Winds of Change for the NHS?
by John Symon, SVP, International Markets
Next year in July the National Health Service in the UK will turn 70. With a staff of 1.7m doctors, nurses and associated care givers, the NHS is the 5th largest employer worldwide. Despite all the doom and gloom and growing political & financial pressures faced by such government funded health organisations, the NHS is still the most remarkable institution that provides free healthcare “at the point of delivery”, irrespective of the individual’s ability to pay.
The Current Challenges
A growing, ageing population, an increase of acute medical diseases, a dramatic rise in mental health issues, increased costs, workforce shortages, as well as management & infrastructure challenges are all factors resulting in increased pressures on healthcare bodies worldwide.
In a January 2017 report, spending watchdog, the Office of Budget Responsibility (OBR), estimated that publicly funded healthcare is currently costing Britain 7.3 % of GDP and that by 2066-67 it will have hit 12.6 per cent. The OBR is far from alone in making such warnings, with a recent paper in Lancet Public Health reporting the number of elderly people needing long-term care will rise by a quarter between 2015 and 2025. Today, in the UK, some 30p out of every £1 spent on all public services goes on health.
A recent report by the UK’s Care Quality Commission (CQC) highlighted:
- Staffing shortages, with vacancy rates in the NHS, rose by 16% over the last two years, despite an increase in staff of 4%
- Bed shortages in hospitals with occupancy levels being consistently above recommended levels since April 2012
- Falling numbers of nursing home beds – down by 4,000 in two years at a time when more are needed
- Rising numbers of people not getting support for their social care needs, with the numbers hitting 1.2m - up 18% in a year
- Number of detentions under the Mental Health Act up by a fifth in two years to more than 63,000 last year.
Further, in a report by the King's Fund on physical and mental health provision, “professionals should take a ‘whole person’ perspective, and have the skills to do so. The high rates of mental health issues among people with long-term physical health problems, along with the poor management of ‘medically unexplained symptoms’, cost the NHS more than £11 billion a year in England alone”, says the report. Integrating both physical and mental health care could both improve outcomes and save money.
There is a recognised, urgent need to join up primary, secondary and social care services.
The NHS’s Five Year Forward View proposes a series of measures to bring about the ‘triple integration’ of primary and specialist hospital care, of physical and mental health services, and of health and social care.
The Need to Deploy the Latest Healthcare IT solutions
It is now widely recognised that there is an increasing need for an integrated approach for healthcare services and that this can only be achieved by the deployment of the latest technologies to minimise operational costs, while greatly enhancing the quality of patient care.
The UK government announcement in February 2016, confirmed that they will be investing £4.2 billion in NHS technology over the next five years, including £1.8 billion for achieving a paperless NHS by 2020.
The opportunities to digitally enhance the NHS are now widely recognised, but it appears still to be highly regulated, highly layered, slow to move and culturally resistant to external influence.
Four particular technology-related areas are increasingly addressing the afore-mentioned challenges:
- Electronic Healthcare Records (EHR) - Electronic health records are digital records of a patient’s health and care.
- At present, patients may have several paper and electronic records stored in various settings. NHS England’s goal is to connect electronic health records across primary, secondary and social care by 2020.
- This system would allow people to monitor their own health and could improve patient safety and outcomes. Electronic record keeping would also aid the collection of data for research, and inform the commissioning of health and care.
- There is a range of technological and organisational challenges to implementation, such as interoperability, staff training and maintaining the privacy of patient data
Previous attempts to introduce comprehensive electronic health records under the National Programme for IT (2002-11) failed. Originally budgeted for £6bn, the NPfIT ultimately cost closer to £12bn. This was an apparent top down, one-size fits all, centralised approach, that was hugely ambitious, costly and difficult to implement and was allocated to just a limited number of multi-national suppliers to deliver.
- e-Procurement and Payment Processes - involving better solutions for the reduction of revenue leakage, cost recovery & medical asset tracking
Inefficiencies in the procurement and supply chain process for products being purchased and used by the NHS has produced significant wastage and revenue leakage. Systems to track medical supplies, drugs and equipment, together with better allocation of staffing, can now produce significant cost savings. The NHS has a challenge to deliver £22 billion in savings by the end of the financial year 2020/2021, including £700m from improving procurement processes. In addition, correct patient coding can drive further cost recovery benefits. It has been estimated that the overall underpayment value across the NHS costs in the region of £600-700M per year.
- Data Analytics enhancing diagnostics, aiding medical research & holistic patient view
The ability to analyse all relevant information from various data sources, and having access to it at the right time, enables early intervention to prevent adverse developments affecting patients' health.
Such data can help identify individuals who are at risk of serious health problems and minimise the need for retrospective treatment. The ability to use big data to identify waste in the healthcare system can also lower the cost of healthcare across the board.
- Tele & Mobile Health solutions –
Technologies are emerging and maturing that promise to disrupt how patient care is delivered – wearables, precision medicine, preventative measures, medical research, self-service and remote monitoring of health care services for patients or the elderly, both at home and in residential care facilities.
New Opportunities for Technology Innovation
NHS England is currently supporting selected, digitally advanced mental health and acute trusts as “Global Digital Exemplars”. A Global Digital Exemplar is an internationally recognised NHS provider, delivering exceptional care, efficiently, through the use of world-class, digital technology and information. Exemplars will share their learning, experiences & best practice to enable other trusts to follow in their footsteps as quickly and effectively as possible.
Over the past 3-4 years a more decentralised approach appears to have been embraced by the NHS, particularly to allow local, acute healthcare trusts more autonomy with their choice of suppliers and to achieve practical, clinician driven, solutions that deliver better and more timely healthcare for their patients.
This represents significant opportunities for a wide range of software & solution vendors, especially if they are able to demonstrate measurable ROI benefits, increased operational efficiencies and innovation that will enhance the quality of patient healthcare.