Few doubt the scale of the funding challenge faced by the NHS. As the country ages, demand pressures will result in a £30bn funding gap by 2020 unless productivity is boosted. Bridging this financial black hole will require net efficiency savings of 3% each year, but with the historic average standing at 0.8%, this target is ambitious.
At the heart of Simon Stevens’ vision to meet this challenge is the use of patients and communities as a source of ‘renewable energy’ – an asset on which the health service can draw to cut costs. Harnessing this hidden workforce could save the NHS £2bn by 2020, according to research recently published by Reform.
Each person with a long-term condition already spends 5,800 hours each year caring for their health outside of NHS services. Maximising these hours could deliver better value, better quality care. Unnecessary visits to A&E units fall when patients better understand their conditions. If citizens lead healthier lifestyles, they are less likely to demand medical treatment in the first place.
New technology could allow patients to do jobs previously carried out by clinicians. Diabetic patients could monitor their own condition, consult with their doctor via skype about how to control glucose levels, and then self-administer insulin – removing the need for thousands of pounds worth of primary care services. Treatments such as renal dialysis, once confined to hospital settings, can now be done from patients’ homes.
It is striking that outside healthcare, technological innovation has long been crucial in leveraging the power and contributions of consumers, transforming the delivery of goods and services through co-production. High street banks have reduced overheads as consumers, through online services, replace many of the functions of the local bank clerk; self-checkout facilities have cut waiting times for shoppers and the wage bill for employers.
But as recognised by the Five Year Forward View, the NHS has been slow to capitalise on the opportunities presented by the ‘information revolution’. Progress over the last Parliament has been made, but technological false starts have been a hindrance. The National Programme for IT, subsequently Connecting for Health, has been the subject of numerous National Audit Office reports and Public Accounts Committee investigations. Online patient records have been repeatedly delayed, while telehealth and telecare has yet to be rolled out at scale.
Meanwhile innovation has been emerging outside the NHS. Apps such as Babylon and DrThom are giving patients access to ‘virtual’ primary care and online diagnostic advice simply using smartphones. A study of 13 developed and developing countries recently found that nearly nine out of ten people have used the internet as a source of health information and advice. Social networking sites such as IWantGreatCare and PatientsLikeMe give patients a forum in which to feedback on services, learn from other patients and track their own conditions.
Widespread adoption of these types of technologies could yield considerable productivity gains for the NHS. Expediting the ‘kitemarking’ of health apps could harness existing efficiencies, assure professionals and patients of the clinical merit of these products, and give entrepreneurs the confidence to pursue new ideas. But with patients increasingly seeking to take control of their own health, this would also be an important step towards creating a more patient-centred health service.
Of course, creating a more patient-centred health service will be more than the sum of any one initiative. Important lessons, for example, could be learned from industries which have already undergone the journey towards consumer-centric services. But the adoption of a more open approach to disruptive technologies would significantly contribute to this process and help the NHS address the productivity challenge.
