21 September 2016
The NHS’ Sustainability Transformation Plans (STPs) are local plans, covering 44 ’geographical footprints‘, which aim to improve service quality and develop new models of care; improve health and wellbeing and improve NHS efficiency by 2020-21, as per the NHS Five Year Forward View (FYFV).
They are place-based systems of care being developed by local health and social care organisations (NHS trusts, CCGs, local authorities). Rather than planning services around individual organisations there is a focus on collaboration and integrated care to meet the needs of the local population. The final STPs are due for submission in October, and they will run for five years.
The fundamental goal of STPs is to develop new models of care for the future through transformation. A Nuffield Trust report has reviewed STP progress, covering a third of the footprint areas, and has found common themes across the plans. These include proposals for ’major changes in where and how care is provided for the large number of patients in hospital who could be cared for in other settings‘, development of new models of primary care and supporting self-care for patients with chronic conditions. However, another key priority of STPs is to achieve £22 billion in efficiency savings within the next fi ve years, and they have received much negative press of late over fears that they are simply a cost-cutting scheme. Indeed, uncovered draft proposals reveal that plans include the closure of A&E departments and district hospitals, and reductions in hospital beds.
Despite this recognition of the crucial role of technology to achieve service transformation and efficiency in the STPs, there seems to be a much stronger focus on how services will be reconfigured and a comparative lack of direction regarding how innovation and digital technology will be used.
Given the parlous state of NHS finances in the face of soaring demand, major efficiency savings are certainly badly needed. Alongside changes in workforce and estate management approaches, digital technology has been identified as a key enabler to drive this. Despite this recognition of the crucial role of technology to achieve service transformation and efficiency in the STPs, there seems to be a much stronger focus on how services will be reconfigured and a comparative lack of direction regarding how innovation and digital technology will be used. This is at odds with another programme hatched from the NHS FYFV, which is all about harnessing innovation and technology to transform service delivery.
The NHS Test Beds programme addresses the need set out in the FYFV, to improve the NHS’ ability to apply innovations. It is designed to tackle flaws in current methods of NHS innovation by testing new technologies in combination with innovations in service delivery, in real world settings. This is hoped to accelerate innovation and ultimately improve patient outcomes and increase the efficiency of service delivery, including through the integration of care.
The first wave of Test Beds, launched in January 2016, includes five health and care Test Beds, which bring together combinations of innovations that offer the prospect of significant improvements to health and care services, at the same or lower cost as existing services, and two ‘Internet of Things’ (IoT) Test Beds, which seek to implement IoT technologies at scale within the NHS. Test Beds are structured as collaborations between innovators and the NHS and are coordinated by Academic Health Science Networks (AHSNs). They are spread across different areas of England and each has specific aims focused around a particular local clinical challenge. For example, the Care City Innovation Test Bed aims to promote healthy ageing and self-management, and the RAIDPlus Integrated Mental Health Urgent Care Test Bed aims to achieve a predictive, preventative, integrated and efficient mental health urgent care service for patients and their relatives.
Across the Test Beds there is a strong focus on digital technologies such as sensors, wearables and mHealth to promote patient self-management and reduce GP visits and hospital admissions. Some examples include, home-based monitoring systems for dementia patients, a telehealth service for managing patients at risk of developing long-term conditions and a personal dietitian app for diabetes patients. Other types of intervention include efforts to create a data-sharing infrastructure and the use of data analytics for prediction and prevention for at-risk patients.
The Test Bed programme clearly identifies ways in which digital health innovations can drive transformation and efficiency in the NHS. Although the North West London draft STP does vaguely mention ’using technology‘ to reduce face-to-face outpatient consultations, this is much less apparent in the STPs. This may be due to the rapid timescale within which footprints have had to come up with these large-scale ambitious plans, as well as the risks involved with implementing new technologies. Nevertheless, there appears to be a lack of joined-up thinking, relating to how outcomes of the NHS test beds, which are due for completion in 2018, can be incorporated into STPs, particularly those that encompass Test Bed sites.
As well as testing new technologies, the Test Bed programme places strong emphasis on performing robust evaluations to identify high value innovations - those that produce significant health improvements at the same or lower cost than existing practice. They aim to develop an approach for diffusing the highest value innovations more widely in the NHS according to local need. Thus, an ideal opportunity still exists for STPs, when midway through their remit, to take advantage of digital technologies that have been identified by the Test Bed progress to have proven success within real-world settings.