James Barlow, Professor of Technology & Innovation Management, examines the future of healthcare
In 2012 the Department of Health invited Chris Evennett and I to examine the future of health care. We were asked to lead an inquiry into potential scenarios for healthcare in England in 2030. Four years later and with health care at the top of the news agenda we have reviewed our assessments against present health trends so that we can see which path the NHS is travelling down.
Our original research was designed to stimulate debate about the opportunities and risks associated with delivering an affordable health care system over the next two decades. With the help of the inquiry experts, we identified four scenarios which considered the impact of higher and lower levels of technology adoption and higher and lower levels of public engagement with their health.
Scenario one: “The Gadget Show”
This scenario involved high levels of technology adoption and high public engagement
Key points:
- A revolution in public attitudes towards 24/7 self-care and treatment, with many GPs put out of business as a result of self-diagnosis and treatment
- Centralised specialist acute care, traditional district general hospitals in decline. Private sector provider brands become household names, especially in diagnostics and self-care
- Elderly and vulnerable unable to embrace new technologies left out
Four years on:
There is limited evidence that this scenario is taking shape.
There are flickering signs of technology advancement in health care. The NHS Digital Technology Strategy is up and running, focusing on connecting up different parts of the health system, improving the patient experience and ensuring the NHS is paper-free at the point of care.
The agenda for integrating health and social care services is also gathering pace, so much of the focus of management over the next few years will be about aligning IT platforms to deliver the benefits of integration.
Innovations in self-diagnostic technologies that reduce the demand on primary and secondary care are continuing incrementally but are unlikely to result in any radical changes to the NHS for at least the next five years.
The revolution in public attitudes hasn’t materialised yet. Public engagement with healthcare doesn’t seem to have changed much. The number of overweight people has increased, although there are slightly fewer people classified as obese.
Scenario two: “Plural Provision”
This scenario involved low technology adoption with high public engagement.
Key points:
- Patients increasingly travel (physically or virtually) to either innovative NHS organisations for treatment, the private sector or abroad
- Vulnerable or passive patients struggle to gain access to the best healthcare, as provision is more complex and harder to navigate
- Start of a stronger community spirit and voluntary organisations
- Widespread duplication and fragmentation of healthcare without a standardised communications platform
Four years on:
The NHS does not appear to be moving towards scenario two as there is neither the supply nor demand for greater plurality of healthcare provision at the moment.
The development and uptake of self-diagnosis technology continues to be incremental, while financial constraints have constrained the adoption of some novel drugs and more expensive technologies.
Public engagement with their own health also appears stable and satisfaction levels with the NHS even rose slightly in 2014.
The integration agenda has diverted commissioners away from competitive tendering for services, and seems to be deterring some companies from entering the market.
Scenario three: “Stability with Integration”
This scenario involved low technology adoption with low public engagement.
Key points:
- Some aspects of NHS fossilised
- Comparative stability of the system and improved productivity through greater integration across community services and acute trusts
- Dominance of fewer, more powerful NHS providers
- More personalised services, where integration has been successful, but those seeking latest treatments need to look outside the NHS
- Wide variations in service provision remain
Four years on:
There is strong evidence that scenario three is emerging as the new direction for the NHS, at least in the short to medium-term.
The NHS “Five Year Forward View”, with its commitment to exploring new models of care, has begun to gather pace. Horizontal integration between local NHS organisations and social care is more common, but vertical integration between acute and primary care is being piloted too.
The CCGs – GP-led bodies for commissioning new services – have all but stopped testing the market with competitive service tenders and are discussing greater integration.
Scenario four: “Modern Traditional”
This scenario involved high technology adoption with low public engagement.
Key points:
- Strong NHS providers still have major influence on shaping healthcare delivery, using technologies to meet local needs and strengthen their own position.
- Not all technologies are cost effective
- Treatment often delivered from large acute centres, in joint ventures with private sector
- “Over the counter” diagnostic and treatment technologies reduce need for GPs
- Services for the vulnerable removed from large powerful providers, integrated with social care and commissioned by local authorities
Four years on:
Scenario four looks unlikely right now. A lack of strategic investment and financial pressures continue to constrain the take-up of new technologies, so changes to treatment pathways remain incremental.
Integration of services is being driven by the Five Year Forward View, rather than by the impact of technology adoption.
Conclusions
The publication of the “Five Year Forward View” has helped hasten a move towards scenario three – greater integration of services but comparatively low take up of new technologies.
But although there are huge opportunities from more integrated approaches to care, other opportunities are being missed.
We urgently need to understand how the NHS can improve its productivity, not just through integration but also by carefully using new technologies to enable its current workforce to manage the escalation in demand.
The risks of dissatisfied medical staff moving aboard – and the effects of this on care services – are only too clear.
