One disheartening aspect of this year’s Party conferences was that the main policy debate over the future of healthcare focused on which party would throw more money at the NHS. Other ideas about ways to improve Britain’s creaking health care system seemed thin on the ground.
The simple fact is that Britain’s healthcare system faces a ticking financial time bomb. The NHS was founded in 1948 to treat a youthful population suffering largely acute conditions. Today, it must cope with a much larger, ageing population suffering from chronic ailments. Diabetes alone is estimated to cost the NHS £3.5 billion per annum – over £9.6 million every day. That figure is expected to rise to £20 billion/year in 10 years’ time. Medical conditions that were previously untreatable can now be cured or managed with new drugs and procedures, but place ever greater financial burdens on the NHS. At the same time, fewer people are buying private medical insurance and patients’ expectations about the quality of healthcare services are rising.
In short, the model needs to change. Thanks to developments in technology, there are means to deliver more and better with less.
People not patients
The essential starting point is to end the practice where the first time individuals make contact with a healthcare professional is when something has already gone wrong. Doing so means treating problems when they are at their most expensive, not to mention harmful to the individual. Healthcare should not just be about treating patients, but keeping people well in the first place. Prevention is both better and cheaper than cure.
Thanks to the rise of self-monitoring health apps, this is now entirely possible. Individuals can record a constant stream of data about all their vital signs, helping to preempt when there might be a problem. An increasing number of products help us share data with family members and carers (helping vulnerable people remain in the comfort of their own homes), so why is it not possible to share that data automatically with our doctors, too?
Doing so could help address spiralling costs. Every 1% reduction in face-to-face interactions with the health service could save up to £200 million. Research by the Department of Health found that innovative uses of technology in the management of long term conditions reduced death rates by 45%, visits to accident and emergency departments by 15% and emergency admissions to hospital by 20%. Research for the NHS found that event basic digital tools such as online triage services, video consultations and online booking systems could unlock cost efficiencies of up to £3 billion.
My body, my data
The key to encouraging greater use of technology is for individuals to have access to – and control of – their own electronic healthcare record. To be worthwhile, it should allow them to upload data from personal devices and apps. It should enable patients to share their data with medical practitioners to provide them with a seamless journey through the healthcare system. Following the debacle of Care.Data, it should also put them in control of opening up their information for medical research, helping deliver breakthroughs for the benefit of the whole nation, as well as personalised medicines for themselves. Having a centralised national health service offers incredible possibilities for medical research, but they will only be achieved with the public’s trust.
Individuals should additionally be empowered to connect their records to health insurance providers, gyms and other third parties offering services and support. Those who worry about sharing health data with private organisations should remember that their supermarket already knows more about them than their doctor. (We are – very literally – what we eat.) The point is that each individual should be able to choose for themselves who sees their data.
Global Health Service?
Policymakers must also acknowledge that the ‘national’ part of the National Health Service is increasingly antiquated. Patients will no longer have to rely on local medical services when they can send their data to the best-qualified practitioners anywhere in the world. If the NHS does not make this possible, there is no doubt the private sector will. More services will be offered by health tech firm that will warn us of upcoming problems based on our personal data. Diagnosis will be by algorithm as well as by doctor. That in itself is no bad thing as it will relieve some pressure from health services. But the NHS could proactively harness it as well.
Britain has a huge international reputation for healthcare, so why not be part of a global marketplace where parts of the NHS develop, provide and export the best health ideas, products and services around the world? Just as Britain aims to be a global leader in specific technology sectors, why shouldn’t our healthcare system serve people from China to Australia to make a profit that can be ploughed back into frontline services at home? The potential for UK companies (and therefore the UK economy), medical research and the health of the whole nation could be exponentially improved if we looked at the potential beyond our borders.
In short, rather than focusing solely on saving money, there is no reason why healthcare has to be a net cost to the nation. It could be our greatest export. If the UK does not realise this, other countries will.
Fight the right fight
Naturally, this kind of change seems threatening to those who champion the NHS and fear creeping privatisation. Yet whatever politicians do, the reality is that people will vote with their feet and turn to new technologies and the private companies that provide them of their own accord. (Facebook and Google are already moving into this area.) That should be welcomed: currently, Britain has a healthcare divide where the wealthy can afford private medical care, and the rest have no choice. Far better for everyone to have control of their own data and the option of seeking the best free or paid solutions from around the world.
So where does this leave political debate about the future of the NHS? Paul Kirby, a former Head of the Number 10 Policy Unit, has argued that ‘NHS’ should not refer to a collection of organisations, buildings or people, but a principle. That principle is that healthcare should be free at the point of entry. That is what British people and politicians sincerely wish to protect. That should be the focus of policy.
The single greatest threat to that principle is continuing with a healthcare model that is financially unsustainable.
We must preserve the concept of free at the point of entry, but be open to new ideas on how it is delivered. Technology has advanced to the point where we now have plenty of potential solutions. It is up to politicians from across the political spectrum to have a serious debate about which of them we should embrace.
Follow Eddie Copeland on Twitter @EddieACopeland
