Predictions round-up: How will the NHS fare in 2015?

The year 2015 promises much for the NHS and healthcare technology.

NHS political football has kicked off – the election year starts with a burgeoning crisis in Accident & Emergency departments across the country. NHS chief executive Simon Stevens will be hoping his request for a multi-billion pound transformation fund will get on the score sheet, and so help the service deliver the changes to cope with rising demand. Technology will be a key enabler.

How do leading thinkers believe the game will play out in 2015? Here are some of the highlights.

Professor Chris Ham of The King’s Fund warns that the NHS has to face three major challenges:

• Preparing for the post-election spending review; it is not yet clear whether Stevens’ invest-to-save model will be taken on board by all major parties.
• Achieve much closer integration of health and social care, potentially through single ring-fenced budgets.
• Move beyond heroic leadership to one that engages staff at all levels – a drive reportedly echoed by a critical investigation into NHS management by former Marks & Spencer chief Sir Stuart Rose.

Ultimately, Professor Ham notes that the outcome of the election is a huge uncertainty for the NHS; the possibility of another coalition means that NHS leaders should set out clearly their priorities for the incoming government. Given this, The King’s Fund election tracker will be an interesting resource for updates from the political parties.

The BBC reports that the NHS is set for a bumpy start to 2015. With Accident & Emergency departments already at full stretch, Nigel Edwards, chief executive of the Nuffield Trust think-tank, warned of “some spectacular collapses in local healthcare systems” if flu and norovirus took hold. Politicians are taking note, and opposition parties taking aim.

This comes after a year in which clearer direction was set for the NHS, and especially its star striker – IT.

The NHS Five Year Forward View set out a vision for the future of the NHS that requested a transformation fund that could enable the necessary changes for NHS efficiency. New models of care are one feature of this vision; as is the drive for greater integration of services. For excellent analysis, visit the Health Service Journal’s Forward View Analysed article; for details on activity for the year ahead, read The Forward View into action: planning for 2015/16.

What the new NHS vision meant for healthcare technology was laid out in more detail in Personalised health and care 2020: a framework for action.

This long-awaited gameplan from the National Information Board included a series of goals to be achieved in 2015 (see below).

It is part of an ambition to make the NHS a digital pioneer for patients and citizens, according to Tim Kelsey, director of patients and information at NHS England. As one of several leading figures interviewed by EHealth Insider (EHI) in 15 predictions for 2015, he hailed the technology framework as the first blueprint that all national bodies, clinical and civil society leaders have agreed.

Both plans have set the scene for the industry, according to Natalie Bateman, head of health, social care and local government at Tech UK. Her prediction for 2015 was that these documents should encourage a culture shift to investing in technology that puts patients first – as Mark Venables, Highland Marketing CEO wrote in his blog last year, 2015 could be the year of the patient.

Charles Gutteridge, chief clinical information officer at Barts Health NHS Trust, predicted that the prize for the end of the year will go to “those who have established systems for aggregating data at local level for population health management”. He saw the year ahead promising the application of national standards for messaging, health information exchange, use of SNOMED, and structured data; and a wider take up of a single systems approach to developing an electronic health record.

And Shane Tickell, chief executive of IMS MAXIMS, recognised that the accessibility of patient records in both primary and secondary care would play an important role in 2015, and we will see the enhancement of mobile applications linking to electronic patient records become the norm. Energised collaborations between clinicians, patients and developers will be facilitated by open source products and people, he said.

The more widespread use of mobile applications, and associated data, was also heralded by IDC FutureScape for Health Insights in 2015, for cost efficiency reasons amongst others. It stated: “To control spiraling healthcare costs related to managing patients with chronic conditions, 70% of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring, and virtual care by 2018, which will create more demand for big data and analytics capability to support population health management initiatives.” The same report predicted increased risk of cyber attacks and a proliferation of unprotected data.

The US-led annual health industry issues report from PwC’s Health Research Institute (HRI) anticipated that the top 10 trends for 2015 would include the expansion of ‘do-it-yourself healthcare’, with people using wearable tech and mobile devices to monitor and manage their health. Increasing demand for new evidence and definitions of positive health outcomes is expected, and non-traditional partnerships will push healthcare companies out of the comfort zone toward new competitive strategies.

Another report with a US focus was 10 trends impacting healthcare from healthcare consulting firm Perficient. This included globally relevant ideas such as the use of big data, the drive for population health management, and greater use of mobile health and telehealth. As in the UK, there will be a drive for greater use of electronic patient records, and challenges around the use of clinical standards such as ICD-10. Organisations that take a strategic approach to healthcare IT are forecast to have a competitive advantage.

Population health management may also be driven by the rise of Accountable Care Organisations (ACOs) in the UK, which were proposed as part of the Five Year Forward View. Commentator Ben Gowland in the Information Daily said that he saw these taking over from Clinical Commissioning Groups in the year ahead – one of several doom-laden predictions that included GP bankruptcies and Better Care Fund failures. Worried GPs even have a game to play on Pulse magazine that asks: Will your practice survive 2015?

Meanwhile the advances of technology will continue, building on 2014 as the year of the wearable. The rise of genomics is set to continue in the year ahead, according to future-gazing by NHS Choices. The screening of an individuals’ DNA can be done for a few hundred pounds, and may appeal to the ‘worried well’; NHS England’s plan to sequence 100,000 genomes to tackle cancer and rare diseases may improve disease prediction and prevention, and allow the personalisation of drugs and other treatments to specific genetic variants.

This promises much, and will be one to watch. Healthcare Business and Technology summarised four healthcare trends to watch in 2015 neatly as follows:

1. Patient privacy vs convenience – patients can increasingly access their data and records, but this presents challenging data security issues.
2. Rise of patient apps – the UK and US are looking at how to regulate this area, but it is sure to grow.
3. DIY health care – patients may well use devices at home to transmit results and monitor health.
4. Taming the ‘1 per cent’ – in the US, one in 100 patients use up 20% of the country’s healthcare spending. Managing high usage patients will become ever more important.

Technology is becoming ever more disruptive in the healthcare space. It is advanced enough in some areas to be the leading goal scorer. In others, the focus on the here and now might not play in its favour. The key issue will be how much time is left on the clock.

Personalised Health and Care: 2015 targets

By March 2015
Proposals will be set out for the enhancement and extension of the MyNHS service on NHS Choices.

By March 2015
NIB will publish a roadmap for alignment of existing national programmes with the outcomes of this framework.

From March 2015
All citizens will have online access to their GP records.

By 1st April 2015
Health and Social Care Information Centre to publish the roadmap and standards care organisations will be required to meet to be able to access core transactions systems.

By 1st April 2015
Health and Social Care Information Centre to publish proposals to deliver an enhanced suite of data services, which could provide a core element for the collection and sharing of data and records at the national level.

From April 2015
Use of NHS number as primary identifier in clinical correspondence and for identifying all patient activity will be mandated in health and care.

By April 2015
The National Information Board and partners will coordinate agreement on national technical and professional data standards required to achieve digital real-time and interoperable care records.

By April 2015
NHS England to publish new “Insight Strategy” for making better use of patient outcome and experience data.

By June 2015
The National Information Board will publish proposals on the regulation, accreditation and kitemarking of technology and data-enabled services, including apps.

By June 2015
NHS England to develop proposals for ‘Code 4 Health’.

By June 2015
Health and Social Care Information Centre will develop proposals with industry for personal data usage reporting.

By June 2015
The National Information Board will agree a core ‘secondary uses’ dataset that all NHS-funded care providers have to make available to support commissioning, regulation and transparency.

By June 2015
NHS England, with the Health and Social Care Information Centre, will publish proposals to consolidate NHS e-Referrals, appointment booking and repeat prescription ordering with NHS Choices, as a basis for providing a single, common portal for all care providers and service users.

By June 2015
NHS England and the Health and Social Care Information Centre will publish a prospectus for new General Practice Systems of Choice (GPSoC) requirements to stimulate the supply of new and innovative systems for out-of-hospital services, with a particular focus on integrated care services and supporting citizens and carers. In addition new forms of ‘software-as-a-service’ clinical systems to support new providers of primary care services will be encouraged.

By June 2015
A number of retail pharmacies will have access to Summary Care Records, with a view to a national rollout and then extension into social service providers and nursing homes.

By September 2015
Proposals will be published for linking 111 with NHS Choices.

By October 2015
The Health and Social Care Information Centre, the Care Quality Commission, Monitor and NHS Trust Development Authority will publish data quality standards for all NHS care providers.

By October 2015
The Health and Social Care Information Centre will publish enhanced data security standards and requirements and will re-launch the Information Governance Toolkit.

By October 2015
Digital Maturity Index key indicators for NHS trusts will be published via NHS Choices.

By December 2015
The Health and Social Care Information Centre will publish a plan on the progressive opening up of connectivity with and use of the NHS infrastructure to all care providers and service users, subject to accreditation. This would include low-cost secure access to the N3 network and to SCRs.

Throughout the year
NHS England will work with providers and patient groups to launch new experiments during 2015 to develop patient-centred outcome measures in specialised services as well as in maternity.