By Mandeer Kataria
The response to the COVID-19 crisis has provided a glimpse into a plausible vision for innovation and transformation within the health service, by way of speedier adoption of health tech solutions. Notable examples across primary, secondary and community care include the introduction of GP Connect to all practices to enable secure sharing of patient records across primary care; the use of AI to predict critical care capacity, equipment and staffing; and the widespread carrying out of remote GP consultations. Remote monitoring is now crucial for providing care for vulnerable patients who have been shielding or those who simply do not feel comfortable in visiting a hospital. With regards to an overstretched workforce, healthtech can provide remote education opportunities to upskill professionals. It can also alleviate pressures by allowing staff to work remotely and by assisting with administrative tasks, freeing up time to focus on caring for patients.
The momentum for change through the uptake of technology must be sustained as we adjust to the ‘new normal’, whereby the NHS adapts to living with the virus for what will likely be an indeterminate stretch, with new norms prevailing in order to control the spread of the virus, namely social distancing and enhanced hygiene regimes. Technological solutions could prove indispensable in helping the NHS and general public adhere to newly imposed measures.
The virus persists against a backdrop of pre-existing, entrenched problems within the healthcare system, specifically mounting waiting lists and the build-up of demand. Waiting lists were reaching record levels in 2019, with the HSJ reporting the proportion of patients waiting less than 18 weeks for treatment as being at its lowest level in a decade. Additionally, cancer waiting times were the worst recorded, with 73% of trusts failing to meet the 62-day cancer target. The wait for diagnostic tests was at its highest level in over a decade, with 4.2% of patients waiting over six weeks, against a desired target of under 1%.
The fallout from COVID-19 has exposed and exacerbated existing issues in the NHS. According to analysis by the British Medical Association (BMA), between April and June 2020, there were up to 1.5 million fewer elective admissions than usual, up to 286,000 fewer urgent cancer referrals and up to 15,000 fewer patients commencing their first cancer treatments after an urgent GP referral. Figures from Cancer Research UK show that approximately 2.3 million fewer cancer tests have taken place since lockdown compared with the same period last year. The BMA assert that the “drastic extent” to which the NHS had to shut down routine care is a result of more than a decade of underinvestment and cuts to essential services. To add to the pressures on waiting lists, further novel requirements generated by COVID – in the form of infection control measures – could precipitate a productivity decline without the support of external forces. These include the need to keep vulnerable patients out of hospitals; enhanced PPE requirements; and significant extra time for cleaning routines.
How has technology been successfully employed thus far to support the system?
Technological solutions abound, but crucially, we need to understand what adaptations the NHS can achieve in a climate of resource-constraints, and what will have the potential to ease the burden on the system during the anticipated resurge of the virus in the coming winter months. A recent noteworthy example is the rollout of predictive technology to help NHS teams forecast COVID hospitalisations. Developed by the AI firm Faculty, the new technology will allow local teams to balance priorities by helping clinicians and scientists to model hospitalisations up to three weeks ahead.
A further case worth mentioning is the use of ‘virtual wards’ to discharge patients from hospital. Here patients are monitored at home with devices or technology through which consultants provide care. They may receive ‘virtual visits’ from varying members of the ward team, including nurses, therapists and pharmacists, thus minimising hospital stay for potentially vulnerable patients, and freeing up capacity in hospitals.
Given the eye-watering predictions set out by the Academy of Medical Sciences of hospital deaths in a worst-case scenario of a winter resurgence, technologies such as this could spell untold benefits for the system. Particularly when considering recent warnings from the senior figures within the Royal College of Surgeons and the BMA that the NHS must “never again” act as a COVID-only service. The health system must heed these warnings as we head into an uncertain winter and utilise the tools at our disposal to aid the provision of normal care.
On 31st July, NHS England and Improvement wrote to all NHS trusts and foundation trusts to set out the third phase of the NHS response, effective from 1 August. The third phase set out a desire to accelerate the return to near-normal levels of non-COVID health services. This included ambitious targets to restore elective capacity in September to 80% of last year’s activity and in November, to 90%. The third phase letter also spoke of ‘locking in’ beneficial changes seen through the pandemic response.
With worst-case scenario warnings that waiting lists could rise to 10 million by December, health tech undeniably has a role to play in not only alleviating waiting lists but also in creating more joined up care between currently fragmented primary and secondary care services, reducing hospital stays or removing the need for individuals to visit hospitals at all, through remote monitoring solutions. It is imperative therefore that during these unprecedented times, the debate on the role of healthtech can play in tackling these unprecedented challenges is front and centre.
Even healthtech that is only deemed to deliver incremental changes to the build-up of demand could deliver huge benefits. Of course, the change to the manner in which it is being adopted relies upon the provision of adequate investment, along with the means to incentivise adoption and efforts to remove bureaucracy which stifles adoption. It will also require trusts to think beyond unit cost, especially as some healthtech products deliver a return on investment beyond their first year of uptake. Indeed, one of the key learnings from the COVID-19 pandemic is that a focus on unit price over patient outcomes can lead to unintended consequences. Much like the move towards Integrated Care Systems, there ought to be an integrated approach, with the Department of Health and Social Care and NHS England working hand-in-hand with Clinical Commissioning Groups, Trusts and all relevant parts of the wider health system, including industry, to harness the benefits of healthtech.
The blog was posted on Med-tech news website here.