24 October 2014
Yesterday NHS leaders published their Five Year Forward View a stark report of the future faced by the NHS and, for once, including plans for realistic, but steady evolutionary change to tackle the major funding gaps. Simon Stevens, NHSE chief executive was blunt in his assessment that the NHS needs to change: the demands of long term health problems, fuelled by an increasingly obese and unfit population and combined with the increasing autonomy or self-determination of people to be informed and involved in their own healthcare; the transformation that new technologies bring to prediction, prevention, diagnosis and treatment of disease – and the acknowledgement that there are better ways of organising care; and finally the rapidly increasing funding gap, which will get worse rather than better. Fortunately, there is fairly broad consensus about what a better future will be.
Two strands of the solution chime with PHG Foundation aims: using technologies and transforming healthcare systems. Most importantly, we agree that these must be looked at together. It is not enough just to develop new products, whether these are new biomedical diagnostics (genomic or otherwise), sensors for monitoring people with chronic conditions at home, new treatments or electronic technologies for patients to keep their own records or hospitals to manage their data. These must be integrated with a view to changing the way we do things at all levels, from policy to frontline patient care.
And it was refreshing that the paper acknowledged previous shortcomings in translating discovery into clinical practice, promoting the idea of ‘real world’ sites for ‘combinatorial innovations’. Despite their anticipated placement alongside Academic Health Science Networks and Centres we would advocate strongly that these should not be viewed as research initiatives, even if very ‘applied’. In our experience such ‘real world’ implementation of complex new technologies, especially where it will involve health professionals doing things differently - new pathways of care, development of different and improved experiences for patients, shifts in funding, and steering a careful course through a variety of stakeholder interests and perspectives - are complex and time consuming tasks that do not sit comfortably with academic skill sets, interests or reward structures.
So how do we make a difference to health and healthcare? We believe that a commitment to personalised care is at the heart of this transformation. Although becoming rather an overused concept, personalised care is fundamental to addressing the gaps of ill-health, care and quality, and funding and efficiency noted in the report. For the individual this means understanding and tackling personal disease risk, ensuring quick and accurate diagnosis and treatment and, for those with chronic illness receiving finely tuned long-term care and support. Accurate and timely information for patients, whether through the modality of a biomedical test, feedback from electronic sensors in the home or arising from an NHS or other databases will be vital in achieving this.
But for healthcare systems, adopting the principle of personalisation acknowledges that health service provision is the summation of many thousand individual health transactions that take place every day, each of which has to be of the highest possible quality, timely, appropriate and efficient. Healthcare systems must use all available technologies to ensure this happens and effective use of a range of diagnostics is at the heart of this capability. For Simon Stevens’ concerns about A&E services we should remember that this may include providing a rapid ‘bench top’ test quickly in a community setting to ‘rule out’ a diagnosis (avoiding the trip to hospital ‘just in case it is something serious’) just as importantly as a positive result.
Alongside biosciences and digital technologies, the final side of the triangle that will make a difference is the effective use of data. At the genomic level, access to comprehensive databases is vital for accurate interpretations of tests for individual patients; at the health system level, we have to be able to aggregate information about patients, diagnoses, treatments and outcomes if we are to continuously improve services. And at societal level, there must be recognition that an institution as complex as the NHS, dealing with the breadth and subtlety of disease and clinical practice cannot function in the 21st century without a commitment to collect and share data.
I believe that the way forward for better health and healthcare involves the convergence of all these knowledge sets and, most importantly, the consideration of how these technologies can be integrated and used to transform healthcare. Although our skills at PHG Foundation are honed through consideration of the particular technologies involved in genomics they are generalisable to other technologies. Most importantly, moving forward as the NHS Five Year Forward View requires, will mean that many different academic and health service ‘camps’ must be brought together to think and plan innovatively to make a real difference. We look forward to the forthcoming debate and to being part of the action to deliver change.