THE dust has finally settled on the government’s controversial health reforms, but the NHS is not out of the woods yet. The Office for Budget Responsibility’s latest forecasts suggest that its best-case scenario will see health spending remain flat for the rest of the decade. The challenge to do more with less is intensifying.
So far, according of the National Audit Office, the NHS’s efforts to balance its books have plucked only the low hanging fruit. But with pressure to invest more in expensive new technology and drugs, only a radical transformation of everything the NHS does can provide better, affordable healthcare for patients and taxpayers.
Fortunately, the answers are out there. At Harvard Business School last week, two NHS chief executives made the trip to hear about the balancing act inherent in using pricey technology to deliver cheaper healthcare. They learned, from pioneers like the Cleveland Clinic in Ohio and the Schon Klink in Germany, that it’s vital to think radically about the structural changes required to make the most of technological innovation.
Often, the most revolutionary breakthroughs simply exploit everyday technologies to their full potential. In Mexico, a company called Medicall promises immediate 24-hour healthcare advice to over 1m households through mobile phones, all for £5 a month. Calls are answered in three seconds by a doctor, and nearly two thirds of cases are resolved over the phone. A US company has gone one step further and replaced doctors with non-specialist staff, who use a computer search engine to answer nearly every question the patient has. The upshot is that patients become less reliant on established providers. No more long waits in GP surgeries to see a doctor or expensive hospital admissions; this is simple, quick and cheap.
In the US, some of the best providers understand what business realised long ago – that what gets measured gets managed. The famous Kaiser Permanente health system tracks the performance of every doctor in its practice. Kaiser’s leaders check that each doctor is prescribing the right drugs, ordering the right tests and making the right diagnoses. Data is shared between staff, allowing Kaiser to harness its doctors’ competitive natures, improving quality and reducing the waste of unnecessary tests or prescriptions.
One of the most exciting technologies to have emerged is telecare. This uses phones and personal computers to connect doctors to their patients, allowing them to manage their illness in the comfort of their own home. Patients with diabetes can measure insulin levels, enter their results into their computer, which will track their condition and alert their doctor if their sugar levels are too high. Telecare is now up and running across the globe. In India, doctors from the Narayana heart hospital can provide consultations for patients across the country via videoconferencing. Meanwhile, in Jönköping in Sweden, patients with kidney failure now conduct their own dialysis in specialist centres.
Leading NHS hospitals have begun to join the revolution. While much of medicine remains a pen and paper business, sophisticated IT systems are replacing bed-side charts and white boards. University Hospitals Birmingham is a centre of excellence, with some of the most innovative IT in the UK. Whenever a doctor or nurse orders a test, makes a prescription or discharges a patient, they enter it into a handheld tablet that immediately records the decision, and screens it for errors based on real-time information. Each day, this system stops 400 mistakes, saving lives and making the hospital more efficient. Yet while England’s top hospitals now function in high definition, much of the NHS is still in black and white.
Real innovation is not just gadgets; it is about the deployment of this kit by people to replace the old, slow and costly with the new, fast and cheap. If you overlay an old organisation with expensive technology, you end up with a more expensive old organisation.
For technology to deliver its potential, new ways of working must be introduced alongside. When treatment can be provided at home, or patients can access health advice without a GP appointment, we shouldn’t be surprised when we need fewer hospitals and fewer surgeries. Just as HMV and other high street brands fell victim to internet shopping, the bricks and mortar of the NHS could, and should, make way for the healthcare of tomorrow.
Thomas Cawston is research director of the independent think tank Reform.