Understanding digital prevention: A conversation with Rima Makarem

The NHS 10 Year Health Plan presents an ambitious and urgent challenge: shifting from treating sickness to prevention, and improving lives for generations to come. We believe in the power of bringing together our experts, NHS leaders, and communities to solve problems once thought unsolvable. Our Q&A series supports this mission by bridging the gap between policy and practice, turning vision into action.

These insights, alongside a survey of senior leaders, shape our digitally-powered prevention report.

What do you see as some of the biggest challenges to delivering the prevention agenda?

I believe that we are working towards a shared understanding of what prevention means amongst all the sectors that influence the wider determinants of health improvement and illness prevention. A healthy population is one where people are supported to remain well so they can get on with their lives. This creates an economically active population, with children being given a good start to life and the elderly living independently for as long as possible. Traditionally the NHS has focussed on treating people and keeping them out of hospital, but has perhaps not always considered individuals’ needs beyond their immediate healthcare.

In my previous role in Milton Keynes, the Council was driving wider population health management. They focused initially on Bletchley Park, the most deprived neighbourhood, and pulled together all the organisations supporting that community including education, police, fire, GPs, social services, and the voluntary sector. Partners were working together to wrap services around the population’s unmet needs.

Now is the time for the NHS to plan and manage health services in the context of an excellent understanding of population health, health improvement and illness prevention and to work in partnership with other agencies such as councils, the third sector and other public sector agencies.

How can the health system draw on community and neighbourhood engagement to address health inequalities?

In Somerset, our head of Child and Adolescent Mental Health Services (CAMHS) worked closely with the Council’s Director of Children’s Services to support looked-after children who had suffered from trauma and were struggling to integrate into mainstream education. They worked with the Shaw Trust and developed houses for three to four children at a time to provide therapeutic education. In coordinating mental services with social services and education, they are able to rehabilitate children into mainstream education and improve their life prospects.

In Southeast London, the Integrated Care Board (ICB) used health inequalities funding (given to all ICBs) to focus on the Afro-Caribbean community, inviting people to community centres to take their blood pressure and educate them about the risks of high blood pressure. They also discussed healthy nutrition and came to understand the economic reasons why people were not eating well. They couldn’t afford to buy the ingredients that underpin their traditional cooking, such as plantain and yam. As a result, each person was given £8 a week to buy vegetables, and an extra £2 per head of household so they could cook healthy meals for the family. That is a very cost effective solution, working in partnership with communities.

Another example comes from Hilary Cottam’s book Radical Help. A single mother was caring for multiple children with various challenges – it was a full-time job. One child was permanently excluded from school, one was pregnant, and another was in trouble with the police. She had 60 to 70 points of contact cross health, police, and social services. A small multidisciplinary team was built around the family. The mother was able to work out how to deal with the triggers for her children’s problems by speaking to one or two people rather than 60, and was eventually able to find employment.

There are many more examples all around the country, demonstrating the importance of different sectors pulling around local communities and neighbourhoods. Not all solutions have to be complicated and expensive either, but listening and co-producing solutions with the population is key.

What role can data play in identifying the right preventative support?

At the basic level, there’s getting data, and then there’s doing intelligent analysis so that we truly understand what it’s telling us and where we can take action. The NHS is awash with data but business analytics can be lacking. We also need to share data more widely across different sectors. For example, in Bedfordshire, Luton, and Milton Keynes ICB, the Chief Digital Officer is linking up data from social services, the local authority, fire services, and the police to quickly detect vulnerable, socially isolated people who may need more support. The data is also underpinning the development of a population health observatory.

Triangulation of data can also help to spot disease early. For example, at Somerset Foundation Trust, one of our hepatologists has developed an AI function that pulls in patient data from different sources to pinpoint individuals at high risk of liver disease such as cirrhosis or liver cancer. Early on in disease progression, the symptoms are non-specific, but key data points – such as a blood test or a seemingly unrelated GP appointment – can flag a problem. By pulling together these data points, it’s possible to identify cohorts of people who are at risk of having early liver disease. It’s also a much faster way to recruit for clinical trials. However, it does require triangulation of data.

Caldicott rules don’t prohibit sharing information to support a patient’s journey. But there are key questions to ask. Should data on a patient in hospital be shared with other medical settings that the patient visits? Does the person know you’re sharing it? Do they approve? Have they asked for their data to be forgotten? People are understandably concerned about their data being shared if they think it's going to be sold for commercial purposes. But they tend to be more comfortable sharing it when it supports their healthcare or research into better treatments.