CEO, Hive Health
After months of changes in leadership, new Health Secretary Thérèse Coffey arrives at the Department of Health and Social Careat a rocky time.
Coffey has set out her ABCD plan – ambulances, backlogs, care, and doctors and dentists – as the key priorities to address and deliver in the near term.
Her Plan for Patients identifies important issues. Urgent and emergency care is likely to be a killer this winter – literally.
We’re going to lose people in ambulances or on trolleys if handovers and the backlog isn’t addressed. Social care needs extra funding if it is to free beds for those most in need.
However, workforce issues need to urgently be addressed. Equally, the energy crisis is putting the system and wider society under huge pressure. These are absent from the plan.
The NHS may push people out of hospital to reduce its own energy bills, but who will pay the gas and electric for the patient at home?
One CIO, for example, has shared how he can get a bigger return on investment from helping people with energy costs than putting money into an individual’s own care.
This shows the potential to exacerbate health inequalities when trying to ‘fix’ system pressures. Nothing is as simple as ABC(D) when it comes to health and care.
We need a focus on the future as well as the present
Coffey is pushing integrated care systems to deliver against her own priorities. She also needs to ensure that the important things that determine the nation’s health don’t get crowded out by playing to newspaper headlines.
Politicians can be tempted to micromanage, yet the NHS needs to be given the space for its great operational leaders to get on with the job.
Further investment in the integration of health and social care will be vital, so promised funding in social care to aid discharge bodes well. However, there is much more to be done, especially with technology.
Data from social care services is not always available in a shared care record or health information exchange, for example. Data needs to be continuous across settings for care to be continuous, and this costs money – and can take considerable time.
For the new health secretary to truly deliver for the patient (and citizen), she must provide the NHS with the stability it needs and create a platform for the impactful technology and innovation it so desperately needs.
The NHS needs to commit to innovation
Commitment needs to run alongside stability to make for a lasting positive relationship. Those of us in the technology space will recognise that such commitment can be sporadic at best.
Take virtual wards. Some in healthcare see this as a box ticking exercise. The potential for new digital processes is being overshadowed by looking at home-based care through an analogue lens.
Perverse invectives reward basic implementations that fail to create value, and a piecemeal approach is the result.
Who in acute hospitals will be monitoring alerts to manage these virtual wards? Will ambulances be given a priority to respond to patients being monitored at home ahead of others?
Will ‘virtual wards’ be prioritised over ‘hospital wards’?
Without clarity on such issues, it feels like some minister is going to announce the success of virtual wards in January, backed up by some questionable economic model that won’t have moved the needle on capacity management at all.
Encouragingly, those great operational leaders in the NHS are out there doing the necessary groundwork to make the most of virtual wards.
They are working across the system to develop answers to the questions that the innovation has posed.
Recent NHS England guidance provides the insight from which others can learn.
As Dr Shelagh O’Riordan, consultant community geriatrician and professional advisor to NHS England notes, there are different models of virtual wards.
“Some will involve staff working remotely, using technology to monitor the patient in real time, but others are much more like a hospital within the home, providing multidisciplinary care and hospital type interventions such as point of care testing and intravenous therapies, face to face.”
By applying the right approach, virtual wards could even be used to address some of the issues in urgent and emergency care that we currently face.
This good work makes me cautiously optimistic about their future.
This will look more promising when connections between the different organisations involved become stronger, and they can take the time to strategically think how they apply these innovations to meet their local needs.
Innovators need to commit to the NHS
One example of where much time was spent connecting organisations and thinking strategically was with Babylon and GP At Hand.
So, it’s not good news to see it exit the UK market in favour of adventures across the globe.
This a huge blow to the employees involved. It also erodes confidence in the use of digitally-enabled innovation in healthcare.
Babylon had a huge opportunity to transform care, with fantastic endorsements from the very top.
We were sold a dream that man and machine – doctor and computing power – could come together and change the world.
It had a positive impact in many ways. I doubt we would have had the NHS App as fast as we did without its arrival. It raised hundreds of millions in investment.
But it feels like it has just used the NHS as a huge petri dish for its model, and now it is looking to apply that model elsewhere.
Let’s not pretend; the NHS made Babylon. The GP At Hand model was proven using NHS data sets.
The NHS doesn’t need to repeat this mistake. It can provide suppliers with access to some of the biggest single care records in the world.
It is relatively well-funded; it is packed with smart people. It wields huge power that can be used to co-create healthcare innovations that have a global impact.
To access this opportunity, the NHS should look for greater commitment from its suitors. Suppliers need to be signed up for five to seven years and show they want to make the relationship work.
For the NHS, short-term flirtations with the major names in tech may provide a fleeting buzz, but they are unlikely to provide the foundation for a long and lasting marriage.
In August 2022, Wired magazine explored recent developments announced by Babylon in scaling back a range of NHS projects.
Entitled ‘Babylon Disrupted the UK’s Health System. Then It Left’, the article highlighted the fact that ‘rather than move fast and break things, new systems and technology should be introduced only without risk to patients, other providers, and budget’.
This is the lesson from which we all can learn. Disruption does not have to be a disaster if we anticipate the impact that change can bring. We need a steady ship to chart new waters.
Commitment and stability have been sorely missing from public life in recent months.
If these can return to the NHS and its supply chain, then there is a chance that we can come together to deliver the patient-first system that the new health secretary espouses.
Let us hope that the next few months see a renewed focus on the right issues for the citizen, the system, and society.