Piyush Mahapatra, a consultant orthopaedic surgeon and chief innovation officer at Open Medical, considers the latest consultation on the future of the NHS and argues that what is needed is not a new vision but a plan for delivery and some radical new thinking on the role of healthcare technology
There is a new ten-year plan for the NHS. It will “focus efforts on preventing, as well as treating ill-health,” make “out of hospital care a much larger part of what the NHS does,” and “upgrade technology and digitally enabled care.”
Are we talking about the 10-Year Health Plan that will be published next summer? Yes and no. These quotes come from the NHS Plan in 2000, the Five Year Forward View in 2014, and the NHS Long Term Plan in 2019.
However, they closely mirror the three shifts the present government wants to see – from hospital to community, treatment to prevention, and analogue to digital. If these three shifts are not new, then the question is: how do we make them a reality this time?
Technology will be an essential part of the answer, but we need to think new things for that to happen. We need to ensure that technology is not seen as a ‘nice to have’ or an ‘enabler’ of change but as an essential, everyday tool.
And we need a shift in mindset as to what that technology looks like so that we can move away from time and capital-intensive IT programmes and adopt revenue-funded, zero-footprint platforms that drive efficient, high-quality pathways that work for clinicians and patients alike.
Hospital to community
How does this work in practice? Consider the ‘left shift’ from hospital to community and primary care settings. This can deliver many patient benefits, including faster care access and reduced travel times and costs.
However, it will generally be more efficient for clinical expertise to remain in acute settings, serving larger populations. So, the key is to get the mix right, and to move aspects of the pathway, rather than the whole pathway, into the community.
Tele-dermatology is a great example of how this can be done. Diagnostic-quality photographs of skin problems can be taken in skin hubs or community diagnostic centres and sent for expert review, after which the patient can be reassured and discharged, or referred for specialist care.
This has been in the operational planning guidance for several years, but many regions have still not deployed despite NHS England having funded extensive health economic studies evidencing the benefit of turnkey solutions such as eDerma, which already serves significant areas of the country.
For this to work effectively, information must flow between primary care, these new care settings, secondary care and the patient.
From treatment to prevention
Similarly, prevention can deliver many benefits for the system and patients, including avoiding more costly treatment. However, it can be challenging to deliver in practice.
Prevention may require the analysis of large data sets to identify suitable cohorts of patients for intervention and ring-fenced, dedicated services to ensure they receive that intervention. So, this is another area where technology is essential.
Trauma teams across the NHS use Open Medical’s trauma system to manage their orthopaedic trauma patients and theatre operations as efficiently as possible. Building on that experience, Pathpoint FLS has been developed to replace cumbersome, time-consuming, manual patient identification processes.
It provides a centralised system for patient identification and management. Then, it automatically generates the worklists and patient communications required to ensure patients are assessed and managed. Critically, Pathpoint FLS provides data to monitor outcomes.
All new services represent a cost to the NHS regarding facilities, staff and resources; so we need to show they are delivering the expected cost and outcome benefits.
From analogue to digital
Tele-dermatology and fracture liaison services are examples of the government’s first two shifts in action. But to deliver them, it is not enough to simply digitise existing records and paper-based workflows.
Since the NHS Plan, the NHS has focused on rolling out national infrastructure, electronic patient records and, more recently, shared care records to try and join up secondary, primary, and social care. This is a capital and time-intensive activity.
It can take years for a trust to procure, implement, and optimise an EPR; in that time, requirements and technology will move on. We must develop a more evolutionary mindset that embraces software-as-a-service models that can be deployed in hours and updated rapidly.
We also need to become far more clinically focused. At heart, EPRs and SCRs are repositories of patient records and operational data, in which it can be difficult for clinicians to find the referral, or note, or key piece of information that they need to help the patient in front of them.
What clinicians need are platforms that can integrate with these big record systems to drive communications along the clinical pathway and provide the contextual information they need to make a patient decision when they need to make it.
New thinking on decision-making, funding and technology
Some additional changes will be needed to drive the three shifts. The big question is who will plan and implement new models of care and preventative services.
Integrated care systems evolved out of the Five Year Forward View and should be well-placed to take on this role; however, many are focused on finance and performance management.
Whatever new or revamped planning bodies emerge from the 10-Year Health Plan will need budgetary authority to implement change. Currently, funding is directed to primary or secondary care, and new pathways must be followed. That money also needs to include IT so that information can move around the system.
There also needs to be a shift in thinking away from IT procurement as capital investment and a move towards revenue-based, software-as-a-service models that can flex in response to demand and further innovation. Also, on the IT front, we need a renewed focus on enabling applications and enforcing standards, particularly for interoperability.
The NHS’ central digital bodies could have an important role here, not by building new, national applications, but by requiring the big suppliers to open up their systems or creating middleware to make their data accessible to smaller and more innovative companies at a reasonable cost.
From vision to execution
There are many other issues to consider. How do we persuade the NHS to run smaller, more agile technology projects that solve specific problems for clinicians and patients? How do we get more clinical involvement?
How do we ensure a workforce equipped to embrace and manage all this change? How do we engage our patients and ensure we are not increasing digital and health inequalities? However, what matters is that we ask the questions and find answers.
The government’s three shifts are well understood, so we don’t need the 10-Year Health Plan to create another vision for healthcare. What we need is for it to lay the groundwork for execution.
That means identifying decision makers and funding pathways, recognising that healthcare technology is essential for delivery, and moving away from large, capital and time-intensive IT implementations to revenue-funded, cloud-native, browser-based solutions that can scale and flex at need.
Over the past two decades, companies like Open Medical have developed the clinically-focused, patient-centric platforms we need. Now, it’s time to use them.
