the medic of the future - cde themed call launch 16 july 2013

© Crown copyright 2013 Dstl

23 July 2013

The Medic of the Future

Centre for Defence Enterprise

Rapid technological change

© Crown Copyright MOD 2011

The aim of CDE


Prove the value of novel, high-risk, high-potential-benefit research


To enable development of cost-effective military capability advantage

23 July 2013

Five key operating principles underpin the CDE model

Engaging innovators

23 July 2013

Accessible opportunity

Sustaining incentives

Minimising participation costs

Compliance

Intellectual property

Two routes to funding

Online bid submission

Themed calls

CDE themed call programme

Secure communications Call close 22 Aug 2013

Innovation in drug development processes

Call close 29 Aug 2013

The medic of the future Call close 5 Sept 2013

Novel solutions for emulating ship signatures

Call launch 23 Jul 2013

Strengthening biological security Call launch 17 Sept 2013

Register and further details at www.science.mod.uk under ‘Events and Calls’

All calls close at 17:00 hrs

Defence Open Call

Seeking the exceptional

4568 proposals received

17% proposals funded

£41.5M contracts awarded

Exemplar project

Fuel efficiency

‘Micro generators’


Effective proposals

Challenge, pace & exploitation

The future of CDE

Network and question


01235 438445

[email protected] www.science.mod.uk/enterprise

Surgeon General

Defence Medical Services

Air Marshal Paul Evans

Surgeon General

Surgeon General

Defence Medical Services Mission

Our Mission. Provide health policy & advice, healthcare

and medical operational capability in order to maximise

the fighting power of the Armed Forces

Surgeon General

AIM

To PROMOTE, PROTECT & RESTORE

the health of the Defence population in order to maximise fitness for role

Aim of the Defence Medical Services

HealthcareAdvice

Operational Capability

THE STRATEGY FOR THE DMS

Surgeon General

Role of Surgeon General

End to end process owner of healthcare pathway for

Service personnel

Head of Service

CEO of Defence Medical Services

Surgeon General

Surgeon General

Scope

Main Effort

• Operations: Afghanistan & return to contingency

Primary Care

Rehabilitation & Mental Health

Secondary Care

Education & Training

Research

Current Issues/Discussion Points

Surgeon General

The Operational Patient Care

Pathway

Surgeon General

The Operational Patient Care Pathway

Point of Wounding }

Buddy-Buddy Care } Pre-hosp

Role 1 Effect – Medic + Doc }

Evacuation – Damage Control Resuscitation } Care

Role 2/3 • Damage Control Resuscitation

• Damage Control Surgery

• Hold

Evacuation • Tactical

• Strategic

Surgeon General

The Operational Patient Care Pathway

Role 4

• Royal Centre for Defence Medicine – Birmingham

– Clinical Care

– Support to the Patient Group

• Defence Medical Rehabilitation Centre Headley Court

Return to Duty / Medical Discharge

Surgeon General

Operating Theatre History

Number of trips to theatre 27

Specialities involved 6 inc: Orthopaedics, Plastic Surgeons,

Vascular, Urology, General Surgeons,

Intensivists.

Total amount of time spent in surgery 75 hours & 15 mins

Theatre trip time length Shortest: 1hr 15 mins

Longest: 6hrs

Procedures included Femoral nail, closure of abdo,

consistent debridement & washout of all

wounds, reconstructive soft tissue flap,

split skin grafting, colostomy, insertion

of iliosacral screws, changing of

dressings, inc application of TNP &

other necessary procedures

Surgeon General

The Operational Patient Care Pathway -

Issues

Golden Hour

Bastion Vs Tent

Time to Evacuation

Surgeon General

The formation of Defence Primary Healthcare means that SG will now

deliver end-to-end clinical care in the firm base and the permanent

bases overseas

•More efficient use of personnel & resources;

•Quicker implementation of healthcare policy & Defence

change;

•Better governance and performance management;

•Better links with the NHS to manage access to secondary

care;

•More attractive employer for clinicians and administrative

staff.

Defence Primary Healthcare - Implications

Key Benefits

Surgeon General

Primary Care

1 Apr 13 – Defence Primary Healthcare Care

SG now directly accountable for tri-Service primary

care delivery with budget

DMS legislated to provide primary care

Occupational Primary Care Service

• Return to duty philosophy

Surgeon General

Defence Medical Rehabilitation

Programme Tiered approach – Multidisciplinary occupational approach

Tier 1 – Primary Care Rehabilitative Facility (PCRF)

Tier 2 – Regional Rehabilitation Unit (RRU)

• 16 in UK

• Function:

– Medical Injury Assessment Clinic (MIAC)

– Group Treatment capability

Tier 3 – Defence Medical Rehabilitation Centre (DMRC)

• Complex Trauma

• Musculoskeletal

• Neuro

Surgeon General

The Future – Defence National Rehabilitation Centre

A decision on a Defence National Rehabilitation Centre to

meet future UK rehabilitation needs is likely this year

•With a Defence element at its core, it would replace Headley Court

•A campaign to raise £300M is being led by the Duke of Westminster

•The Duke has already acquired a site – Stanford Hall in the Midlands

•An announcement is likely once £200M has been raised (possibly later in 2013)

•If confirmed, the intention would be to open the Defence element in 2017

Surgeon General

Defence Mental Health

Occupational Community based service

Departments of Community Mental Health (DCMHs)

• Multidisciplinary – Psychiatrists, Clinical Psychologists, Mental Health nurses & social workers

• 13 in UK

Minimal requirement for in-patient capability

• NHS contracted service with South Staffs consortium

• NB – Lower admission threshold

Academic Centre for Defence Mental Health - Kings

Surgeon General

Secondary Care

NHS Provision under our entitled access to

secondary care

• Vast majority for provided under NHS routine access

driven by clinical need

• Majority of elective care is outpatient or day case

• Contract for rapid access to Imaging & Operative

orthopaedic care

Surgeon General

Strategic Challenges – Secondary Care Commissioning

We need to resolve uncertainty about funding to meet the secondary

care needs of Service personnel under new NHS arrangements.

•Funding for military patients will be held

centrally by NHS England, not regionally.

•Will funding requirement be calculated

accurately?

•Discussions held up by delays to

establishing posts within NHS England.

•There is uncertainty about who will fund

occupational referrals.

•Our position: Any funding shortage

should be a NHS risk not a Defence

one.

Surgeon General


Doctors:

• Medical Cadets

• Specialist training

• GPVT

• Direct Entrants

Nurses

• Direct Entrants

• In-house Nurse Training – Birmingham City University

AHPs

• Some In-house some recruited post training

Surgeon General


Defence Medic

• Current Training Programme

– Common Core 20 weeks

– Individual Services

Army/RAF – 7 weeks

RN – 19 weeks

– Professional Status

– Keogh Barracks Aldershot

Surgeon General

The Future – Creating a Regional Centre of Excellence

DMS Whittington will be at the hub of a regionally-based

centre of professional excellence for the 21st Century

•£138m construction including HQ, training and accommodation

•Future home for over 1,000 military and 400 civilian staff

•Phase 2 Construction will be

completed by Feb 2014

•Currently on-time/on-budget/to user-

defined requirement

•Feedback is good across the board

Surgeon General

Research

Created Medical Director post in 2009

Mission:

To support deployed DMS personnel through academia,

research, clinical policy, personnel management, and

equipment capability developments, which ensure the

highest standards of governance, whilst continually

promoting innovative, world leading, quality and safe

patient care.

Surgeon General

JMC Medical Directorate

Title ‘Medical Director’ aligns to NHS titles

Job is outward looking to civilian NHS and academic

practice

Combines professional leadership with academic

research

Development of Clinical Policy and provision of

clinical advice to Theatre/PJHQ in real time

Surgeon General

Defence Medical Academia

8 Defence Profs with senior lecturers and lecturers

• Emergency Medicine

• Surgery

• Orthopaedics

• Medicine

• Anaesthetics & Critical Care

• General Practice (GP)

• Mental Health

• Nursing

Royal College recognition

All are deployable and most have deployed in last 18 months

Surgeon General

DMS Academia & Research

Research is focussed through SG’s Research Plan

Multiple Internal, National and International

Collaborative Partners (Dstl, Russell Group Universities, NIHR,

TRBL Blast Centre, US, NATO

Research and audit is part of medical revalidation

Clearance of all clinical papers

End users are often the researchers – unique to

Defence

Surgeon General

Issues

Surgeon General

QUALITY AND ASSURANCE

Care Quality Commission

• Very positive review of both Primary and secondary care

including operational environment

Inspector General

• Accountable to SG

Defence Internal Audit

Joint Force Command / SoS /HCDC

Surgeon General

Revalidation

No different from civilian requirement

NB – full clinical practice

• Operations

Role of Medical Manager

Surgeon General

Clinical Skills post Afghanistan

Is a ‘dip’ in performance inevitable following draw-down in

Afghanistan and if so, how deep will it be?

•Unless maintained, skills will have to be

relearned on the next campaign.

•Will we retain our most able people if we

return to a ‘peace-time’ routine?

•Our Position. To maintain hard-won

skills, we need to provide:

•quality clinical placements,

•exposure to simulation,

•rewarding research opportunities

•‘real-life’ opportunities

Surgeon General

Changes in NHS

Efficiency pressures in NHS.

DH committed to development of new, mutually beneficial arrangements.

Includes DAs on Partnership Board

Placements for Secondary Healthcare Personnel

Level 1/Major Trauma Centres

Current MDHU Arrangements (placements & commissioning) no longer fit for purpose

Review has DH support.

DMG Scotland

Partnerships & Collaboration

Generate symbiotic relationships

Changes in NHS England

Surgeon General

Conclusion

Surgeon General

VISION

To be recognised by those

we serve as a World Leader in military

healthcare and health advice


Surgeon General


VALUES

Excellence, by striving for continuous improvement and

the highest quality in all that we do

Commitment to patients, and evidence-based practice

Integrity, by adhering to the highest professional and

ethical standards, maintaining the trust and confidence

of all with whom we engage

Teamwork and leadership, which are key to success

Respect, by treating those with whom we serve and

work with dignity and respect

MOD Medical Sciences Research Programme

Overview

Surgeon Commodore Alasdair Walker, Joint Medical Command

Neal Smith, Dstl Programme Delivery Directorate

16 July 2013


23 July 2013

Defence S&T Medical Sciences Programme

23 July 2013

© Dstl

Casualty Care

To investigate techniques and interventions that address complex injuries from current and emerging battlefield threats in conventional (non-CBRN) warfare.

Force Effectiveness and Rehabilitation

Focused on improving numbers of those fit to deploy, improving the quality of life of survivors from military conflict, minimising residual disability and providing aftercare support to wounded veterans.

Medical Systems

Research, develop and evaluate systems that will maintain and/or enhance the effectiveness of deployed forces in extreme and austere environments and produce medical treatments, interventions and rehabilitative support to injured personnel.


23 July 2013

© Dstl

Casualty Care • Resuscitation

• Haemorrhage Control

• Battlefield Pain Management

• Blast Injury Characterisation

• Extremity Trauma


23 July 2013

© Dstl

Force Effectiveness and Rehabilitation

NIHR Programme (Joint MoD/Department of Health)

• Acute response to injury • Microbiology • Regenerative/Reconstruction Medicine King’s Centre for Military Health Research

• Long term investigation into possible health effects of operational deployment among UK Armed Forces personnel (initiated 2003)

Health & Well-Being

• Potential chronic health effects • Help seeking behaviours and stigma reduction • Nutrition • Noise Induced Hearing Loss & Vibration


23 July 2013

© Dstl

Medical Systems


2012: The Extremes of Defence Medical Capability

• Small Rugged Blood Fridge • Spiral peripheral nerve interface • Knitted prosthetic sleeves • Integrated patient monitor • One arm drive wheelchair

Today… 2013: The Medic of the Future: Training and Support

CDE Medical Call 2013

The Medic of the Future: Training and Support

16 July 2013

UNCLASSIFIED

FOR PUBLIC RELEASE © Crown copyright 2013 Dstl

23 July 2013


• Context

• Technology Challenges:

– 1: Exploring the potential of simulated training and high-

fidelity models

– 2: Identifying novel systems that will help those injured in

battle

• Exploitation

UNCLASSIFIED

FOR PUBLIC RELEASE © Crown copyright 2013 Dstl

23 July 2013


• Context

– The human component is central to delivering military

capability

– Provision of sufficient, capable and appropriately trained

personnel is critical to operational success

– There is a need to sustain capability by protection, treatment

and rehabilitation

– Provision of high quality support, care and treatment at all

points along the continuum of care is essential


23 July 2013 UNCLASSIFIED

FOR PUBLIC RELEASE


Technology Challenge 1

• Exploring the development of high fidelity models with

enhanced haptic feedback to replace existing live

simulation methods especially in advanced clinical

practice and surgery

– Simulated Environments

– Mannequins

– Synthetic tissue

– Trauma scenario simulation

– Virtual coaching



FOR PUBLIC RELEASE



• We want systems which:

– Novel and innovative systems

– Consider cost to MOD of introduction

– Provide realistic scenarios, but avoid live models

– Consider standards and measures of competency

– Provide constructive feedback to trainees and trainers

– Demonstration of proof-of-concept for further investigation.



FOR PUBLIC RELEASE



• What we don’t want

– Management or provision of training services.

– Consultancy on training and education.

– Existing ‘off the shelf’ products.



FOR PUBLIC RELEASE



• Identifying novel systems that will help those injured in

battle

• Opportunities to maintain force effectiveness

– Equipment enhancements

– Easing burden for the battlefield medic

– Enhanced protection for patients

• Military Patient Transport

– Reducing contamination and infection

– Enhancing safety and protection



FOR PUBLIC RELEASE



• What we want


– Proposals that demonstrate the benefits of tailoring

conventional medical systems to bespoke defence challenges

– Demonstration of proof-of-concept for further investigation

• What we don’t want

– Systems which result in an unrealistic burden on other

components of capability



FOR PUBLIC RELEASE


Exploitation

• Research integration

– Medical Sciences Programme

– Training & Education Programme

• Procurement

– Refine, trial or purchase

• Policy

– Refinement and implement

– Development of doctrine



FOR PUBLIC RELEASE


Summary

• Technology Challenges

– 1: Exploring the potential of simulated training and high-fidelity models

– 2: Identifying novel systems that will help those injured in battle

• What we want


– Systems which consider full cost of introduction

– Realistic models that assist training

– Systems which ease the burden of the battlefield medic

– Enhancements for patient and medic safety

– Demonstration of proof-of-concept for further investigation



FOR PUBLIC RELEASE

Centre for Defence Enterprise Submitting a Successful Proposal


Maximising your chances

Know what is available

Read available information

Start with –

Quick Start Guide

plus other CDE manuals – Account Manual, User Manual, Technology Application Manual


Developing a CDE proposal

Value from technology

Innovative concept

Future capability

Proof of concept Incremental development

The essentials

Description

mins

Assessment

Not an exam

MOD Performance Assessment Framework

Five criteria:

Operational relevance

Likelihood of exploitation

Builds critical S&T capability

Scientific quality/innovation

Science, innovation and technology risk

Commercial tab

Government-furnished X

Health and safety

Ethics

Unclassified

Proposal health check

Claim of future benefit

Contribution to future benefit

Logical programme of work

Generation of evidence

Demonstration of progress

Based on a claim of future benefit

Contribution to realisation of future benefit

Logical programme of work

Evidential outcomes

Demonstration of progress towards goal

Health check

Early birds

This call closes:

17:00 hrs on

Thursday 5 September 2013

Deadline

www.science.mod.uk

Events and Calls > Current calls for proposals > The Medic of the Future

Webinar:23 July 2013 14:30-15:30

Register online

Further information


[email protected]

www.science.mod.uk/enterprise

Call process queries

© Crown copyright 2013 Dstl 23 July 2013

1. Exploring the potential of simulated training

and high-fidelity models

2. Identifying novel systems that will help those

injured in battle

Technology Challenges

HD&[email protected]

Call technical queries


23 July 2013

the medic of the future - cde themed call launch 16 july 2013

Technology

surgeon general primary

surgeon general aim

care role

defence enterprise

defence element

defence population

defence open

general surgeons