The next 70 years of the NHS: sustainable healthcare now and in the future
October 9, 2018
As the NHS marks their 70th anniversary this year, it is looking forward to the next 70 years to determine how the health service must evolve to meet the needs of patients.
A presentation at the 2018 NHS Health and Care Innovation Expo in Manchester explored how the NHS will tackle sustainable healthcare now and into the future.
Here is a summary of the key areas of discussion:
The future of diagnosis
Cat Oyler, Global Head Strategy and Operations at Johnson & Johnson External Innovation, would like to see the future of healthcare become more integrated with humans.
Oyler believes the prevention, interception and cure phases of treating a medical condition will become more predictive.
Monitoring devices, integrating personal data including medical history and behavioural changes, will alert people to the potential development of a disease, allowing for intervention before the disease develops.
Oyler likened this concept to when a car encounters issues – it alerts us with signals such as a ‘check engine’ light before it reaches the point of breaking down.
“Patients want to stay healthy or be restored to health; they don’t just want to have the symptoms of their disease managed,” Oyler said.
One example Oyler gave of future possibilities with diagnosis was the early detection of post-partum depression through monitoring a person’s social media channels.
Oyler suggested an option could be to monitor their Facebook or Twitter accounts, to detect a change in language, such as using more absolutist words, which may signal the development of early stages of depression.
Perhaps then the person affected could be notified personally that this is happening or perhaps they could opt in for their doctor to get the signal. This would allow the doctor to intervene at a time when they could stop the disease before it has started.
The power of this is two-fold: it can prevent depression occurring in the mother and it can prevent the disease from being passed on to their child, as children born to mothers with post-partum depression are five times more likely to develop depression in their teenage years.
Oyler said that all healthcare professionals need to partner – clinicians, academics, industry – to meet the reality of a future healthcare system like this.
The future of patient self-care
Richard Stubbs, CEO of Academic Health Science Networks (AHSN) for Yorkshire and Humber, said a shift in behaviour in the use of healthcare technology, among patients, is one of the biggest challenges when looking to the future of healthcare.
Trustly’s 2017 report The state of online banking showed that 94% of people shop online, 91% use online banking, and 35% use a banking app on a mobile or tablet.
However, the 2017 GP Patient Survey by NHS England showed that only 11.8% of patients ordered a repeat prescription online via their GP surgery in the past 6 months, 8.9% booked an appointment online with a GP or nurse, and 1.6% accessed their medical records online.
Stubbs said the future of the NHS is not necessarily about looking to new technology but seeing how we can implement current technology.
Technology that is already available and can make an impact on the future of healthcare is using smartphones as a medical device – to record, monitor and manage clinical conditions.
For example, healthy.io helps patients save time by giving them the ability to test urine samples at home. They receive a testing kit, perform the urine test, then scan the urine stick results with a smartphone, which is immediately sent to their doctor for review.
The test can be used to diagnose urinary tract infections, prevent chronic kidney disease and help pregnant women monitor their health.
This opens up opportunities for early detection and improved prevention within existing clinical pathways.
The future of STPs and ICSs
Verena Stocker, Deputy Director of System transformation Group at NHS England, said structures are important for a sustainable NHS.
“STPs and ICSs are the vehicles through which we can see integration and innovation really flourish,” Stocker said.
The 14 ICSs in the UK were selected because they performed strongly against five criteria that are important when looking at how to integrate health and care: leadership, a track record of delivery, strong financial management, coherent and defined population, and compelling plans as to how they will integrate health and social care.
“These ICSs matter because they are doing things differently on the ground. We’re seeing pockets of outstanding practice that we think might be replicable to other places in the country,” Stocker said.
One example is in Frimley, where they have drawn on their experience in their vanguard to look at how GPs collaborate to provide same-day access so that patients can receive urgent care appointments. As a result, they have seen a 7% reduction in secondary care referrals from those GP practices.
As more STPs become ICSs, Stocker predicts we’ll see more of the following in the future:
- CCGs coming together and increased informal collaboration in the commissioning landscape
- Further horizontal integration between hospitals
- Greater flexibility and autonomy at the system level (systems taking on more resources and functions)
- Other organisations taking on a more systems-based approach.
The future of managing multiple conditions
Juliet Bouverie, CEO of Stroke Association and member of the Richmond Group of Charities, said when looking to the future of the NHS, it is important to remember who the core users of health and social care services are.
Bouverie was involved in gathering data from patients living with multiple long-term health conditions and what the research showed was that many conditions went undiagnosed because patients were often diagnosed for single conditions in isolation, rather than assessing their health holistically.
The research showed there were many missed opportunities for diagnosis, despite the fact that most patients with multiple long-term conditions were under the care of several clinicians and regularly saw healthcare professionals.
Looking to the future, Bouverie said embedding holistic, coordinated and personalised care would be part of the solution.
This would include care and support planning, social prescribing, patient activation and self-care, measuring wellbeing as an outcome, polypharmacy and deprescribing, and ensuring flow of data across the healthcare system, among other strategies.
Bouverie said the NHS would need to shift their care to a more patient-centric approach.
“What really came out of the research was the importance of personalised care and support care planning so that people have their own care and support plan that they are at the centre of, that is focused on the outcomes that matter to them,” she said.