the recognition that we needed to ensure that we are working together with industry as a true strategic partner in the delivery of 3millionlives, rather than simply as a transactional supplier.  

Given the significant changes in the NHS since it was introduced, we felt that it was timely to look at the concordat and the membership of the Industry Group to ensure it was still fit for purpose under the new NHS England vision for delivery of 3millionlives.

Under our redefined vision for the programme, we intend to engage with, work with, and enable the 3millionlives brand to be associated with a much broader range of technology solutions and organisations.  We therefore needed to ensure that industry is working with NHS England as a true strategic partner in the delivery of 3millionlives.   We agreed with the Industry Group that it would cease to operate in its current form, and that members would adopt new ways of working with the NHS, social care and third sector moving forward.

NHS England has now convened a much wider ‘Integrated Care for 3millionlives’ Stakeholder Forum, bringing together Industry – including all of the original members of the Industry Group – commissioners, providers, colleagues from Social Care, the Third sector, and Local Government and housing, to form a collaborative group to collectively debate and resolve key system-wide issues around the delivery and implementation of the programme.  

This is the first time all of the different stakeholder groups with an interest in delivery of 3millionlives have been brought together to look at issues collaboratively.  The Forum met for the first time in October.

The programme will also now look much more widely across the system, to harness where the energy lies locally for delivery of 3millionlives.  It will also now include a much broader range of assistive technologies – telehealth, telecare, telemedicine and telecoaching.  The previous delivery model only focused on the first two of these.

The programme is now much more closely aligned with both the integrated care and technology strategy agendas, and the programme has been repositioned as ‘Integrated Care for 3millionlives’.   It will be delivered as a unique collaboration between the NHS, Social Care and Industry to support integrated care, management of Long Term Conditions, and the enablement of 7 day services; an announcement about which is imminent.

So what’s next?

Working collaboratively with our stakeholders, we have identified four key areas where we need to either demonstrate progress, or have in place a clear plan for delivery by the end of this financial year.  These are:

  • Improving information governance
  • Developing commissioning skills and capability
  • Improving procurement levers and frameworks
  • Developing measurement and metrics

We have established four rapid Task and Finish Groups, one to progress each priority area, and have appointed co-chairs for each. 

We propose the findings and recommendations of these Task and Finish Groups inform the publication of a 3millionlives NHS England Delivery Plan for 2014-17, which we plan to publish by the end of March 2014. 

I’m delighted that we have such a range of experts with such a breadth of experience driving the progress of these groups forward. 

Already in the last 6 months, we have come a long way in moving delivery of the 3millionlives programmes in the direction we all want.  For the first time, this truly feels like a collaborative effort to make 3millionlives a success.


rachel-cashmanRachel Cashman
Head of Collaboration for Excellence, NHS England

Rachel leads on creating the conditions and incentives for the behavioural changes needed to foster a culture of collaboration and excellence within NHS England, across the wider NHS and between healthcare stakeholders, demonstrating new ways of working to deliver health outcomes, quality care and economic growth.

She utilises evidence and research of network leadership to spread new ideas, build and orchestrate communities that foster learning and knowledge exchange, and achieve effective cooperative action and peer support.  Rachel coordinates across NHS England and its industry, third sector and social care partners the Integrated Care for the 3million lives programme enabling new investment and operating models for the self-management of long term conditions and clinical collaboration underpinned by new technologies.

Prior to joining NHS England, Rachel was the Head of the Innovation Health and Wealth (IHW) programme in the Department of Health have worked as part of the NHS Chief Executive’s Review of Innovation and co-authored IHW.  This was a role on secondment from worldwide pharmaceutical company Pfizer where Rachel lead on policy and public affairs in the areas of UK R&D and Science Policy, Oncology, inward investment and Life Sciences sector engagement with UK Department of Business and Department of Health, product and strategic value proposition and QIPP,  NHS partnerships and advising the business on the strategic operating environment in the UK.

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