Minding the gap

I read in Health Service Journal last Sunday (6 July 2013), comments from NHS England director for patients and information, Tim Kelsey that the funding gap in the NHS is set to reach a £30 billion deficit by 2020. Just as I got my head around that figure, I read yesterday (11 July 2013) that in just five additional years time to 2025, the deficit will double to £60 billion. I decided to stop reading just in case that figure doubled too.

There is no doubt that healthcare costs are rising dramatically (predominantly due to increased needs of an ageing society) and yet funding is more or less staying the same. As leaders in the NHS and beyond haggle over the pain-points in the current financial-management-clinical triangle, what is the next strategic move for the UK’s 65-year old health system?

Any next steps need to look beyond the 2025 deficit and consider medical trends in the long term. Former health minister Lord Darzi said that the “opportunities in the next decade that will possibly disrupt the NHS will be technological” and it will be interesting to see how that will develop in health and social care as the system plays ‘catch up’ with other private sector industries. As I see it, the NHS has three main strategic options (and I make no apologies for the simplified explanation here!) which all hold a heavy influence from technological advancements.

1. Make more money

Funding is being ring-fenced so the NHS needs to look elsewhere for additional income. As we all know, one of the founding NHS principles is that it is free at the point of need, so charging for fundamental services would cause national uproar.

So what about generating income from other nations? There is an opportunity to use the skills and expertise of our first-class health service and sell it overseas if resources allow. As trusts adjust to the new market economy within the NHS, extending into other (international) markets may seem an attractive option.

Initiatives have already been put in place for ‘selling’ the NHS brand abroad, but with improvements and adoption in communication technologies, why can’t NHS staff be based here in the UK and provide consultation and diagnosis via video calling and photographs? On the reverse, the Department of Health recognises the NHS has a longstanding weakness in charging foreign nationals who use the health service and has plans in place to counter this issue.

2. Cut costs

The emergence of CCGs is aimed at identifying local needs, as a centralised approach to commissioning was not working effectively enough. Whilst the NHS reforms will cost money (GPOnline reported that in March 2013, the reforms had already totted up to £1.1 billion), the theory is that costs will be reduced in the long term. Further considerations are required to identify how costs can be lowered further.

Health and social care integration is high on the agenda. Identifying and diagnosing conditions (especially long term conditions) earlier will reduce the pressure on acute and secondary care. This, in my opinion, requires a serious culture change across the nation. Technology such as mobile phone apps to monitor blood pressure or websites such as NHS Choices need to be engrained within the community at a local level and used in our everyday lives. This culture change needs to be led from within the NHS with GPs, clinicians and frontline staff showing leadership in adopting technology that allows integration between many disparate organisations to the benefit of patients.

3. Increase efficiency

Opportunities galore here! Whether you are reducing administration, cutting A&E waiting times or increasing patient safety, the list is large and varied. Leaders always seem to get scrutinised on the subject of efficiencies, but I think with the right data, at the right time, better decisions can be made for the benefit of the patient and the performance of the NHS as a whole. Issues can occur when demonstrating these efficiencies through management reporting actually impedes the quality of care of a patient (often by frontline staff spending time on administration rather than with the patient).

Investment in technology is a must. It is the cost of replacing old systems, which is a major concern here. Indeed every case is different, but there are also many IT suppliers who are willing and able to work within existing systems rather than ‘rip and replace’. It is not just NHS personnel who need to show leadership in a time of change – IT suppliers need to demonstrate that they understand the problems of healthcare providers and how they can support their aims to become more efficient.

Society expects

What do the people want? The right care, at the right time, at the right price (which is normally free). I think it is time to educate the nation about the scale of our NHS dilemma, so they understand and can empathise with what is trying to be achieved and in turn respect our health service and use it appropriately.

So how do we communicate effectively with an entire nation? Again, technology can play a role here. An emerging tool is social media. I see many campaigns broadcasting messages on policy, health matters, mandates, etc, but the platform is not utilised enough for actual public engagement.

As NHS England set out its programme of engagement under its recent NHS belongs to the people: ‘A call to action report’, it would do well to monitor, communicate, and analyse Twitter, and Facebook as the social spaces where current and future generations of NHS patients are already providing their feedback.

With current and future financial pressures on the NHS, there is a clear role for creativity and innovation within the next strategic move for the organisation. It has taken the NHS a long time to adapt to the needs of today’s society, and the slow adoption of technology is an obvious component of this. Looking ahead, we need a technology structure that is flexible enough to adapt to not just today’s needs, but those we will face in 10-15 years time.

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