The Download: Opening up the FDP

Lord Darzi’s report into the state of the NHS came to a succinct conclusion with regards to technology: that the last decade has been a “missed opportunity” to prepare the NHS for the future and that the health and care system still struggles to “fully realise the benefits” of information technology.

Attention will now turn to what the Labour government plans to do about it.

While there is lots of talk about large national IT projects and the potential of things like artificial intelligence to revolutionise the NHS, there is a growing consensus that the NHS shouldn’t overlook existing successful projects developed at the local level.

One such project is CIPHA.

The Download sat down with outgoing Mersey Care chief executive Joe Rafferty and CIPHA senior responsible officer Jim Hughes to talk about the programme, its achievements, and how it could shape services in the future.

What is CIPHA?

The Combined Intelligence for Population Health Action programme was launched early in the pandemic, in April 2020, when Mr Rafferty was asked to be the out-of-hospital lead for Cheshire and Merseyside.

Recognising that a lack of connected data was making it difficult to track covid infections, it became clear there was a need for a “persistent, longitudinal record” as opposed to a record that was made up of “bits of episodes” of care.

The integrated care board (as it is now) received funding from NHS England, and from this, the first instance of CIPHA was developed on the Graphnet platform.

Within three months, 40 organisations had access to dashboards providing real-time analysis on capacity and demand, epidemiology, and population stratification.

By November, Cheshire and Merseyside was the first area in the country to get data on covid testing, which allowed local authorities and the NHS to collaborate to target resources where they were most needed, such as placing mobile testing units in areas with higher rates of positive tests.

Building on the initial success

Four years on from its inception, CIPHA now covers 11 integrated care systems and a population of around 17 million people.

Key to this rapid uptake — in addition to the extraordinary circumstances of the pandemic — was the collaborative, “bottom up” approach that was “tight on governance” and “light on bureaucracy”, according to Jim Hughes.

He said: “We had established a collaboration model, so something that was developed in one place could be easily shared for the same platform to be used elsewhere. So, each of us were developing and learning and also deploying from other places.”

The principles behind the platform, too, proved popular. As opposed to simply providing dashboards that displayed information, the pandemic drove home the need to use these insights to take action.

What emerged from the initial deployment of CIPHA was a model that “moved us from a kind of NHS thinking about [itself] as see and treat services, into one that could actually be about prediction and prevention”, Mr Hughes added.

One piece of work undertaken by CIPHA was to identify people in Cheshire and Merseyside with COPD and other long-term respiratory conditions, and then narrow this cohort to include people who may be living in poorly insulated or cold homes. From there, these people were directed to services where they could gain access to winter fuel payments, reducing the pressure on the front door during winter.

Joe Rafferty said this was a key facet of the programme: that there would be no use case to simply collect data “unless we’re clear what the action is going to be at the other end”.

He said: “The ‘A’ [in CIPHA], people often think is analytics. The analytics is built in, but the ‘A’ is about action.”

A model for the future?

With national attention firmly on big projects like the Federated Data Platform, there is a fear in some areas that locally developed solutions like CIPHA or the Advanced Data and Science platform in Greater Manchester will be overlooked.

The Mersey Care team are more optimistic, though, and hope that CIPHA has demonstrated its usefulness as a model more than a platform.

Mr Rafferty said: “It’s scalable, it’s safe, it’s dynamic. And it has, I think, created a sort of core belief that population health management has moved from talking about it in a poetic sense to talk about it in a sense of real prose.

“Here’s the detail. Here’s what you can do with it. Here’s how it moves your agenda on. Here’s the benefits for patients, the benefits for clinicians. And actually, here’s a potential benefit for the public purse as it goes.”

Despite a push from NHSE for trusts to adopt the FDP, and health secretary Wes Streeting signaling an intention to speed up its rollout, the team behind CIPHA are not concerned about a “tanks coming into town” situation.

Jim Hughes said conversations have taken place between NHSE and places like Cheshire and Merseyside and Frimley, which both use CIPHA.

He said: “Instead of just saying the FDP will come along and undo everything you’ve done and start again, what [NHSE] is saying is, actually, if you’ve got all this good stuff, what can the FDP do that’s additive, not replace?

“[NHSE] said, we don’t want to reinvent. We don’t want to take all your risk stratification and dashboards and then produce them in exactly the same way for exactly the same audience, because that’s going to take us years. Why don’t we build something which we can offer, because we’ve got access to national resources… then we can start to look at capacity and demand in a different way to support the work you’ve already done.”

The hope, he said, is for a “hybrid” approach that can help support the FDP population health management component to be a success.

One suggestion made by Joe Rafferty was to put CIPHA on the FDP “bookshelf” and allow other organisations to use it, but “not necessarily the data”.

Already, he said, the principles and core components of CIPHA can be replicated anywhere and do not necessarily need to sit on a Graphnet deployment like in Cheshire and Merseyside.

FDP may be an opportunity to showcase local innovation such as this – or similarly ADSP in Greater Manchester or Dorset Intelligence and Insight Service in the South West – and bring it to a wider audience that may benefit from it.