A new funding settlement needs to put the NHS in everyone’s pocket
Talk of a new financial settlement for the NHS has reached fever pitch. The alluring symbolism of additional money as a “birthday present” will be difficult for politicians to resist. For staff working flat out, additional money couldn’t come sooner.
But the most important question isn’t how much, it’s what we do with it. Spending to sustain an increasingly archaic way of working must be swept swiftly off the negotiating table. New money must be used to unleash digital change. When we bank, travel, order food – we do it digitally.
When we interact with the NHS, we rarely do. The innovations set to disrupt the NHS exist, many of them created by clinical staff who could clearly see a better way. We just don’t yet use them at scale.
Care for long term conditions is a great example of the potential for change, with the NHS spending 70 per cent of its budget here. On diabetes alone, the NHS spends £14 billion a year, £1.5 million every hour. The vast majority of this is not on preventative care that will reap future benefits, it is spent mopping up the complications of uncontrolled illness.
There are strong preventative digital solutions and many that support better self-care. Systematically implementing those with the strongest evidence base, even just across five conditions where the most mature solutions exist – diabetes, prediabetes, COPD, cardiac rehab and asthma – would have a phenomenal impact.
There are also brilliant, cheap devices now that combine with smartphones to enable sophisticated home self-care and remote monitoring: blood pressure cuffs, mobile ECGs, home urine testing, peak flows, smart inhalers. These and other digital therapeutics work best when there is a partnership between the patient, their GP and where necessary a team of specialist clinicians or coaches supervising results, coaching and encouraging.
The results are powerful – weight loss, blood glucose stability, increased activity, better adherence to medicine, improved self-care, and savings in the longer term to the NHS, thanks to fewer complications.
Trusts tell us they don’t want to just digitise their outpatient processes – they want to transform them. Academic Health Science Networks are supporting a number of trusts to introduce video, phone and email consultations, make services one-stop to avoid unnecessary visits and communicate results in new ways. Their take on the barriers is fascinating. Patients aren’t the problem, they’re often keen and demanding new models.
It’s not clinician resistance either; busy clinicians can see that the digital solutions they use in their daily lives will free up time to care for patients who need them most. It’s money.
Both the perverse disincentives to digital, with examples of trusts being paid £27 instead of around £200 for a visit, and the lack of funding available for staff to take the time to implement something new. Great solutions exist to book and change appointments via smartphones too, these need to quickly become the default not the exception.
Not all parts of the population can access digital solutions, but that’s not the same as saying that they couldn’t benefit if access was improved
Not all parts of the population can access digital solutions. But that’s not the same as saying that they couldn’t benefit, if access was improved. There’s good evidence that digitally excluded groups, including the homeless and parts of the prison population, could radically improve their health with a smartphone or telemedicine.
Charities like Pathway are already giving cheap smartphones with £10 credit to homeless patients on discharge from hospital and using the devices to support with mental health and addiction through remote cognitive behavioural therapy. The success rate is impressive.
Consider that homeless people’s NHS care is typically eight times the cost of that of homed people a year (£1.5 billion a year according to the Centre for Equity Studies) and maths is clear.
We know that putting the NHS in people’s pocket works. How can we use additional funding to make it a reality?
Scale up digital therapeutics where the evidence is strongest and commit to truly digital outpatients. Create a digital innovation fund to give NHS organisations the investment they need to look beyond the day-to-day and make this a reality. Remove perverse barriers and the disruptive power of new technologies will help with the rest.
Be bolder with devices to make sure those who need it most can also benefit from a real digital health revolution. Explore offering these through personal health budgets, or partnering with the private sector to give these out as an inspired NHS birthday present.
Revolutionise the recycling of smartphones so that they end up in the hands of the homeless and other digitally excluded groups.
Unlock real patient power. The sooner we can get securely held patient records and results into the hands of activated patients the better.
Create a digital innovation fund to give NHS organisations the investment they need to look beyond the day-to-day and make this a reality
Invest more in projects that make use of artificial intelligence, now. There have been considerable advances in cognitive medical imaging and AI research but we are yet to see any real world application with patients in the English NHS. The fund could support those trusts who have a very specific use case.
We must be mindful, too, as we go on this journey that the gap between the best and the rest narrows, rather than increases. This means support for parts of the system that are struggling with digital, as well as the incentives we have for exemplar sites.
Across the NHS we have great, innovative staff. Across the country we have people who could benefit from the best digital innovations in health and care. The solutions are out there. Smart use of new funding can make it happen.