Lessons from COVID-19: How can healthcare change for the better?

No one expects a rapid return to normality following COVID-19. As policymakers focus on how to minimise the damage to health services, it has never been more important to learn key lessons from COVID-19 over the last few months.

A potentially lethal mix of backlogs and reduced capacity

Despite the surge in remote appointments and online consultations, we know that appointments and care episodes have dropped substantially since March. Just a handful of geographies have seen GP appointments return to last year’s levels, and it is notable that these are dominated by areas where DHC members have forged stable partnerships with local healthcare providers.

Referrals have plummeted well below half that of what we would normally expect, admissions have fallen even further and it is inevitable that this growing backlog of demand will be counted in millions, not thousands.

Social distancing in healthcare, slower processes to incorporate PPE and squeezed staffing availability all suggest we cannot simply ramp up traditional face-to-face capacity to achieve the latest centrally-set targets.

Even without a second wave, it is therefore inevitable that health service capacity will be reduced, affecting everything from waiting times through to day-to-day management of chronic conditions. This means more pain and discomfort, conditions worsening without treatment, and yes, for some, it may shorten their lives.

Digital health is one of the most innovative and competitive sectors in the world
No single organisation has a monopoly on innovation, though undoubtedly some are better at it than others. It follows that we need to make the most of everyone’s expertise.

In the months and years before COVID-19, the centre emphasised the importance of creating a rich and diverse supplier community, rather than imposing top-down solutions. That means open tenders, transparency, and integration. That was undoubtedly the right approach, but we have since seen several rushed procurements that have led to unintended consequences and distrust from the markets. For example:

• A single closed procurement for secondary care outpatient appointments.

• Pricing that advantaged single feature providers rather than more established companies with fuller-service offerings, i.e. working against exactly the sort of approaches that have helped GP capacity recover most effectively.

• Bullish attempts to own all IP.

• Confusion around the consistent implementation of standards.

Building on online consultations

Video should be the bedrock of the remote experience, integrated with face-to-face provision where required. Some will choose telephone consultations, especially in cases of digital exclusion, but underpinning wider service gains is integration into the care pathway. This means giving patients access to ongoing support and monitoring, linked into records, and ensuring that all patients are connected with the right expert clinicians at the right time. Add in digital triaging and insights from deep analytics and we really start to get somewhere. It is that integration of robust, quality solutions which is key to realising the full benefits.

Although we have seen rapid procurement at scale in recent months, the focus on low-cost point solutions risks fragmenting the benefits we could achieve. In turn, we risk missing major opportunities. The phrase ‘penny wise, pound foolish’ springs to mind.

Meanwhile, the lack of published data has thrown a cloak of opacity over progress. Even where we collect data centrally, i.e. directly from providers on video consultations, we are yet to see systematic publication. That transparency is vital to make informed decisions.

Key lessons from COVID-19

The lessons the Digital Healthcare Council draws from these experiences are that procurements should:

• Focus on integrating solutions that prioritise the user experience. We do this best when tenders define the problem allowing providers to propose and implement a range of solutions.
• Support and empower local users to choose solutions that work for them. This means making information available, devolving down decision making (and money), and supporting a diverse range of suppliers.
• Avoid spending money twice – if a local service wants and is willing to pay for a more integrated solution, then allow them to use funding that would otherwise be made available for point solutions.
• Comply with regulatory standards – including CE marks, privacy standards – and implement those standards consistently.
• Require and publish data on utilisation and quality metrics.

The top-down National Programme for IT in the early 2000s demonstrated that monopolies and state-sponsored first-mover advantages struggle to deliver. Some Trusts are only just moving on from that programme. Despite widespread acceptance that we have learnt those lessons, the past few months have seen too many examples of a return to top-down closed, proprietary, centralised solutions being dictated on the NHS from a central function, with little local freedoms to spend the budget as they see fit.

If we are to avoid being overwhelmed by the challenges we face from COVID-19, we must rediscover the vision and ambition of a thriving digital ecosystem that works for patients.