Harpreet Sood, Sr. Fellow to CEO of NHS England

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, pretty scary developments in recent weeks the CDC has
announced that the first completely antibiotic resistant bacteria strain has reached our
shores , this is not good news .

Margaret Flinter: Well it's downright frightening news Mark , and I am reminded of our
interview last year with the CDC's Dr. T om Fried e n he was focused at the time on the
Ebola epidemic but he told us then that the thing that keeps him up at night isn’t
outbreaks like Ebola but antibiotic resistant bacteria because we just don't have any
viable alternatives yet for fighting infection in a post - antibiotic world .

Mark Masselli: And this particular case involves a 49 - year - old woman with a strain of E.
coli that was resistan t at last resort antibiotics , the first reported human case in this
country .

Margaret Flinter: And that is a dire reminder that frontline clinicians have to be
extremely judicious with the prescribing of antibiotics , but also play a role in this Mark,
they have to stop demanding antibiotics for every malady .

Mark Masselli: What most people don't know is medicine resistant infections killed
700,000 people worldwide last year and malaria, tuberculosis and E. coli are the most
potent players in this deadly scenario .

Margaret Flinter: And because of that it's now estimated that antibiotic resistant
bacteria will be the leading cause of death in 2050 so very serious threats and that
requires a global response . And speaking of global health , we would like to take a look
at how health systems function differently around the world from time t o time and
comparisons perhaps are most often made between the American health system and
the National Health Service of England .

Mark Masselli: And we a re revisiting our conversation with Harpreet Sood , Senior
Fellow to the Director of the National Health Serv ice . He spen t time working in health
systems on both sides of the pond so he has a unique perspective .

Margaret Flinter: Indeed . And Lori Robertson will be stopping by , the Managing Editor
of Factcheck.org she is always on the hunt for misstatements spoken about Health
Policy in the Public Domain . And as always if you have comments , please email us at

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

[email protected] or find us on Facebook or Twitter because w e love to hear from
you . We wi ll get to our interview with Dr. Harpreet Sood in just a moment.

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

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. Changes on
the exchanges as states prepare for this year's round of open enrollment under the
Affordable Care Act there will be changes UnitedHealthcare is opting out of the
California exchange , the nation's largest insurer announcing in April that it was dropping
out of all but a handful of 34 health insurance markets it participated in. Only a handful
of customers about 1200 actually purchased their exc hange products in California this
past year .

And the Virginia exchange will be dropping the bronz e plans next year the bottom tier
insurance plans that offer the least number of covered services , during 2016 open
enrollment period 23% of market insurers s igned up for bronze plans which are cheaper
compared to 68% who chose silver and 6% who chose gold and only 2% platinum, the
highest level .

The World Health Organization has issued new guidelines for those returning from zika
infected parts of the world l argely South and Central America and the Caribbean, the
greatest risk for zika leading to microcephaly in women seems to be during that first
trimester of pregnancy if they become infected . Scientist s found the virus lingers longer
than previously thought in blood or other body fluids , if the male partner in a couple
planning pregnancy has symptoms of the zika virus , the period of safe abstinence would
be six months a ccording to a WHO spokesman .

As the opioid addicti on and overdose trend continue s seemingly unabated there is more
awareness about the overdose antidote naloxone which is becoming more widely
available and more costly . Analysis of the market shows price has doubled in recent
months as more public health departments make the antidote available for those
struggling with addiction and awareness of naloxone’s powers of overriding an overdose
become better well - known .

A parents ’ worst scenario , babies under the age of one coming down with the stomach
flu they caught a daycare . It's no secret that daycare centers are germy little places and
kids catch bugs like wildfire often , but a study shows that early exposure to some of

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

those pathogens lead to a healthier immune system for years later on . In a study
publ ished last month in the Journal of Pediatrics researchers in the Netherlands
followed a large group of children over the first six years of their life looking at how often
doctors diagnosed acute gastroenteritis . Being in daycare as an infant increase s the
child's risk of having acute gastroenteritis in the first year of life , but also had a
protective effect after that lasting up until age 6 . I am Marianne O'Hare with these
healthcare headlines.

(Music)

Mark Masselli: We are speaking today with D r. Harpreet Sood, Senior Fellow to the
CEO of the National Health Service of England, where he is involved with
transformation of care models. Dr. Sood is an advisor to Partner’s Health Innovation at
Boston and has served as a Deland Fellow at Brigham and 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. Harpreet Sood: Oh fantastic [PH] .

Mark Masselli: You have a special approach having worked on both sides of the pond ,
and I think it’s fair to say that in the healthcare system of our two countries there are
some similarities in scope and purpose but also some real significant differences . 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 . Starting with the UK, I think it’s important to highlight that
the key strength of the N ational System here , w e have a robust primary care system
which has been around for decades , and 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 a nd I think th ese are kind of important hallmarks for the strengths
of the UK System.

Looking at the US, in its own way it has its own strengths, you know the fact that it has
world class research facilities and innovation going on, the pockets of care that are
provide d have been excellent , level is great college [PH] perspective, t he academic
medical centers you have here : the Kaiser’s, the Mayo’s, the Cleveland Clinics, the
Massachusetts, UCSF and CareMore , what y ou touched about , there is also the Fee for
Service aspect that’s quite important because, I think we are now on that stage where
you know both sides of pond, we are looking at sustainability, both sides of pond we

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

have invested lot of money over a 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. Now we are
looking at the facts how do we actually make it more sustainable so that from our
prospective, UK’s prospective when that value to tax payers comes and the value to the
public is we are accountable for, what are we doing to develop sustainable strategy and
we are seeing now where, where we are looking to invest more in the community, more
in prevention and take 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 with bundled payments and these large health systems and others who
are now also trying to invest in communitie s and primary care because that’s how we
see sustainability happening and care being placed into people’s homes or in their
homes, so we must leverage on those strengths to address some of the weaknesses.

Margaret Flinter: Well Harpreet , until the passag e of t he 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 given considering the univer sal 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
comment on the NHS constitutio n , w hat healthcare rights exactly does it aim to protect
or guarantee , and how does that expand upon the mission of the NHS?

Dr. Harpreet Sood: We spend 10 pens in every 1 pound in the UK on Healthcare , and
ultimately the NHS belongs to the people, so 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: Number one, t he fact that NHS provides a comprehensi ve
service available to everyone irrespective of gender, age, race, disability, sexual
orientation or religion , i t is based on clinical need and not on the individual’s ability to
pay. The fact that NHS aspires to be of the high standards of excellence [P H] , the
constitution that was built up is something that was going to be reviewed every 10 years
is an important aspect about how we are able to protect them. And again , the NHS Five
Year Forward View for example is based upon all those principles and val ues we talk
about.

Mark Masselli: You know Dr. Sood, right now both countries are struggling with the
health reform that’s going on and in England talk a little bit about what’s happening in
the marketplace there , and also the external challenges that ar e upon you?

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

Dr. Harpreet Sood: Yeah . More than two - thirds of our UK public believe that the NHS
works well , c ancer survival rate is as high as ever here, operation waiting lists are down ,
e arly deaths from heart disease are down over 40% , we have got 16 0,000 more nurses,
doctors, and other clinicians , 22,000 people more outpatient appointments h owever,
demand for care is also rapidly growing. We are also faced with a burden of avoidable
influences in England from unhealthy lifestyles , 1 in 5 adults stil l smoke, one - third of
people still drink too much alcohol, 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 have got new technologies and treatments improving our ability
to predict , diagnose and treat disease and we have got new ways of delivering care . So
we want to dissolve traditional boundaries between how care is delivered, we want to
improve the coordination of the care around patients , also we want to improve
outcomes and the quality.

The NHS published the Five Year Forward View which was the first time ever the NHS
as a system has come together and published this document which looks at where is
h ealthcare going in the next five years in England . And it identified three key gaps to
this : f irst , was the health and wellbeing gap, and what this is saying is that , if we don’t
get radical upgrad ing prevention, we are not going to be achieving what we want to
ach ieve , s o we are backing National Programs o n P revention with the NHS Diabetes
Prevention Program . The second gap is the c are and q uality g ap 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 Systems and this is the whole , you
know how a large health system virtually integrat ing in havin g potentially Primary Care
Practices but also Community Hospitals in a one kind of system approach. Second is
how do we scale primary care, so you know form these kind of multi - specialty
community providers, looking at how are we at scale providing primar y care with
specialty care in the communit ies . And thirdly the key one is, how are we providing
enhanced care in care homes, so looking after our elderly care population but then we
now have added looking at acute care and how we formed urgent care center s around
that and developing what we call [ Inaudible 00:12:02 ] 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. So you can see where we are headed in 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.

Margaret Flinter: Well Harpreet, w e hear so much in t he United States about part of the
negative impact on primary care being the incredible debt load that our young
h ealthcare professionals come out of their training with and that this influences the

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

choice of careers needing to really select a more lucrati ve career, tell us about how this
workforce issue is addressed within the UK in terms about the cost of education or
salary differentials , j ust shed a little light on that .

Dr. Harpreet Sood: So, I mean compared to US for example medical school here is
m uch cheaper s o you can pay up to maximum £ 9 , 000 a year now at medical school , a t
my time I paid £ 1 , 000 compared to US where you can pay up to the end and have up to
$ 200 ,000 - $ 300 ,000 debt , s o I think that is an important aspect of the workforce here .
F rom a central perspective, we do have a kind of scale of pay for trainees as we move
along , and then when you get to consultant level you have your basic pay rate that can
be supplemented with bonuses or little bit of private practice , so the p rimary c are from a
national perspective is well remunerated

But I think the attractiveness is what gets people excited in order to work for NHS for
example , the NHS Graduate Manage r s Training Schemes which is one of the most
sought after schemes in this country a nd probably one of the most competitive thing to
get into is a 2 - year scheme that we have here to train the next generation of managers
that come through . And you see the national leadership at the moment including our
current Chief Executive Officer, Sim on Stevens who have come from that scheme and
gone on to achieve stable careers . But we do face a challenge like all health systems;
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
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 health ier lives but give them that mental health wellbeing and
space to them, 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 Englan d. 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.
Tell our listeners about the Mighty Lungs Project?

Dr. Harpreet Sood: This was a project that was funded by the Harvard Medical School
where we go t the C - Grant [PH] to go and kick start a project with the local community
health center and really trying to solve that problem of pediatric asthma, medication
adherence and how do we actually incentivize kids to take their inhalers . And this was
a big problem where 40% - 50% of the childr en would end up in the emergency room
because they weren’t taking their medication . And one of the things that I encourage a

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

lot of entrepreneurs is that how do you go about solving real problems to our providers ,
s o this was a real problem that we were t rying to solve for them . So our plan was really
to firstly develop a video game that would incentivize children to take the ir inhalers and
then we would encourage to sort of developing of sense . So every time they took the ir
inhaler we could monitor that and send them reminders and messages , we want t o
make it more of a fun process for them so that they take it.

But ultimately, I think the timing wasn’t quite right and it failed , but a great opportunity to
learn about the whole startup experience, the cu lture working with a great team and you
know moving on now I think it's important that what this experience really showed and
this is great thing about the American system : (a) , the culture which you talked about ,
b ut 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 for such a tall order and maybe bit by bit and doing
incremental innovation which w ill ultimately lead to I think bigger gains.

The experience in Boston with the UK system great people , at Brigham and Women's
for exampl e , I was quite involved with helping set up the innovation hub there called the
iHub which does exactly that , i t kind o f hand - holds, guides frontline clinicians and
managers to go and innovate, and it take s their ideas from ideas and to achieve fully
fledged startup 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: We have in common Tsunami in the increase in patients with Type II
Diabetes and particularly what we see coming in through our adolescents , and diabetes
is both about the basics, diet, exercise, medication . But it also requires that we think
about innovation and we think about taking some risk , c an you tell us a little b it about
the Diabetes Prevention Program that’s being implemented which you are overseeing?

Dr. Harpreet Sood: You know Type II Diabetes constitutes for over 90% of all those
with diabetes in England, the human cost , the annual NHS cost of treating diabe tes is
estimated to be around £ 10 billion which is you know roughly 10% of our NHS budget .
So you could see the scale and the gravity of the situation, yet the Diabetes Prevention
Program , this was a kind of randomized control trial. They have documented 30% - 60%
reductions in Type II Diabetes in youngsters and adults who have impaired fasting
glucose through intensive lifestyle interventions that you talk about. The biggest out of
these was the US based Diabetes Prevention Program and that showed that pe ople
with impaired glucose tolerance, who lost 5% - 7% of their body weight and achieve 150
minutes of moderate physical activity per week reduced their chance of getting Type II

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

Diabetes by 58% over an average 2 to 3 years , t hose numbers speak for themselves, I
mean if this was a drug of some sort we would already been using this . 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 worl d that has a National NHS Diabetes
Prevention Program.

We plan to have this program rolled out in the next five years . And this again rolls back
to the Five Year Forward View plan that we have and I just talked about where
prevention is like I said a key aspect of our strategy 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 prevention to be taken
more seriously . It would also demonstrate from a financial perspective that it makes
sense from a social perspective using our existing infrastructure around primary care we
need a corrected primary care system to achieve this.

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

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

(Music)

Mark Masselli: At Conver sations on Healthcare we want our audience to be truly in the
know 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 advocat e for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: At a congressional hearing, on the impact of environmental regulations
on farming, Rep. Steve King of Iowa underestimated wha t scientists know about the
relationship between farming practices and water quality. King said, scientists don't
know about the quality of water in the US when the Buffalo roamed because there were
no water quality tests then. Pre - 1900 water quality dat a is relatively scarce, but experts
can use sediment cores from water bodies to evaluate past water quality.

King also implied that this lack of baseline data prevents scientists from knowing
whether applications of crop fertilizer are too much. But expe rts say they don’t need
19th century data to know fertilizers have negatively impacted water quality. There was

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

water quality monitoring 18 0 0s, for instance chemists developed methods for evaluating
water pollution from sewage and response to outbreaks of cholera and typhoid fever .
And in the late 1800s Massachusetts carried out what’s been called the Great
Sanitation Survey with more than 40,000 water samples collected , but by that point
humans already had drastically reduced bison numbers. However, s cientists can use
sediment cores from water bodies, to evaluate the water quality of the past.

In modern times , w ater quality monitoring increased substantially in the 20th century,
especially after the Clean Water Act passed in 1972 and m any reports and papers have
concluded that 20th century crop fertilizer use, combined with soil erosion from farming
and other factors has negatively impacted water quality in the US . And that’s my fact
check for this week, I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players, and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact t hat you would like checked, email us at
chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you here
on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellne ss a part of our communities and everyday lives. Charles Slaughter learn ed the
value of entrepreneurship from an early age as a paperboy growing up in Connecticut .
Later he took the passion globally as a field organizer for micro - finance company , then
came his first successful venture TravelSmith , a $100 million online clothing supply
company for serious global travelers . But his travels also showed him another stark
reality , the number of children dying in Third World countries from treatable di seases
due to lack of access to basic medicine .

Charles Slaughter: On average in the country is somewhere between 50 - 100 out a
1,000 have failed to reach their fifth birthday but the barrier is effectively delivering what
we know works.

Mark Masselli: He wondered how we could put the power of healing in hands of
villagers themselves and he realize d the successful model already existed .

Charles Slaughter: I am thinking about and I go, wait a minute hold phone isn’t there a
business model that excels at that and you start to think about Amway and Avon.

Dr. Harpreet Sood, Senior Fellow to the CE O of the National Health Service of England

Mark Masselli: After training as an Avon lady himself he founded Living Goods , sales
associates go from home to home in their villages teaching the families and the entire
community how to use these life - saving essentials .

Charles Sl a ughter: We recruit, train and support networks of community health
promoters who go door to door every day teaching families how to improve their health
and wealth and then making a livi ng by selling high impact health products like simple
treatments for malaria and diarrhea healthy fortified food s , high - efficiency cookstove ,
solar lights and water filters .

Mark Masselli: There are now Living Goods sale associates serving the needs of some
5 million residents th rough sub - Saharan Africa and in some cases infant and child
mortality is down 25% in the communities being served .

Charles Slaughter: And now , they get a Smartphone that can help them with a guided
diagnosis of childhood diseases and within 10 years time it's possible that every
community who needs a community health worker can have one to make sure that that
kid doesn’t die of malaria or something else ridiculous ly simple that they needed.

Mark Masselli: Living Goods , a simple grassroots business mod el , generating income
while saving lives and improving the health of the community as well . Now that it's a
bright idea .

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Ma rk Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.