In 1970, UK public and private healthcare spending in the UK amounted to 4% of GDP. By 2016 it had risen to almost 10% and if the trend continues, by the end of the century we will be spending 40% of our GDP on healthcare. The UK is not alone, research by PA Consulting’s health economics unit suggests that France will spend 39%, Sweden 48%, Canada 56% and the US 90% of GDP to fund their health services.
This is clearly unsustainable and the only way to meet these growing demands will be to improve the productivity of the NHS.
While this has proved very difficult in that past, the advantage we now have is that there are a range of technological tools available, from data analytics to robotics that can both drive significant increases in efficiency and improve the quality of care.
At the heart of the new approaches is the way technology enables healthcare systems to be more precise in who they treat, and how and when they are treated. That in turn brings more efficient, and higher quality of care that is personalised and targeted.
A recent announcement of plans to create an index to measure the nation’s health and use the measure to drive policy shows how these approaches are rising up the agenda. These options have only become possible because of technology, in the form of sophisticated data management systems that can integrate the full range of information about people and their health risks.
The benefits can be seen in a project PA worked on for a leading integrated care system. This examined why there were an unusually high number of children coming to A&E and being admitted for respiratory problems.
Power of data
Through evaluating the data and working with informatics, operational and clinical teams, we created a predictive risk model which identified why some children were at higher risk and which children were more likely to end up going to hospital.
This information was then used to deploy services where clusters of children at greatest relative risk lived and proactively target individuals to get them to enrol in intervention programmes. This kind of approach could also be used in other population health initiatives such as, identifying older people with multiple conditions who often end up in A&E, or in understanding mental health risks.
Some of the biggest productivity gains can be made in hospitals where data analytics can be used to manage patient flow and make better use of expensive resources such as operating theatres. Too often hospital managers still manage beds using paper-based systems which, at best, only give them a partial view of the situation.
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Yet there are technological options available that enable them to understand patient flows in real time and operate a control centre model which means they can make much better and more timely decisions about the resources they have.
In work PA did for the Leeds Teaching Hospitals Trust, the scheduling process for operating theatres was transformed through live automated scheduling tools that linked to the waiting list.
The system is individualised to each consultant, and can identify which procedures can be fitted into a particular time slot in that theatre. This has enabled 500 additional procedures a year to be carried out. It has also reduced overruns and early finishes by 100 hours a month, adding up to a significant increase in efficiency.
While this was a project based around technology it was implemented in a careful change management process which included training of schedulers and ongoing coaching to ensure they could see the benefit of the new approach. That engagement was as critical to its success as the technology.
While there are major productivity gains to be secured through better management of clinical activity, technology can also transform many of the NHS’ support functions. In particular, the recruitment and the management of temporary staff is often slow and inefficient, with checks being carried out manually. Yet many of these processes could be automated and significantly reduce the time taken to get staff where they are needed on the ward.
The opportunities are not just to improve the way the providers work. Patients too can benefit from the increasing availability of online and skype consultations which save them time and provide better, more accessible care. They are also more efficient.
It is undoubtedly true that technology has often been hailed as the answer to the NHS’ problems and then it has disappointed. The reasons for these failures lies in the NHS’ tendency to buy technology and then look for a problem for it to solve. To secure the productivity gains it needs, that approach must be reversed. The starting point needs to be real clarity about what the problem is, whether that is about data, use of resources, or cultural challenges, followed by a focused process to find the right technology that will provide an effective solution.
It is also vital to recognise that the power of technology will only be realised if it is implemented as part of a change process, where the benefits are clearly set out and those who will be using it understand what they have to do and what benefits it will bring to them. The success will depend as much on getting the right people and culture in place as the technology. That all needs to be underpinned by an understanding that any change in healthcare is difficult because it has to be implemented in a live situation, where the hospital has to keep functioning.
There is often cynicism about the value of technology but the projects underway today show what can be achieved in driving up efficiency and quality. There are real grounds for optimism that innovation and ingenuity can transform the NHS and bring the productivity improvements that we need to secure its future.