Johanna Moss

Johanna joined Moorfields in July 2015. Johanna's responsibilities include strategy development, capital investment and development, annual planning, business development, marketing and communications, external relations, and corporate and social responsibility. Before coming to Moorfields, Johanna was deputy director of strategic development at University College London Hospitals NHS Foundation Trust.

The shift to system working provides a great opportunity to bring local partners together with a mandate and a challenge to do something different. At Moorfields we are working with the primary care optometry sector and system partners at a regional and national level to improve both outcomes and peoples' experience of eye care in exciting and truly transformational ways.

The eye-care sector has its challenges, including fragmented commissioning, variation, and delays in accessing care. But it also has some enviable assets, not least the willingness of the sector to come together (for example through the UK Ophthalmology Alliance), the opportunity and the means to make clear advances (being the largest outpatient specialty), and often the ability to do this at pace (artificial intelligence, virtual clinics). Additionally, we hope that the work the eye care sector is now embarking on will provide a useful replicable model of collaboration that can be a catalyst for integration well beyond eye health.

A population-based approach

At the moment, Moorfields and our partners are starting to have some really exciting conversations about how eye-care services could be commissioned across the whole population. We're in the early stages of discussions to help us try and understand what that model might look like and what the financial risks and benefits might be. These are big questions but, if we get it right, there is the potential to really transform the way patients receive eye care. Here at Moorfields, we are working on some really important interventions for older people, focused particularly on sight loss prevention, early diagnosis, treatment and support. We are confident this work will contribute to achieving the ambitions of the NHS long term plan in a very demonstrable way.

The regional value-add

Moorfields is a specialist hospital with a local, regional and national outlook – though unlike many other specialist hospitals the majority of our work is commissioned by CCGs. The creation of the NHS England and Improvement London region offers a real opportunity for a clear commissioning voice for the capital that supports greater efficiency and reduces waste and duplication in the system. To date, our experience has been very focused at an STP level, which makes perfect sense for most NHS services. However, we provide services across eight different STP footprints, so a real challenge for us is ensuring we are working meaningfully across them all. There is some great clinical collaboration at STP level, bringing together providers and commissioners. The added value the London region can bring for us is to provide a strategic framework for these collaborations and act as a real catalyst for widespread positive change.

Seeing beyond competition

Most of us working in these new systems – clinicians, commissioners, community and hospital leaders – have grown up working in a competitive NHS environment. I think individually and organisationally it's important to recognise that adjusting to the new collaborative context and adopting the leadership behaviours to make it work is challenging, particularly when the new structures and processes are at an early stage of development. Creating the right context and support for local system actors is critical in allowing us all to work together, think differently and resist the temptation of resorting to our old transactional behaviours focused on the bottom line.

Creating the right context and support for local system actors is critical in allowing us all to work together, think differently and resist the temptation of resorting to our old transactional behaviours focused on the bottom line.

   

The high street challenge

One aspect of system working in eye care, which is still at an early stage, is understanding how the high street, both independent opticians and large multi-national chains, will interact and align with a more collaborative NHS system. This 'high street to hospital' dynamic, shared with dentistry, actually shows very clearly that we work with and across a number of systems that are not as closed and controllable as we might like. It provides another challenge to creating shared incentives and the right behaviours. While there are a number of issues that need looking at, we think some of the solution lies in IT infrastructure improvements (sometimes as basic as making NHS email addresses available), so that clinicians across care settings can work effectively with patient data to provide responsive, joined-up and quality care.

Harnessing the patient benefits of digital and innovation

Overall, this new environment has created lots of new opportunities for innovation and has given us the freedom to think differently. Our strategy places a clear emphasis on innovation and being a pioneer in discovering and developing new diagnostics and treatment models in eye care. In recent years, a key focus has been on how informatics and digital technology can act as an enabler for clinical decision-making as well as the shape of service provision. We've recently been awarded a Health Data Research UK bid, which is being led by the University of Birmingham, with partners including Google Deep Mind, patient organisations and other commercial organisations. It's a great example of where access to new funding sources are creating opportunities for us to explore and realise the potential of digital.

Overall this new environment has created lots of new opportunities for innovation and has given us the freedom to think differently.

   

Particularly in ophthalmology, patients will be able to access advice and guidance without having to physically travel to an appointment. The impact of reducing the need for our patients to travel to us is huge. A significant proportion of our population are older and often living with some level of sight loss, so making sure we're only asking our patients to travel to an appointment when they absolutely need to is important. Wherever possible, we're bringing care closer to them and technology should enable us to do that more and more.