As part of our focus on data strategy, HTN spoke to Malinko, to find out about their caseload management system, their partnership with NHS Wales, their goals for the future, and the importance of community health data sets for the NHS.
We were joined for a virtual chat by Rob McGovern, Malinko’s Co-founder, and Róisín Reade, Head of Implementation and Product Manager, to discuss how data can be harnessed to support everything from joined up working to workforce scheduling and greener systems.
Hi Róisín and Rob – tell us about yourselves and Malinko
Rob: I fell in love with the NHS in 2005 – or more specifically, with how technology can help the NHS to deal with some of the pressures they face. During this time, I was part of the senior leadership team for a healthtech company called Dynamic Change, which was eventually sold to Allocate Software.
The experience and knowledge I gained there gave me the appetite for more. That’s why my business partner Andrew Threlfall and I embarked on this journey, hoping to make an impact through our clinical software and to enable the NHS to deliver safer, effective care in the community.
It’s been great to understand more about the issues community services face as we move forward with an increasingly ageing population.
Róisín: I’m a clinician by background – a Speech and Language Therapist – and I worked in community NHS services in Colchester for seven years. I was a Locality Manager just before I left, managing a variety of therapy services – Early Supported Discharge for Stroke, Speech & Language Therapy, Intermediate Care and Lymphoedema Services.
In 2017 I was introduced to a system called Malinko that was being used by the nurses in the locality I managed – It unleashed a love for software and healthtech that I didn’t know I had.
Joining Malinko was a big career leap for me, but I’m absolutely delighted to be playing a bigger part in NHS community services than I would have been able to do while working in a single NHS organisation. I’m not the only clinician at Malinko, which is what sets us apart – we’ve got colleagues with a variety of backgrounds in NHS and social care.
How is Malinko supporting NHS data strategy?
Rob: It starts with understanding where the supplier fits. We’re here to serve the NHS’s data strategy, however, it’s important to remember that it’s not the NHS’s data, and it’s not a supplier’s data – it’s society’s data. It needs to be used to benefit the whole population.
How does that manifest? We try to be the best supplier possible, in that we see interoperability and openness as an opportunity because when you look at NHS data strategy, we’re talking about four NHS systems within the UK. We’re providing those community services with a system that has a reliable data set to help them plan their services.
It’s about delivering better, safer care, at a lower cost.
Róisín: I’m a former electronic patient record (EPR) user and we would save our patient activity as a round number. So, it appeared that all our visits were 15-30 minutes long and so on. What Malinko is doing differently is capturing contemporaneous, accurate data about how long clinicians are spending with patients.
That might be 13 minutes or 17 minutes – the activity data is suddenly so much more accurate. It’s all that data that evidences how busy the community services are.
That’s something that’s really been overlooked before, it’s never been about community – it’s been about the big acute trusts or hospitals, and what data they have. Community is where the data is key. You can really start to pull those patients out of the hospitals and deliver more services in the community. But you need the data to evidence staffing levels and to make sure the caseloads are safe and fair. Without the data, we just can’t do that.
Rob: It’s about enabling the community data set to be reliable and trusted, to support clinical decisions. But it’s also about giving it parity with the other data sets out there, so that it sits alongside the datasets for A&E, for example.
The big goal at Malinko is to look at this – in my opinion – undervalued and underfunded community services and put them at the front and centre of digital transformation initiatives.
What are the learnings from the roll-out of your community caseload management system in Wales?
Rob: We work in both Wales and England. In England we work by organisation. It’s’s a huge population – and with big names like the Northern Care Alliance. It’s just about being the best supplier we can be for all 12 trusts that we work with.
In Wales it’s slightly different, as it’s an Integrated Care System (ICS), which is quite interesting when you look at what England is trying to do now with the 42 new ICSs emerging. But they are different approaches. It’s a national roll-out in Wales and our contract is with NHS Wales.
They’ve been very clear that the mandate is to help them become a data-driven service. Being part of that whole ecosystem of seven collaborating health boards is an unbelievable experience for us, and some of the results are very promising.
Róisín: In Wales, Malinko is the only system that’s commonly used across all district nurses. There are a few still on paper or on electronic patient records. That’s why the Malinko data in Wales is so key. We’ve almost completed the roll-out there, having been rolled out to 3,000 district nurses.
What’s interesting is that they want to put all their national data into a data repository and match up their Malinko data with public health data, to really get a sense of what is happening in the country. They really are at the forefront of this and are very forward-thinking, so it’s very exciting.
They’re also looking at developing Welsh levels of care – which is an intuitive system that will influence safer staffing levels. They’ve asked us to do that piece of work, so we’re really embedded there now.
How do you support your NHS partners with the unlocking of their data?
Róisín: There’s a lot of ways that we do this. It’s only recently that we’ve realised just how powerful the data is. Originally, it was just about scheduling and reducing the time spent doing that. It’s only as the NHS has started to call us a caseload management system, that we’ve realised how crucial the data is.
There are a variety of different ways that we support them. Frontline teams can access reports to help with caseload management and MDTs [multidisciplinary teams]. We also enable organisations to pull the data out via our API. We provide their data free of charge, so they can do whatever they want with it. It might be that they want to put it into a business intelligence tool and build their own dashboards into a data warehouse.
The resource and the skill to do that isn’t that prevalent in the NHS, especially within community services. It tends to be within those trusts that have a big acute sector. So, we really felt a responsibility there to build our own dashboards that they would be able to access. At the end of last year we launched Malinko Analytics – we’re still releasing dashboards to that but overall, it’s a suite of visuals that looks at upcoming plans, capacity versus demand, and historical trends in the data.
It gives the NHS a good sense of how they can manage their services. They can also be looked at from a team level right up to an NHS organisation or Health Board level. We’re hoping to progress that into what we’re terming ‘Malinko Intelligence’ and we’ve recently done some work with Salford Royal Hospital on predictive analytics.
As one of our first partners, they have got a lot of data in their Malinko system and worked with our data analyst to look at predictive analytics, to predict their capacity versus demand 12 months into the future. They can look at a specific day or week and say, ‘we’re going to have problems’, based on the patterns and historical data. We’re in the early days of that, but we want to roll that out across the rest of our NHS partners.
Amanda, our Quality Improvement Lead, has a huge part to play. She’s now working with all our partners, really drilling down into the raw data to show how changes can be made – which could be as simple as up-skilling staff or having extra bodies. We also have ‘what if’ scenario testing systems, where you can put in an extra Band 5 staff member for example, and check the impact that will have before you recruit.
Rob: It’s a clinical system with a huge workforce planning element to it, which has been a key part of the journey. And we’re educating our partners on why this is important. With any caseload management project, if you’re asking nurses to adopt technology and different ways of working, then they need to be able to see the benefits.
Ultimately, we want to be judged on our ability to promote this undervalued, underserved, underfunded so-called ‘Cinderella Service’. Until community services sit alongside the great work consultants do in emergency departments and ICUs, we’ll still have more work to do.
Róisín: “We are also starting to work with GPs, Primary Care Networks (PCNs) and local authorities, so that they can link up health and social care in the community, so there are no wasted visits, and everything is more efficient.
At Cwm Taf Morgannwg University Health Board in Wales, we’re going to start working with their primary care nurses, who are based in GP practices. They’ll be using Malinko and that’s a first for us.
Rob: The reality of what Malinko is doing on the ground is that our system is being used by a workforce that’s supported by a local authority or a county council, with NHS employees on the same system. That, for me, is true integrated working – putting the needs of the citizen before the needs of respective organisations.
Róisín: You can have your District Nurses, your Physios and Social Workers all within a single system – which means you can do double up visits and avoid wasted ones. In a way, what that’s also doing – as well as promoting intelligent care coordination – is making us a ‘greener’ system, as well. We’re reducing the amount of mileage per patient and the number of clinicians going out to patients – supporting continuity of care for patients who are where they want to be – at home.
To find out more, visit malinkoapp.com.