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A year on from the first lockdown – what’s next for healthcare?

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The vaccination programme is progressing and the coronavirus infection rate is falling. Gemserv’s head of health, David Newell, looks at what the NHS should focus on now to make improvements in healthcare.

The past 12 months have been a period like no other for healthcare and the UK population: lockdowns heartache, frustration; but also incredible dedication and courage, new innovative ways of working, and some great examples of community spirit. So how does the NHS focus on the positives and move forward in a way that will be beneficial for both the service and the nation?

Tackling the backlog of treatment

The Covid-19 vaccination programme and managing capacity in intensive care units are understandably the current main priorities for the NHS. This should change around the middle of the year when the majority of the adult population has received at least one jab and the pressure on ICUs has dissipated. As the critical vaccine milestone is reached, trusts will be able to move their focus toward the massive challenge of the treatment backlog.

Due to the scale of demand this could take up to 36 months, or even longer, to get back to the target average 18-week referral-to-treatment time, but there are strategies that could help. These might include: increased digital administration and remote monitoring for pre-operative and follow-up assessments; wider adoption of technology for triaging and monitoring hospital patients, leading to faster interventions when needed; and increased sharing of data across trusts to speed up collaboration.

The government has pledged an additional £6.6bn to cover the healthcare costs of the pandemic and tackle the backlog of treatment, and although this falls short of the £8bn that NSH England’s chief executive, Sir Simon Stevens, said would be needed, he has welcomed the announcement.

Integrated care

The pandemic has reinforced that more needs to be done to forge collaboration between trusts and other organisations in the health and social care system. It has also highlighted that one key driver for healthcare to become more efficient, is through effective use of technology, and there is now an opportunity to capitalise on both fronts to make potentially significant improvements.

The move to create more Integrated Care Systems (ICSs) and to clarify and formalise their powers is the undoubtably the right thing to do, but we must consider what those powers will be. As part of this, it is fundamental that the NHS moves away from being primarily focused on hospital care settings and treatment, to becoming more patient-centric and proactive in promoting individual wellness.

David Newell, Gemserv Health.

At Gemserv Health, we have had the opportunity to consider how to create a fully integrated health and care system on the Isle of Man, which has been both challenging and rewarding as we see the recommendations being implemented. We strongly believe that by putting in place the right structural approach – supporting it with a duty to collaborate across existing organisations – and also supporting it with digital transformation, can enable a step change. This is a co-ordinated methodology from which newly forming ICSs can learn valuable lessons.

For ICSs to form as fully functioning authorities, all stakeholders will need to align to a common vision. Key issues will need to be addressed, including governance and information sharing, and a cohesive technological philosophy to form the basis of a digital transformation programme. All organisations within an ICS will need to consider how to raise the bar to achieve rapid progress and deliver demonstrable benefits for the areas they serve.

Additionally, shared care records are due to be in place by this September in all parts of the country, but this will be a tough challenge given the vast number of health and care organisations involved, and the fact that dealing with Covid-19 and reducing the backlog of referrals and treatment will dominate activities for months to come.

Accelerating the pace of digital transformation

Despite the difficulties of the past year, the pace at which digital systems have been developed and tested, or commissioned and deployed, has been much faster than ever before. Tasks which used to take months or years to complete are now being carried out in a matter of days and weeks.

But security and information governance need to be addressed on technology that was rapidly deployed during the pandemic without some of the normal rules being applied. We must ensure that patients’ data is secure as further services are rolled out, and that the public has confidence in its proper use.

Faster drug development

There haven’t been many positives over the past year, but the speed at which Covid-19 vaccines have been developed, put though clinical trials and gained regulatory approvals, has been a success. Concerns in some European countries about the AstraZeneca/Oxford vaccine have been raised, but both the UK’s Medicines and Healthcare products Regulatory Agency and the European Medicines Agency have stated that any small risk of blood clots is far outweighed by the benefits of being vaccinated.

Companies, universities, and regulators have worked together with a common purpose that has been both beneficial to society and heartening to see. The challenge for 2021 is to maintain that momentum to develop vaccines and treatments for many other diseases.

Carbon net zero

Reducing carbon emissions to reach net zero is an issue that continues to be a focus, both for the country and the NHS. The two are interrelated in several ways: the health and care system is responsible for around 4-5 per cent of the UK’s carbon footprint, and so there is an obvious need for the NHS and associated organisations to do more to reduce emissions; and research also shows that pollution is one of the factors that causes ill health.

In November, the 26th meeting of the United Nations’ Climate Change Conference of the Parties (COP26), will take place in Glasgow, and so the eyes of the world will be on the UK. Seen as the spiritual successor to the 2015 Paris Agreement, the conference will urge countries to raise their game when it comes to cutting carbon dioxide emissions and tackling climate change. As the host nation, the pressure will be on the UK to demonstrate that it can put words into action.

As regards the NHS, there is a link also to the acceleration of digital transformation. In England, a net zero target has been set for 2040, with the NHS’s supply chain aiming for 2045. It is estimated that cutting 124 million hospital outpatient appointments each year could mean 100 million fewer car journeys, while a 30 per cent cut to GP appointments would save 300 million journeys each year.

Reducing emissions will also have a positive effect on people’s health. Reaching the UK’s goals from the Paris Agreement on climate change could see more than 5,700 lives saved every year from improved air quality, around 38,000 lives saved annually from a more physically active population, and more than 100,000 lives saved each year from healthier diets, according to the NHS Net Zero report.

Through all the issues that the NHS will be focusing on as we navigate our way out of the worst aspects of Covid-19, strategic changes will need to be delivered in parallel with tackling the backlog of treatment whilst delivering day-to-day services.

To paraphrase Eric Topol, an internationally renowned cardiologist, scientist and author, if we share data and knowledge, we can all get smarter faster.

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