NHS England have recently published the 10 Year Health Plan is part of the government’s health mission to build a health service fit for the future. It sets out how the government will reinvent the NHS through 3 radical shifts:
hospital to community
analogue to digital
sickness to prevention
Link to the full document found here:
I think it’s an ambitious and excellent plan. I particularly applaud them for stating "Digitalisation, as in other industries, will deliver far more productively for far lower cost’, and how they have put digital front and centre in their plan.
Hopefully this plan will help to sway a change in direction from NZ viewing digital as a cost centre, to instead being a key lever to improve productivity, (there is plenty of good data out there outlining why we will be unable to simply recruit enough staff or build enough hospital beds to meet future demand).
To continue to under invest in digital may slowly but surely relegate the New Zealand to having a 3rd rate public hospital system whilst our OECD peers bound ahead.
Here us to hoping that NZ comes out on the right side of history.
There is certainly plenty of caution from those in the UK about this ‘plan’, mostly centred on it being both unachievable in that timeframe and it being devoid of any actual concrete action. This is articulated nicely in this Guardian article:
There is also some very interesting (and well informed) digital health discussion around the 10 year plan on the Digital Health Networks (the UK’s eHealth Forum):
The transformation for the NHS is certainly daunting (as is the demand in healthcare forecast for all developed countries). I applaud the UK for their ambition recognising the scale of the challenge (even if they may fall short in some areas).
I am more concerned for countries that have the demand projections but do not have equally ambitious plans to meet the demand. For instance, Australia is forecasting that 46% of all government spend will need to be directed at healthcare by 2050, (or said an alternate way, there will need to be 4 times as many healthcare workers by 2050, or the current healthcare workers will need to be 4 times as efficient), but I haven’t seen an equally ambitious plan from Australia, (or NZ).
Yeah. I read it. Some time ago, I also read the blurb about NPfIT.
Here’s NPfIT from 2005: https://www.digitalhealth.net/2005/11/making-np-fit/
An ageing population, a shortage of qualified staff, better informed patients, Gershon efficiency savings and the creation of a patient-led service mean the NHS is heading for unprecedented change. To cope, a dramatic reframing of healthcare delivery may be needed, in which NPfIT must play a fundamental part.
But overlaying 21st-century technology on a 20th-century organisation will not yield transformation. That needs changed mindsets, innovative thinking and the creative application of IT. In other words, NPfIT’s centralised information must catalyse devolved innovation.
Structural change
It is impossible to imagine information-rich industry sectors such as hotels, banking or travel functioning without IT. They have applied it to reducing costs, reconfiguring operations and improving standards of customer service.
Though information is the basic currency of patient-clinician encounters, healthcare has been remarkably slow to embrace IT. It has been used to improve care on a particular ward or in a specialty or department. Few of the improvements have been dramatic.
In the NHS, there are no examples of wholescale organisational and inter-organisational change. Though exemplar sites with electronic patient records can point to qualitative benefits and a few quantitative ones – such as those arising from electronic prescribing – the NHS has mainly applied IT to improving existing processes, rather than transforming them.
By deploying a range of essential systems and the Care Record Service, NPfIT has the potential to catalyse organisational change.
Etc. etc. We know how that turned out: £14 bn down the gurgler.
There are some apparent good bits to this NPfIT 2.0. Like improved access to dentistry. And more: end corridor care; expand same-day emergency care services etc. More money for mental health EDs. They have borrowed the NZ smokefree generation concept that was killed by our government. Expand free school meals for kids.
This seems appealing:
… launch a moonshot to end the obesity epidemic. We will restrict junk food advertising targeted at children, ban the sale of high-caffeine energy drinks to under 16-year-olds, reform the soft drinks industry levy to drive reformulation, and - in a world first - introduce mandatory health food sales reporting for all large companies in the food sector. We will use that reporting to set new mandatory targets on the average healthiness of sales.
They trust that (a) AI and (b) ‘genomic science’ will be the fix?? They don’t understand the problems. “Free up hospitals to prioritise safe deployment of AI etc”. They will create a 'single, secure and authoritative account of their data - a single patient record - to enable more co-ordinated, personalised and predictive care". But they don’t say how.
And they want to make money out of the NHS: “an engine for economic growth”. They don’t say how this can realistically be done.* They have slogans instead. What is their “new operating model”? Where is the overall structure? How will they practically implement it?
They are going to dump more on GPs. They will enforce ‘agreed care plans’ on everyone. I’m interested in the ‘personal health budget’ but what if you need more? Will they really fund the ‘one stop shops’ adequately? Where’s the money?
And some of this is scary. They talk about “earned autonomy”. Their priority will be to address underperformance in areas with the worst health outcomes. This sounds like targets and practical encouragement of Goodhart’s law all over again. There is no mention of CQI. Instead they have ‘high autonomy’ (and how then is successful quality shared?) They will make the ‘foundation trusts’ financially liable for their borrowing. They will chop things up into integrated health organisations (IHOs), but all of this in the context of a single unified patient record. Yep.
They will ‘continue to make use of private sector capacity’. Patient power payments will allow patients to limit payments if they are pissed off with the provider. That is “give me what I want and not what I need, or else”.
They want to “usher in a new era of transparency”. This sounds great—until you realise this is based on “easy-to-understand league tables”. They have learnt nothing from Goldstein & Spiegelhalter.
And they’re going to cut staff. [Magic happens here]. “While, by 2035, there will be fewer staff than projected in the 2023 Long Term Workforce Plan, those staff will be better treated, more motivated, have better training and more scope to develop their careers.” Pull the other one. Sickness rates among staff will magically diminish (so heaven help you if you’re staff, and sick). Targets, you see.
Managers will be ‘pay for performance’. You know how this will pan out. They will also magic up local staff, cutting back severely on international recruitment which currently makes up 20% of their entire workforce, and over 1/3 of their doctor workforce.
And their reform will cut the spend. They will do this by setting targets (2% year-on-year productivity gain) i.e. trading short term hacks for appropriate long-term system engineering. They will ‘restore financial discipline’. But they will have five-year plans, like Mao, too. And they will steal low-risk pension capital. Providers will be “rewarded based on how well they improve outcomes for each individual, as well as how well they involve people in the design of their care.” So those who service the rich and know the game will get rewarded for looking after well people, and someone who adds value to a person with a low baseline will be penalised for not doing enough in near-impossible circumstances. Targets, again.
Nice plan.
My 2c, Dr Jo.
Is it a good thing or a bad thing to be overly ambitious?
Some ambition is good, as is willingness to shake up the status quo. As long as it is backed by true action, determination, and empowerment / mandate.
Too much ambition (especially when completely unrealistic) delivers certain failure. Especially when it is pure rhetoric and not backed with solid commitment.
My concern is that this represents the latter (and @DrJo seems to agree). I’d love to be proven wrong - anyone else see cause for optimism?
You may have misinterpreted that - I read that as a healthier population will/would be a more productive one. Otherwise, you’ve hit a few nails on the head.
The salient question is what level of taxation is acceptable to pay for the public healthcare system. As an NHS Baby Boomer (lived in the UK from 1956-1992), I can state, from lived experience, that the pre-1979 NHS was wonderful. Free GP visits, GP surgeries open in the evenings and at weekends, home GP visits, etc., etc. However, the top rate of taxation jumped up to 83% and that became, shall we say, electorally unacceptable. Subsequently tax rates went down and the NHS went into decline (not helped, of course, by governments that didn’t believe the NHS should be run by healthcare professionals - sound familiar?).
LSS - healthcare strategies without investment (e.g. NZ) are a waste of time. At least the UK one, for all its obvious flaws, now has significant financial investment.
I’d suggest that two things in reply:
Closely tied to that second question is the often-touted and almost-never-practised concept “prevention is better than cure”. What it should read is “prevention is almost always cheaper than cure, and more beneficial, provided you do it right”. But that doesn’t make a snappy slogan, which is what most politicians care about these days!
My 2c, Dr Jo.
Image is from DQYDJ.
