Happy 70 National Health Services! Time to rethink the care model

Last week the UK’s NHS turned 70. Born on July 5, 1948, the National Health Service was – and still is – a hugely ambitious and unique project founded on the belief that good quality healthcare is universal and should be accessible to anyone. That it is social and about community engagement with the proactive participation of patients. Every 24 hours it sees one million patients, and with 1.7 million staff it's the world's fifth biggest employer.

A brief history of the NHS reveals the great advances we’ve made in healthcare technology since its establishment. In 1972, for example, CT scans were introduced to revolutionize the way doctors examine the body, and in the 1980s, MRI scanners would prove more efficient than earlier equipment in providing information about soft tissue, such as the brain. The NHS integrated this technology to further its aim of promoting good health – not simply to treat illness – and as we look to the future of the service, technology will continue to play a pivotal role.

That future starts now, and the NHS has made a statement of intent by announcing that it is primed to launch an app that will allow users to book appointments, order repeat prescriptions and see their medical files held by their doctor’s office. Former Health Secretary, Jeremy Hunt, has said: “In our 70th year as the NHS, we have to look forward as well as backward and the big change that is going to happen in the next decade is the technology revolution.”

The app is a first step towards a much-needed digital model of care; one that connects consumers 24/7, is coordinated, proactive, enables care at home, reduces waste and relieves the pressure on emergency and acute care. The Service recently started adopting digital technologies like remote monitoring and digital pathology to make patient care more effective and efficient, as well as free up NHS staff to focus on care and compassion. It is time to scale this up.

In a large, country-wide system like the NHS, will technology adoption successfully address strains such as lack of resource, delivery fatigue and increased patient volume?

In a large, country-wide system like the NHS, will technology adoption successfully address strains such as lack of resource, delivery fatigue and increased patient volume? Indeed, while there is much to celebrate about the NHS, we cannot pretend the Service is without its problems. Some of these challenges are quite similar to the issues that governments worldwide are dealing with. A shortage of qualified caregivers are under increased stress to deliver quality care to an aging population. Demand for care is growing while budgets are under fierce strain. Most healthcare models are still structured around acute care episodes, rather than prevention and chronic disease management. Reimbursement is still largely fee for service. The transition to value-based care and population health is indeed going slow!

Over the past five years, the cost of prescriptions from pharmacies has increased by around 70%, making the case for a new care model even more pertinent. 

Some challenges are unique to the UK health system. The share of patients seen in Accident & Emergency services (A&E) within four hours was the lowest since records began earlier this year and last winter we saw hospitals all over the country cancel operations because they couldn’t maintain basic services. The cost of care has also risen. Over the past five years, the cost of prescriptions from pharmacies has increased by around 70%, making the case for a new care model even more pertinent. 

If the idea of remote monitoring and digital pathology helping the cause sounds futuristic, in the NHS we are seeing early adoptions that showcase how digital technology can be used to address problems in a famous, legacy health system – and spark conversation for those in other localities facing similar issues.

In Trusts up and down the UK we see several shining examples, that should be considered for scaling.

Electronic Early Warning Systems:

Effective electronic early warning systems detect patient deterioration much quicker, ensuring that preventative care is delivered as soon as it is needed. In Bangor, Wales, Philips is working together with care providers and we have trailed a first of its kind electronic early warning system (EWS) at the Ysbyty Gwynedd hospital. Using patient monitoring and notification systems, nurses at the hospital are now able to detect patient deterioration much earlier, so they can trigger early intervention. There has been a reduction in serious events by 35%, and a cardiac arrest reduction of more than 86%. These are amazing outcomes, that need to be shared with larger populations.

Virtual Network of Pathologists:

The real benefits of technology are in augmenting clinical expertise – not replacing it. As an example, we can turn to The East and South Yorkshire Digital Pathology Network (EASY Path), which brings together the clinical expertise of Sheffield Teaching Hospitals NHS Foundation Trust and Hull and East Yorkshire Hospital NHS. These hospitals are working together with my colleagues in the UK to create a virtual network of specialist pathologists at both Trusts, enabling work to be balanced between the two sites. This ensures rapid analysis of vital histology samples benefitting millions of patients. 

The partnership is supported by the Philips IntelliSite Digital Pathology – it is the first of its kind in the UK. This open platform – consisting of an ultra-fast slide scanner, an image management system and pathology case viewer – scans samples in 60 seconds and provides information-rich digital images. The digital transfer of tissue samples enables pathologists, either in a hospital or remotely, to work together across locations and make informed decisions and assess treatment options more easily. Asking for a second opinion of a colleague pathologist is now done much faster via the network. In doing this highly complex job, the pathologist will soon be supported by Artificial Intelligence helping them with the automated detection and analysis of tumor cells in tissue samples. This will become part of virtual tumor boards, that bring together imaging, pathology and genomics information to provide precision diagnosis and select personalized therapies for cancer patients. 

Philips and NHS Glasgow & Clyde and NHS Lothian will pilot a system for nationally coordinated digital pathology services. Digital pathology could help support standardized sample results and build a world-leading archive of reference data, to increase accuracy of cancer diagnosis and offer transformational services to patients and clinicians in both rural and remote areas.

Diagnostic power at the point of care:

And then there’s Philips Lumify: the world's first tablet-based ultrasound system. The powerful diagnostic capabilities of ultrasound are being unlocked and made widely available. It gives flexibility to clinicians in hospitals to provide diagnostics at the bedside. GPs or home care nurses can take this scanner with them into communities, into the homes of their patients, to provide better care at lower-cost care settings. This solution is now being embraced by the first NHS hospitals, such as the University Hospitals Birmingham and the Aberdeen Royal Infirmary.

At the end of March 2018, Philips announced virtual care capabilities for Lumify. This means clinicians can now call in virtual guidance from colleagues anywhere in the world while scanning a patient, triaging there and then, rather than taking weeks and multiple trips to the hospital.

Philips Lumify is not unique to the NHS of course – and nor is the application of digital technologies. All over the world in fact we find clinicians and innovators who create high impact solutions. The Fortis Escorts Heart Institute, for example, is using telehealth technology to make the expertise of specialists available in remote areas of India, where a lack of critical care facilities and personnel in these remote areas claims many lives every year. Similarly, Babylon Health, a digital health pioneer from the UK now working with the Rwandan government, is offering digital healthcare services to anyone with a mobile phone, irrespective of internet connection.

A Service to be proud of

Technology truly is revolutionizing health systems, but there is still a long way to go. We are wasting valuable resources. There are millions of unnecessary tests and scans taking place because of a lack of coordination and information exchange between care providers and sub-optimized workflows. Hundreds of thousands of people in the developed world countries are being overdiagnosed, subjected to unnecessary tests, treatments or medications. Chronic diseases can be prevented and managed way better.

I am a firm believer of virtual care. The digitization of healthcare offers tremendous opportunities to remove waste, allocate resources in better ways, balance load, create improved access to care, augment our clinicians and to create networks of care where knowledge, capabilities and resources can be shared – at scale.

We are actively supporting the transition to digital care delivery models where care providers can seamlessly work together and exchange longitudinal, contextual data. Sustainable health means refocusing from treatment to prevention, from handling acute episodes to continuous care, from treating disease in hospitals and clinics to holistic home and community care.

Healthcare is complex, and technology alone will never be the answer to solving issues faced by healthcare delivery organizations, specifically one as large and far reaching as the NHS. And yet, the NHS once again shows why its pioneering spirit was celebrated so memorably at the opening ceremony of the London 2012 Olympics. The service continues to be at the forefront of adoption when it comes to innovative technology. Hopefully it takes the plunge into digital health at scale and once again becomes the example to follow for other legacy systems.

Happy Birthday NHS!