A healthcare system for the 21st century

Ben Howlett, Managing Director at Public Policy Projects, discusses why we must invest in technology to enable our healthcare systems to reform, and the role of technology in facilitating collaboration between service providers

The COVID-19 pandemic has placed a significant spotlight on the need for greater use of digital technologies within the UK’s health and social care system.

Population health, underpinned by a framework of shared and accessible data, will enable more effective, preventative approaches to be implemented in the health and social care sectors. Digital health innovation is opening up new possibilities to transform how services are delivered, shifting the focus from episodic, siloed and reactive care to person-centred and preventative care.

Digital technology provides new forms of connectivity forming a ‘glue’ that enables greater integration of services and empowers people with the tools and information to manage their own health and wellbeing. This not only improves quality of life for patients and citizens, it also supports the NHS by reducing the number of required GP visits, ambulance callouts, hospital admissions, and demand for local authority funded residential care.

Usage pre-COVID

In recent years, technology has become increasingly woven into the fabric of everyday life, reshaping industry, enabling consumers to purchase goods and services online, transforming banking and inventing new forms of social interaction. Before the pandemic, digital transformation of the NHS and social care was progressing slowly, falling behind other industries. Fragmented structures, limited resources, and a reluctance to change had hindered progress leaving services struggling to provide effective care against a backdrop of rising demand.

A changing landscape

Around 70% of NHS costs now result from treating chronic disease. This is set to rise further due to an ageing population and growing levels of comorbidity. Health inequalities are widening with variations in life expectancy reaching 10 years between the upper and lower deciles based on deprivation. Without the use of technology and data, providing care for a 21st century population with complex and chronic needs becomes increasingly difficult.

An initiative to create regional shared health and care records is underway and offers the basis for health and care providers to share a single version of the truth. The highly siloed nature of the NHS has contributed towards the difficulty in scaling innovations. Although examples of innovations are growing, there is a replication problem meaning successful trials are difficult to extend across the wider system, leading to fragmented service delivery and greater interoperability challenges.

Technology during COVID-19

As infection rates exploded during the start of the pandemic, health and care systems faced an immediate need to replace face-to-face appointments with remote consultations in order to lower the risk of infection for both the public and healthcare workers.

This required rapid collaborative action to deploy new capabilities at scale. New teams were built, technology adopted, new working cultures developed, and new approaches such as the introduction of remote COVID-19 patient monitoring and virtual wards implemented at a speed never seen before.

Released from bureaucratic constraints and driven by a common purpose the public health system proved it could innovate and transform its working practices at pace. Many within the system claimed that five years of digital transformation had been achieved in five weeks. As countries transition beyond the pandemic, they must ensure that these gains are not lost and that we can capture and retain the momentum created.

The pandemic has emphasised the power of technology in supporting collaboration and effective care delivery. It has demonstrated that health and care providers can innovate rapidly when required. We have reached a turning point where we now need to reflect on the changes that have taken place during COVID-19, learn the lessons of the past 12 months and build on them to set a new direction towards digitally-enabled care in the 21st century.

The value of digitised services

Global policy institute Public Policy Projects (PPP), through its latest ‘State of the Nation: Digitisation and Medical Technologies’ report, sets out a narrative of how digital transformation can redefine frontline care and the enabling leadership, cultural, systems and partnership capabilities needed to achieve this. It calls for industry leaders, policymakers, and the general public to understand the transformational potential for digitally-enabled care and sets out a journey to the future in which systemic approaches to population health are powered by greater use of technology.

The UK Government has set out its priorities for health and care which include a greater focus on prevention and integrated care delivered within the frame of place-based population health. This will require moving beyond digitising existing legacy practices to rethinking care for a digital world.

The use of digital technologies and greater data sharing will form the foundation for the new forms of collaboration needed to make this possible. This will require greater collaboration between health and care providers and the development of a wider ecosystem of industry and community actors who all hold pieces of the population health puzzle. Technology allows greater integration across a more complex system and gives patients greater independence by providing remote health and care support at home. This will be key to empowering individuals to play a greater role in their own health and wellbeing, enabling them to stay healthy and independent for longer.

Clinicians will also benefit from having more holistic and real-time patient insight, and the ability to support patients in their homes through remote patient monitoring and ongoing health support. This strengthens preventative care as care providers are better placed to monitor vulnerable individuals and treat them before emergency or more expensive care is required. This not only reduces avoidable demand on our health and social care systems but also reduces costs for care providers and the public. However, the transformation to integrated population health will not be easy. It calls for a move away from siloed, fee for service models to more person-centred, systems thinking and value-based approaches.

Moving forward

According to PPP and its latest policy recommendations, the Government must place digital innovation at the heart of its proposed health and care reforms. The NHS Long Term Plan (LTP), and the Health and Social Care Secretary Rt Hon Matt Hancock have identified the crucial role that digital transformation will play in our ability to meet the health and care demands of the 21st century. However, we must build on the experience of the pandemic and explore the practical short-term benefits of digitally enhancing frontline care through shared data, remote monitoring and care pathway redesign. Moving forward, we need to consider the wider integration of care around the person, and the long-term transformational potential of technology to improve population health and address the broader social challenge of health inequalities.

The Government will only be successful in its aims to improve the health of the nation if it ensures that digital innovation is at the centre of all health and social care reforms moving forward. The Department for Health and Social Care must build on the momentum generated over the course of the pandemic, and the insights from across the wider health ecosystem to drive substantive culture and practice change.

PPP intends to use this report as the start of a wider initiative to foster cross-sector dialogue and collaboration to explore the digitisation of healthcare.