Irrespective of COVID-19, the transformation of Health and Care must be one of the world’s most important challenges; it certainly is here in the UK.
What’s wrong with our current system?
In the UK, health and care is largely disjointed, unaffordable and focuses on delivering a break-fix service, rather than one of education and prevention. Despite the incredibly hard work of so many dedicated health and care professionals working within the system; at a macro-level, we simply don’t have a viable health and care system. We’re failing citizens and we’re taking advantage of those working so hard within the system. That said; at a micro-level, there are many thought leaders, pioneers and examples of great success in how we can redesign health and care – but it’s inconsistent.
What, in our opinion, are some of the key issues we face?
- We’re working in silos: Health and social care are predominately two separately governed and delivered systems; despite the fact that if you take a people-centred view of the world, they’re both essential to assure our health and wellbeing. It’s incredibly challenging to transition between parts of the system; and often requires the citizen to work out how to plug the gaps.
- We’re living longer: although there is evidence to suggest that average life expectancy has plateaued, and some research would suggest is in decline, we are living longer than we ever have. That means society is faced with supporting a greater number of citizens managing long term conditions, over longer periods, which are debilitating for the individual and resource intensive for the system.
- We’ve largely stood still when it comes to transformation enablers, such as digital: although therapies and treatments have developed, other sectors have embraced transformation enabling technologies at a much faster pace. As a general statement, our health and care systems lack digital maturity. There do exist impressive examples of successful technology adoption, which have resulted in some parts of the system being much more advanced in their use of digital – but the level of maturity is not equitable. This is a significant problem when it comes to taking a holistic view in developing an integrated system – as the lowest common denominator prevails.
- We’re focused on break-fix, rather than prevention: we don’t sufficiently educate citizens at an early enough age to help them make good life-choices in relation to maintaining a healthy lifestyle. We primarily offer a break-fix service – and although it’s an incredible service (in 2017, 86% of those who received treatment rated it between 7 and 10 out of 10); a shift to prevention would reduce overall cost in the long term.
- We have a system that is simply unaffordable: despite the 2018 announcements of increased funding for the NHS, the UK Government struggle to meet the requirements of the cost of service delivery and there is inadequate funding to meet the demands on social care, or the expectations of citizens.
But; there’s a plan right?
Sort of; yes. In terms of healthcare, the NHS Long Term Plan sets out a framework to deliver the transformation of services and outcomes across the NHS by 2024. Its objectives are broad ranging, ambitious, and require collaboration on a scale we’ve haven’t previously seen. However, the benefits of successfully implementing the plan would be significant, and include:
- Improved access to services; including out of hospital care with increased extension of services in the community.
- Operational reform; with assurance that NHS staff will get the backing they need.
- Investment in essential health and wellbeing services which we’re currently lacking and much needed by society.
- A shift from a break fix service to one of prevention.
- Investment in new technologies, as an underpinning enabler for change.
- A focus on ensuring that the NHS is properly resourced in order to deliver.
There is good news. Progress is being made, at a micro-level. As we’ve already mentioned, there are very positive regional success stories which evidence how a shift in the method and nature of services being delivered can help to address some of the challenges we face. However, social care is being left behind in many cases. We don’t believe there is yet a viable plan being implemented, at macro-level, to set the strategy for how we will sufficiently integrate health and social care, and consistently deliver a combined service focused on citizen health and well-being.
Where do we see the opportunity to redesign health and care?
The task is unenviable and far from simple; but the challenges must be addressed.
Redesign of the health and care system requires a multi-organisational approach, nationally and locally, on a massive scale. The NHS alone must be the largest federated organisation in the UK; with governance, leadership and delivery structures in every part of the system. In 2017 there were c.280 NHS organisations, working with c.7,500 general practices and c.850 independent health-related organisations. Add to this the 343 local authorities across England alone, the majority of which are currently responsible for the delivery of social care, with every citizen being a stakeholder, and we have an incredibly complex environment.
Over recent years; the emergence of integrated care systems has begun to demonstrate real value in bringing a combined approach to governing and delivering a combined health and social care system; with citizens placed at the centre of service design. However, progress is slow – and understandably. Change needs to be managed carefully – we cannot afford to destabilise what we have today.
What should health and care leaders be focused on redesigning?
- Approach to collaboration: this requires a new culture, without walls and across organisational boundaries.
- How we determine the needs of the wider environment: and what citizens require of our health and care systems – with them engaged in developing this.
- Models of governance: we need new entities, fewer entities, restructured Boards with some new skills around the table, and new responsibilities for the delivery of a much broader range services.
- Leadership: we need bold, transparent leadership – from those willing and able to face the challenges head on and use the skills around them to lead us through a period of change.
- Services: once we have the mechanisms in place to lead and govern new models of care; we need a better understanding of how we can transform what we are able to offer today; not just in terms of current care pathways which could be enhanced, but new services to citizens which activate them into taking an increased interest in their personal health; and make better life choices.
- Embracing underpinning enablers, such as digital: we must consistently raise the level of digital maturity across the component parts of the system to realise efficiencies and enhance effectiveness. We must be able to share health records and provide them comprehensively at the point of care delivery, at the time they’re needed. We must broaden the data we use to gain insight, to include data collected by citizen tech, and we must place insights in the hands of citizens to support them to manage their own health and wellbeing.
It’s not an easy task – and it’s going to take courage, not conformity.