The NHS Leads the World
Despite the pressures faced on a daily basis, the NHS is still a world class organisation. Almost 70 years from its modest beginnings, the NHS is still considered a world class example of universal healthcare, delivering services in-line with its founding principles; provision based on clinical need, available to all and free at the point of delivery.
In 2017, The Commonwealth Fund compared the healthcare systems of 10 countries; Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA and found the NHS to be the most impressive. *1
When the National Health Service Act, 1946 came into effect in 1948 and commitment was first made to these founding principles, it was probably inconceivable that the NHS would grow to the phenomenal size it is today.
In 2017, the NHS Confederation *3 recorded;
• 207 clinical commissioning groups
• 135 acute non-specialist trusts (including 84 foundation trusts)
• 17 acute specialist trusts (including 16 foundation trusts)
• 54 mental health trusts (including 42 foundation trusts)
• 35 community providers (11 NHS trusts, 6 foundation trusts, 17 social enterprises and 1 limited company).
• 10 ambulance trusts (including 5 foundation trusts)
• 7,454 GP practices
• 853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations.
In the same survey, carried out by the Commonwealth Fund *1, it was found that the NHS ranked 1st in the categories of safe care, affordability and care processes, but ranked last in the category of health care outcomes, indicating that, whilst the methods we use to treat and care for patients are admirable, either the outcome itself needs improvement or the way in which we record, measure and report health care outcomes requires considerable development.
Achieving a positive Health Care Outcome is essentially the core reason why the NHS exists, so what are the factors that are affecting health care outcomes, resulting in them scoring so badly and/or making them difficult to record?
The Factors Being Measured to Secure Our World Ranking
To begin to understand the UK’s apparently low ranking in Health Care Outcomes, we first have to ask what outcomes are actually being measured? Do we rank so badly because the scores are bad or is it because we have no evidence to be scored upon? Additionally, some of the outcomes that are measured, might require long term capture periods, spanning in some cases, decades and would not, therefore, be available at the same time as measuring quantifiable factors such as admissions, value and risk.
Moreover, in addition to measuring values such as effectiveness of procedure, treatment pathways and improvement over time, some outcomes, such as PROMs are measuring patient perception and so are open to interpretation. As clinical outcomes and PROMs are becoming more pervasive additions to medical treatment initiatives, (National PROMs collection for varicose vein and groin hernia interventions began in 2009 (no longer mandatory) and National PROMs collection for hip and knee interventions began as recently as 2017), patients, and often clinical and admin staff, are not used to them being a part of the clinical process. So, completing them is seen as optional and, as a consequence, engagement with patients and clinicians can prove challenging.
Whilst the NHS clearly excels in important and fundamental areas of healthcare provision, it is evident, not only from these statistics and the many reports collated on service usage (found easily in a simple Google search), that essential and systematic changes need to be implemented across many areas reliant on paper-based processes, to reduce existing pressures on the NHS and ensure its survival.
Dramatic changes to population size, society values and patient demographics have all played considerable roles in influencing and shaping the demands placed on the NHS, all of which are outside the control of NHS chiefs. One change, generally agreed as a necessity, and therefore, receiving much public and media attention, is the digitisation of the entire healthcare system. In a day and age where we live our lives through technology, it is astounding that NHS processes and procedures still have the reliance on paper that they do. In 1948, the annual cost of the NHS, per head, per lifetime, was £200*2. In 2017, that figure had risen to £2,225.8 *5 and is set to increase to £2,230.5 by 2020/21*5.
Although a distant comparison to the likes of automated body scanners seen in science fiction throughout the 90’s, there is a real ambition from within the NHS to embrace new technologies and use the innovation as methods to improve care and Health Care Outcomes, reduce workload and reduce the ever-increasing costs associated with the delivery of the NHS.
Innovation will help to reduce the strain
Over the past 5 years, there have been several major initiatives launched with the aim to digitise the NHS. In 2014, ambitious strategic plans were published in the Five Year Forward View, designed to support strategies that digitise the services provided by the NHS*4. It is important that innovation needs to be managed both strategically and at a local level, to ensure the technology solutions are fit for purpose, improve processes and guarantee that any lessons learned are identified and applied. Innovation needs continual development and is integral in making sure there is no repeat of the NHS’s first attempt at digitisation; NPfIT. (“The National Programme for IT (NPfIT) in the NHS was implemented in 2002 to make the NHS more technologically advanced, but after 10 years and almost £10bn the project was scrapped and mostly considered a failure”*9).
Digitisation will help the NHS to reduce workloads, reduce costs and improve the appeal of working in the NHS. It can also help to create accurate controls, allowing the NHS to grow and scale the growth, at a rate that can maintain a more secure outlook. This strategy is evident in the creation of Global Digital Exemplars, a limited number of hospital trusts nominated to trial technology and rolled out to others, if successful.
However, digitisation is not a panacea and needs implementation alongside the development of innovative new technologies and well thought out processes, that reinforce the long-term aims and objectives required. All digitisation needs to be managed within an increasingly secure environment that reassures patients and employees alike, reducing the barriers put in place by fear and uncertainty that can sometimes surround the introduction of digital services and the use of personal data.
As NHS England runs each trust independently, the exact same piece of technology could be adopted by every NHS Trust, separately. This fragmented approach, along with lack of resources, was recently criticised in a report by The Kings Fund for stifling innovation all together*8. There are many innovative new technologies being trialled and tested throughout the NHS, that are both internationally ground-breaking and positioning the NHS as worldwide leaders in healthcare practice and technology. However, technology can be expensive, especially at the scale the NHS requires and in the disconnected manner it currently sustains. The new Sustainability and Transformation Partnerships (STPs) will help to coordinate efforts to identify innovative technology, with a focus on cooperation and partnerships across care settings. STPs will encourage integrated care provision and collaborative use of technology without the emphasis of hospital trust segregation and geographical boundaries.
Innovative technology solutions, that make the best use of available resources, will help the NHS cope with the greater demands being placed on it.
Demands on the NHS are growing in many areas and at greater rates than seen previously, notably, by the UK’s ageing population. ‘The population in the UK is getting older with 18% aged 65 and over and 2.4% aged 85 and over.’ *6
‘Life expectancy at age 65 in the UK in 2014 to 2016 was 18.5 years for males and 20.9 years for females. In other words, a man aged 65 in 2014 to 2016 could expect to live to age 83.5 and a woman to 85.9’*7.
As the average life expectancy lengthens and the over 65 generation grows older, primary and secondary care providers need to enthusiastically adopt innovative solutions to lessen the demand on treatment services, whilst maintaining and improving the overall quality of care delivered.
Ways to Innovate
So, how can the introduction of a new technology help with physical areas of healthcare provision and the outcomes that they are measuring? Specifically looking at Health Care Outcome measures as an area that directly and positively impacts the area of the Commonwealth study that requires improvements*1, there is evidence to show that using technology to manage the Clinical Outcomes measurement process, improves clinical engagement, increases patient involvement and can contribute to improvement of healthcare delivered and the health care outcomes measured.
Traditionally, the collection of relevant data has been cumbersome and costly to collect. Healthcare professionals, best placed to provide the data, have not readily engaged as the available tools are outside of normal daily work practices.
Consequently, data collection has been rudimentary and often too removed and irrelevant to be able to provide any useful basis for decision making.
In addition, due to the historical, paper-based nature of clinical outcomes and PROMs capture, data would only be available months after being gathered, rendering it out of date before it was published and meaningless to support timely decisions regarding patient care.
A digital system for capturing clinical outcomes and patient reported outcome measures will provide the following minimum features and requirements;
- Cost effective capture of clinical outcomes data, from large numbers of patients
- Real-time feedback to clinicians, supporting timely decisions relating to patient care
- Measure the efficacy of treatments being used on a local, national and international level
- Reduction in the administrative overheads associated with gathering data
- Increase in clinical and patient compliance and engagement
As a method of reaching a patient, the same platform being used for clinical outcomes and PROMs, can also be adopted for patient reported experience measures PREMs, further increasing efficiencies in resources and costs.
Furthermore, in the continual search for optimising spend and maximising use within a NHS Trust, the same outcomes systems can be used in many clinical scenarios, including being used for virtual clinics in a secondary care environment, giving clinical teams the opportunity to assess patients based on their clinical needs, the patient’s records and the patient’s PROMs scores, only issuing clinic appointments to those in need.
This type of software is applicable in a multitude of areas, from a primary care environment, to assess and support patients with musculoskeletal conditions to midwifery services and other areas of care that require the long-term monitoring of a condition such as diabetes or rheumatoid arthritis.
There is a multitude of innovative technologies available to help the NHS survive the increasing pressures, that can not only lead to improved Health Care Outcomes, but considerable cost savings and the attainment of additional funding streams, such as Best Practice Tariffs.
An integrated and coordinated approach is possibly the most fundamental element of any investment that takes place in technology and innovation, but critically, the investment needs to take place.
Discover more about the digital collection of Clinical Outcomes and ePROMs
Amplitude offers a digital solution for clinical and PROMs data collection. The Amplitude pro™ series allows clinicians, healthcare professionals and patients to easily collect clinical outcomes and PROMs, using modern web-based technology.
The solution delivers high patient compliance rates and allows simple monitoring of a patients’ progress, supporting clinicians in delivering effective care. The system automates the data collection process using email and SMS reminders and links, with minimal input required by the clinician but with the option to add complexity factors, comorbidities and other relevant clinical data that also supports case mix adjustment.
Request a demo today by calling 0333 014 6363 or +44 (0)1905 673 014 from outside of the UK or simply email email@example.com.
- https://interactives.commonwealthfund.org/2017/july/mirror- mirror/
- http://www.independent.co.uk/life-style/health-and- families/features/the-birth-of-the-nhs-856091.html
- https://england.nhs.uk/wp- content/uploads/2014/10/5yfv-web.pdf
- http://www.health.org.uk/sites/health/files/Autumn-Budget- 2017-briefing.pdf
- https://ons.gov.uk/peoplepopulationandcommunity/popul ationandmigration/populationestimates/articles/overviewoftheu kpopulation/july2017 *
- https://ons.gov.uk/peoplepopulationandcommunity/births deathsandmarriages/lifeexpectancies/bulletins/nationallifetables unitedkingdom/2014to2016 (Point 5)
- https://digitalhealth.net/2018/01/kings-fund- fragmentation-nhs-innovation-report/
- https://cl.cam.ac.uk/~rja14/Papers/npfit-mpp-2014-case- history.pdf
https://www.kingsfund.org.uk/sites/default/files/field/field_publicati on_file/A_digital_NHS_Kings_Fund_Sep_2016.pdf http://www.bmj.com/content/356/bmj.i6691