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The future of healthare: can the NHS lead a revolution?

"To lead this revolution, the NHS will need to sustain Patients' voices, balance top-down and bottom-up approaches to change, enable a transition of power from professionals to patients and harness the potential of technology."

George MacGinnis May 2011

Technology has the potential to act as a trigger for an NHS revolution, but change at a population level requires more, writes George MacGinnis, healthcare technology expert at PA Consulting Group

Hidden behind the headlines in the current debate on NHS funding, there is a real need to revolutionise the way healthcare is delivered. Telehealth offers an exiting alternative to traditional approaches but it needs new approaches to building commitment from patients if it to fulfil its potential.

Faced with the inexorable rise in demand from ageing populations and lifestyle related long term conditions, current practice cannot be sustained. Preventative and pro-active models of care offer an attractive solution. These enable people to take an active role in their own health from home, and have been shown to reduce demand for services, reduce costs and improve patient satisfaction, but have yet to take hold in the NHS.

Can the NHS lead a revolution? Current structures often act to reinforce the traditional approaches to delivering care. Change will need a real shift towards empowering patients. Technology has the potential to act as the trigger, enabling patients to take their place at the heart of the health system as an informed decision makers and commissioners.

Other industries have been through transformations driven not only by new technology but also through harnessing the potential of their customers to fundamentally shift the balance of power away from providers. This is always accompanied by fundamental change in their business. What does this mean for the NHS?

Traditional approaches to commissioning health services may actually be blocking the adoption and potential of new services. A seminar at PA Consulting discussed two contracting models for change. The first was a 'clinical system' mindset for improvement. In this view commissioners start with the question 'what is wrong?' and then look to identify development and improvement needs and then fill any gaps and deficiencies. It is a model familiar across government, based on organisational accountability and driven by the notion that "If I don't deliver this, I fail to meet my performance objectives".

A look at successful community capacity building work reveals an alternative approach to managing change that shifts the focus from compliance to commitment.

These typically start by asking 'what is right that we can build on?' They exploit existing assets and resources, and amplify what works. This approach is based on building commitment and provides the freedom to experiment to see how much can be achieved with the available resources. Typically, those involved are driven by the feeling that if they don't deliver, they let the group or community and its purpose down.

So why does this matter so much to the NHS? Patients with long term conditions represent a very different set of challenges to those which drove the current design of healthcare. Typically there is no cure. Effective treatment is based on management, where the role of the patient in adopting changes in lifestyles is crucial. Self-care, rather than professional care, is the norm. Some patients become more expert in their array of conditions and treatments than their own doctors. Yet the process by which they become 'expert patients' is both haphazard and a poor use of resources.

So while new telehealth technologies that enable care to be provided in the home has much to offer the NHS, a conventional approach to implementing these services is unlikely to fulfil their promise.

Take the example of the Eden Project in Cornwall. It started with the premise that patient with chronic lung disease (COPD) would benefit from exercise, but that they never would visit an attraction like the Eden project because they would find slopes impossible. A group project was established, with a series of pre-defined walks. Participants were encouraged to use pedometers to record their exercise. Over time a group dynamic took over, the walking became more competitive as users felt empowered by information about their own performance. The award-winning project went on to record very positive outcomes.

Significant time and attention is being directed towards developing the future of healthcare. To effect this change requires further debate on the way change can be effected at a population level. The problem is inspiring and invoking this change at a population-level requires more than just technology, and indeed more than just vision. For the NHS to lead this revolution it will mean enabling and sustaining Patients' voices, balancing the top-down and the bottom-up approaches to change, enabling a transition of power from professionals to patients, and harnessing the potential of technology.

George MacGinnis is a healthcare technology expert at PA Consulting Group  

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