Dr. Harpreet Sood, Sr. Fellow to CEO of NHS England

Dr. Harpreet Sood, National Health Service, England

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Mark Masselli: This is C onversations on Health Care, I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret , we have entered November already, hard to believe that
the holiday season is fast approaching , but I don’t want the month to slip by without
acknowledging V eterans D ay earlier this month. We in Healthcare are so cogni z ant of
the unique sacrifices our nation’s 14 million veterans have made , and unfortunately , we
often see it played out in the Healthcare Arena.

Margaret Flinter: Millions of veterans from Iraq and Afghanistan have created a
significant increase in the need and demand for services, but, you know, Secretary
McDonald is working ver y aggressively to modernize the care delivery system, make it
more responsive , and he is also really offering h ealthcare professionals that are seeking
h ealthcare careers , a chance to be part of the solution in the VA system, which is very
promising.

Mark Masselli: The VA has been doing some aggressive recruiting of medical students
to work for the VA but really a majority of American Veterans and their families receive
their h ealthcare outside the VA system , and there is growing concern that the general
medical community is missing symptoms unique t o veterans, in particular, post traumatic
st ress disorder, toxic chemical exposures from the battle field. These issues are not
only affecting veterans but their families and loved ones as well Margaret.

Margaret Flinter: You know, currently there is no protocol in p rimary c are to ask if a
patient or family member has served in a war overseas, although we certainly in p rimary
c are are now asking if people are veterans , s o making that one question mandatory that
might open the door to more targeted clinical assessments in a ti mely fashion before
those underlying issues erupt into major health issues.

Mark Masselli: You know, adapting health systems to meet the large population needs
is something our guest today is quite familiar with. Dr. Harpreet Sood is a Senior Fellow
to t he CEO of The National Health Service of England.

Margaret Flinter: Dr. Sood has worked as a clinician in both countries , s o he really has
a unique point of view on the strengths and also some of the challenges or perhaps
weaknesses of both of the Health Systems.

Mark Masselli: Lori Robertson also stops by ; The Managing Editor of Factcheck.org is
always on the hunt for misstatements spoken about Health Policy in the Public Domain,
but no matter what the topic, you can hear all of our shows by going to chc radio.com .

Dr. Harpreet Sood, National Health Service, England

Margaret Flinter: And as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter. We love to hear from you , and
we’ll get to our interview with Dr. Harpreet So od in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I'm Marianne O'Hare with these Health Care Headlines. The findings
in a recently released study, The Systolic Blo od Pressure Intervention Trial or SP R INT
showed patients receiving more aggressive therapies for hypertension were able to
greatly reduce their systolic blood pressure rates. Those early results indicated that
lowering systolic blood pressure to a rate of 120 rather than the standard target of 140
reduced the relative risk of heart attack, heart failure , and stroke by nearly a third and
the risk of death by almost a quarter. The study inc luded more than 9,000 patients who
had high blood pressure but no diabetes. The mean blood pressure in the intensive
treatment group was about 15 points lower than the standard treatment group yielding
those better survival outcomes. Clinicians , who enac t the intensive approach face
challenges though managing stricter interventions, which require more patient
monitoring as well as clinical support.

Medi - Cal California's Medicaid program covers 12 million people in that state, good
new s for access , but not it seems for outcomes when there is a cancer diagnosis. A
study out of University of California Data shows Medi - Cal p atients fare far worse than
those on private insurance. This study showed patient’s fared about the same as those
with no insura nce; also found that Medi - Cal p atients were diagnosed with advanced
stage 4 prostate cancer more than 3 times as often as patients with private insurance .

S mart P hones may be ubiquitous appendages among the nation ’ s young adults.
Researchers at Duke wanted to see if cheap weight loss a pps developed on the phones
could help the 35% of the young adult population in this country, who are overweight or
obese. In a study , a third were given the App, a third given perso nal coaching sessions
on exercise and weight loss, and a third given pamphlets on achieving healthy diets and
weights. The personal coaching group had lost more weight than the other two but that
lead vanished at the 1 and 2 - year follow - ups. R esearchers had hoped this relatively
inexpensive intervention will provide a low cost solution for the looming health threat of
so many overweight young adults. I'm Marianne O'Hare with these Health Care
Headlines.

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Dr. Harpreet Sood, National Health Service, England

Mark Masselli: We're speaking today with Dr. Harpreet S ood , Senior Fellow to the CEO
of the National Health Service of England, where he is involved with transformation of
c are m odels. Dr. Sood is an advisor to Partner’s Health Innovation at Boston and has
served as a Deland Fellow at Brigham an d Women's Hospital in Boston. He earned his
medical degree at King’s College , London and his Masters of Public Health at Harvard
School of Public Health. Dr. Sood welcome to Conversations on Health Care.

Dr. Sood : Oh, fantastic .

Mark Masselli: You have a special approach having worked on both sides of the pond
and , I think, it’s fair to say that the h ealthcare s ystem of our two countries, there are
some similarities in scope and purpose, but also some real significant differences . The
National Health Service founded in 1948 on the basic principle that all citizens should
be entitled to free access to comprehensive health and conversely here in The United
States, we’re pretty much on a Fee for Service Model and that has priced out ma ny
Americans out of decent care, and I wonder if you can describe for our listeners some of
the hallmarks of each system as well as some of the strengths and weaknesses?

Dr. Sood : Right, absolutely, you know starting with the UK , I think, it’s important t o
highlight k ey s trength of the National System here. We have a robust Primary Care
System, which , you know, has been around for decade s , and you know, you recently
saw with Commonwealth Fund report that came out that UK Health System still ranks
as one of the leading health systems in the world , and I think, these are kind of, you
know, important h allmarks for the strengths of the UK System. Looking at the US, in it’s
own way has it’s own strengths, you know, the fact that it has world class research
facilities and innovation going on, th e pockets of care that are provided have been
excellent; level is great, it’s polished perspective. You know, the academic and medical
centers you have here the Kaiser’ s, the May o ’ s, the Cleveland Clinics , you know the
Massachusetts, UCSF and CareMore. W hat you touched about, there are also Fee for
Service aspect of things ; it is quite important because , I think, we are now on that stage
where you know, both sides of pond , we are looking at sustainability, you kno w , both
sides of pond , we invested lot of money number of years on acute care , but now the
question arises is that sustainable , and I won ’ t call that weakness per se , but it is
something that’s changing . Y ou know, now we are looking at the facts how do we
actually make it more sustainable so that from our prospective, the UK ’ s prospective,
you know, when that value to tax payers comes and the value to the public is we are
accountable for , w hat are we doing to develop sustainable strategy , and we are seeing
now where, where we are looking , you know, to invest more in the community, more in
prevention , and that care out of acute hospitals into the community , and we are also
starting to see that in the US now where the whole population health approach that we
are seeing , you know, with B undle d P ayments from these large health systems and
others who are now also trying to invest in communities and primary care b ecause

Dr. Harpreet Sood, National Health Service, England

that’s how we see sustainability happening and care being placed into people’s homes
or in their homes , s o we must leverage on those strengths to address some of the
weaknesses.

Margaret Flinter: Well Harpreet until the passage of The Affordable Care Act certainly
tens and tens of millions of Americans were just functionally left out of this system and
reform certainly is changing that reality in the US , but we look at the UK , where access
to care is gi ven considering the u niversal coverage there and the fact that consumers
pay no fees at the point of care, but the UK system actually goes a step further than all
of this and ensures that access to care is a guaranteed right. I would love for you to
comme nt on the NH S constitution . W hat Healthcare Rights exactly does it aim to
protect or guarantee and how does that expand upon the mission of the NHS ?

Dr. Sood : Well, we spend 1 0 pens in every 1 poun d in the UK on Healthcare and
ultimately the NHS belongs to the people , s o the constitution you talk about, you know,
we have the principles and values and just touching upon some of the principles that
guide the NHS for example: #1) The fact that NHS pro vides a comprehensive service
available to everyone irrespective of gender, age , race, disability, sexual orientation, or
religion . It is based on clinical need and not on the individual’s ability to pay. The fact
that the NHS aspires to be of the high s tandards of excellence and of professionalism,
the constitution that was built , you know, is something that was going to be reviewed
every 10 years. It is an important aspect on how we are able to protect and again the
NHS 5 Year Forward View for example is based upon all those principles and values we
talk about.

Mark Masselli: You know, Dr. Sood, right now, both countries are struggling with the
health reform that’s going on in The Affordable Care Act . It is being at tacked legally and
in England talk a little bit about what’s happening in the market place there and also the
external challenges that are upon you?

Dr. Sood : Yeah, more than two thirds of our UK public believe that the NHS works well.
Cancer survival ra te is as high as ever here , operation waiting lists are down. Early
deaths from heart disease are down over 40%. We’ve got 160,000 more nurses,
doctors , and other clinicians; 22,000 people more in outpa tient appointments, however ,
demand for care is also rapidly growing. We are also face d with the burden of
avoidable influences in England , you know, f rom un healthy lifestyles. One in 5 adults
still smoke, one third of people still drink too much alcohol , and there are more people
overweight and obese, and 70% of the NHS budget is now spent on long - term
conditions, but this presents us with new opportunities. We know , we’ve got new
technologies and treatments improving our ability to predict, diagnose , and treat
disease , and we have got new ways of delivering care , s o, you know, we once dissolve
traditional boundaries between how care is delivered, we want to improve the

Dr. Harpreet Sood, National Health Service, England

coordination of the care on patients but also we want to improve outcomes in qualit y.
The NHS published the 5 - Y ear Forward V iew, which was the first time ever the NHS as
a system has come together and published this document, which looks at where is
Healthcare going in the next 5 years in England, and it identified 3 key gaps to this.
First was the health and well being gap, and what this is saying is that if don’t get radical
upgrade in prevention, we are not going to be achieving what we are going to achieve ,
s o we are backing National Programs on Prevention, so with the NHS Diabetes
Prevention Program, the second gap is the Care and Quality Gap and this will be filled
in with the whole new models of care that we talked about , s o what we want to have is
3, 4, or 5 may be care models that work and we can replicate and scale across the
country. One firstly is the Primary and Acute Care System s a nd this is to hold, you
know, how a large health system virtually integrate in having potentially Primary Care
Practices but also C ommunity H ospita ls in a one kind of system approach. Second is
how do we scale , you know, primary care, so we are going to form these kind of multi -
specialty community providers, looking at how are we at scale providing primary care,
with specialty care in the community, and thirdly, the key one is, and how are we
providing enhanced care in care homes , who are looking after our elderly care
population but then we now have added , looking at acute care and how we formed
urgent care centers around that and developing what we call [ inaudible 1206 ] and we
have 50 of those in the country , all pushing these care models at scale so that we
achieve good replication all across the country. If we don’t get more efficient and make
more investment, we will have a gap of 30 billion pounds that we have identified by
2020 , s o you can see where we are headed and the urgency and the need of this
transformation that we have to make in order to make the Healthcare System in this
country more sustainable.

Ma rgaret Flinter: Well Harpreet, I was listening for what I might ask you to comment on,
I think it would be the issue of work force. We hear so much in The United States about
part of the negative impact on Primary Care being the incredible debt load that our
young Healthcare professionals come out of their training with and that this influences
the choice of careers needing to really select a more lucrative career, tell us about how
this workforce issue is addressed within the UK in terms about the cost o f education or
salary differentials. Just shed a little light on that?

Dr. Sood: So, I mean, compared to US for example, medical school here is much
cheaper. So, you know, you can pay up to maximum 9000 pounds a year now at
medical school. At my time, I paid 1000 pound compared to US where you can pay up
to the end and have up to 200 - 300 thousand dollars debt , s o I think that is an important
aspect of the work force here. In terms of salaries, I mean, look, there is a range of, you
know, what specialties you choose . F rom a central perspective, we do have a kind of
scale up pay for trainees as we move along and then when you get to consultant level,

Dr. Harpreet Sood, National Health Service, England

you have your basic pay rate , well t hat can be supplemented with bonuses or little bit of
private practice , almost like a Primary Care, you know, from a national perspective is
well remunerated , but I think, it is the attractiveness , is what gets people excited in order
to work with NHS, for example the NHS manages training schemes, which is, you know,
one of the most so rt after schemes in this country and probably one of the most
competitive thing in this is a 2 - year scheme that we have here to train the next
generation of managers that come through and you see the national initiative at the
moment including our current C hief E xecutive Officer, Simon Stevens , who have come
from that scheme and gone on to achieve stable careers, but we do face a challenge
like all health syst em s; training, we are giving them opportunities providing with the
latest innovation , thinking , and also it is in an important way of keeping your staff
excited , and we have just , you know, launched the first time a national program on
Workplace Wellbeing which is same . W e will go out there and produce workplace
wellness initiatives and programs for our staff in the NHS to not only live healthier lives
but, you know, give them that mental health well being and space so that they really
thrive on what they are doing and doing it well.

Mark Masselli: We are speaking today with Dr. Harpreet Sood, Senior Fellow to the
CEO of the National Health Service of England . Harpreet, you had real great
opportunities, you had lot of great opportunities at Harvard . Y ou were really able to
dabble in the startup culture and you and your colleagues were examining how
technology specifically gaming could improve the landscape for patient management .
T ell our listeners about the Mighty Lungs Project ?

Dr. Sood: This was a project that was funded by the Harvard Medical School where we
go to the C - Grant , go and kick start a project with the local community health center and
really trying to solve that problem of pediatric asthma, medication adherence , an d how
do we actually incentivize those kids to take the inhalers and this was a big problem .
40% to 50% of the children would end up in the emergency room because they weren’t
taking the medication , and one of the things that I encourage a lot of entrepre neurs is
that how do you go about solving real problems to our providers. So this was a real
problem that we were trying to solve for them and then ultimately realized actually this
was a problem scaled across globally and so our plan was really to firstl y develop a
video game that would incentivize children to take the inhalers , and then we would
encourage to developing a sense, so every time they took the inhaler, we could monitor
that, you know, send them reminders and messages and hopefully be well because
ultimately we want to make it more a fun process for them, so that they take it. Concept
was great, and we developed a storyboard for the videogame, lot of focus ed groups, but
ultimately, I think, the timing wasn’t quite rig ht and it failed but a great opportunity to
learn about the whole start up experience , the culture working with a great team , and
you know, moving on now I think it is important that what this experience really showed

Dr. Harpreet Sood, National Health Service, England

and this is great thing about the American s ystem , (a) the culture, which you talked
about, but secondly the ability to take risks and if projects don’t work , let us close them
early , which is what we did, but I think going back now if we were to do something again
like this, we wouldn’t set ourselves such a tall order and maybe bit by bit and do ing
incremental innovation which will ultimately lead to , I think , bigger gains . That
experience in Boston, in the UK system, great people, at Brigham and Women's for
example, I was quite involved with helping set up the innovation hub there called the
iHub , which , you know, does exactly that. It kind of hand holds , guides , you know,
frontline clinicians and managers to go and innovate , and it takes the ir ideas into
achieve fully fledged start - up projects , and yes, we are starting to see that in UK now, in
the NHS for example, you know, great experience to learn with Mighty Lungs and I am
helping now to kind of diffuse that learning in the NHS in England.

Margaret Flinter: What we have in common, you know, Tsunami in the increase in
patients with type 2 diabetes and particularly what we see coming in through our
adolescents and diabetes is both about the basics, diet, exercise, medication, --- Yeah -
-- but it also requires that we think about innovation , and we think about taking some
risk. Can you tell us a little bit about the diabetes prevention program that’s being
implemented, which you are overseeing?

Dr. Sood: Yeah, type 2 diabetes constitutes for over 90% of all those with dia betes in
England, and at present , it is continuing to rise at an alarming rate , and you know, we
spend – the human cost – the annual NHS cost of treating diabetes is estimated to be
around 10 billion pounds, which is , you know , roughly 10% of our NHS budget , s o you
could see the scale and the gravity of the situation, yet the diabetes prevention
program, you know, this was a kind of randomized control trial . Five major randomized
control trials have been conducted , you know, C hina, Finland, US, Japan and India, and
they have document ed , 30% to 60% reductions in type 2 diabetes in youngsters and
adults who have impaired fasting glucose through inten sive lifestyle interventions that
you talk about. The biggest out of these was the US based diabetes prevention
program and that showed people with impaired glucose tolerance, who lost 5% to 7% of
their body weight and achieve 150 minutes of moderate phys ical activity per week
reduced their chance of getting type 2 diabetes by 5 8 % in over 2 to 3 years. Those
numbers speak for themselves , and if this was a drug of some sort, you know, and we
would already be using this , and it’s has taken us nearly 12 - 13 y ears in England to
realize that this is an important program that we need to push forward . So we are really
going for a national kind of program here where we want coverage throughout the whole
country and be the first country in the world that has a N ational NHS D iabetes
P revention P rogram. We plan to have this program rolled out in the next 5 years and
this again goes back to the 5 - Y ear Forward View plan that we have and I just talked
about where p revention is, like I said, the key aspect or strategy and this is an example

Dr. Harpreet Sood, National Health Service, England

of how we want to use this moment in the NHS to encourage individuals and
communities to really think about their health , and I think, we can demonstrate this and
pave the way with this program, that will really pave the way for pre vention to be taken
more seriously in this country. It could also demonstrate from a financial perspective
that it makes sense and with social perspective using our existing infrastructure around
primary care ; we need a proactive primary care system to ac hieve this.

Mark Masselli: We have been speaking with Dr. Harpreet Sood, Senior Fellow to the
CEO of the National Health Service of England . You can learn more about his work by
going to the Web, england.nhs.uk, or follow him on T witter at hssood. Harpreet thank
you so much for joining us on Conversations on Healthcare today.

Dr. Sood: Thank you for the invitation , and it’s great talking to you both.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
kn ow when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award winning journalist and managing editor of FactCheck.org a nonpartisan, non -
profit consumer advocate for voters that aim to reduce the level of deception in US
poli tics. Lori what have you got for us this week?

Lori Robertson: At the fourth republican presidential debate Texas S enator Ted Cruz
repeated the long running myth that Congress is exempt from ObamaCare. Law
makers and their staff actually faced additiona l requirements that other Americans don’t.
Thank s to a republican amendment. Cruz said that “the con gressional exemption from
Obama Care was fundamentally wrong and that the law should apply evenly to every
American, but unlike other Americans who get the ir insurance through their employers,
members of congress are now bar r ed from directly doing so. As of 2014, they can no
longer get health coverage through the Federal Employees Health Benefits Program as
they and other federal employees have done for yea r s . Because of a Republican
Amendment added to the law, members are required to get their insurance through the
Affordable Care Act insurance market places , b ut even after the amendment per
congress in t he ACA market places , the exempt claim lived on. Federal Government
had long made premium contributions to pay for part of Federal Employee’s Health
Insurance including the insurance of members of C ongress , and in August 2013, the
office of personal management which administe rs the Federal Employee’s Insurance
Program said that the Federal Government could continue to make this premium
contributions for C ongress, even though members were getting insurance through the
market places , and that’s my fact check for this week , I'm L ori Robertson Managing
Editor of FactCheck.org.

Dr. Harpreet Sood, National Health Service, England

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players , a nd is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you'd like checked , email us at
chcradio.com . W e'll have FactCheck.org's Lori Robertson check it out for you here on
Conversations on Healthcare.

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Margaret Flinter: Each week Conversations highlights a bright idea about how to mak e
wellness a part of our communities and everyday lives. Healthcare Providers are
forever on the lookout for that magic e lixir that can cure a host of chronic ills in one step.
A large study conducted by several institutions including the University of M ichigan and
Edge Hill University in the UK looked at the medicinal benefits derived from regular
group hikes conducted in nature. Researchers evaluated some 2000 participants in a
program called Walking f or Health in England which sponsors some 3 000 walks per
week across the country.

Female : There was investment in these walking groups and training leaders to take
people on walks, finding trails that were good for people to do even if they had health
problems.

Margaret Flinter: Dr. Sara Warber, Professor of Family Medicine , at the University of
Michigan School of Medicine , said the study showed a dramatic improvement in the
mental well being of participants.

Dr. Warber : Depression was reduced, perceived stress was reduced , and people had ,
they experience d more positive feelings or positive emotions.

Margaret Flinter: Dr. Warber says this is the first study that revealed the added benefits
of group hikes in nature and significant mitigation of depression.

Dr. Warber: Because we are really inte rested in whether , if you are more stressed
would you get some better benefits from being in nature and in fact that did pan out.

Margaret Flinter: Walk for Health, a simple guided group nature h ike p rogram, which
incentivi z e s folks suffering from depress ion and anxiety to step into the fresh air with
others, improving their mood, reducing their depression, increasing their overall health
at the same time, now that’s a bright idea.

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Margaret Flinter: This is Conversations on Healthcare, I'm Margare t Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Dr. Harpreet Sood, National Health Service, England

Female: Conversations on Healthcare broadcast from the campus of WESU at
Wesleyan University. Streaming live at WESUFM.org and brought to you by the
community health center.