This week, UK Prime Minister Keir Starmer set out the government’s approach to fixing the country’s ailing elective-care system.
While the promises made are the right ones – a return to treatment targets, greater choice for patients, more power for GPs and a new deal with the private sector – relatively little has been said about the role of data and digital technology in achieving them. Without tech, the plan risks simply propping up an outdated, 1940s patient model and missing completely the opportunity to create a system fit for the 21st century. A new deal with the private sector to increase surgical and outpatient capacity is great, but often it’s the same workforce doing the work. Only tech can deliver the step change in productivity needed to move the dial on elective waiting lists.
It’s true that some of the required technologies are highlighted in the government’s new plan, Reforming Elective Care for Patients, but many aren’t – and many of the technologies missing are the most transformational. The digital health record (DHR) we have previously proposed (see Preparing the NHS for the AI Era: A Digital Health Record for Every Citizen) is a good example. A single view of the patient – shared by GPs, pharmacies, community diagnostic centres and hospitals – can allow health-care providers to collaborate in a completely different way, seamlessly linking community-referral pathways and allowing an entirely new model of outpatient care to emerge. Using a shared record, GPs can directly refer patients for an investigation, the multidisciplinary team can asynchronously review results, and the patient and GP can immediately view the secondary-care plan. An outpatient appointment would often no longer be required. For example, a trial in Sussex using the EMIS platform (combined with technology from Feedback Medical) saw a 90 per cent reduction in outpatient appointments and a 63 per cent reduction in waiting times for the breathlessness pathway.
With 80 per cent of the elective waiting list being for either a diagnostic or first outpatient appointment, the DHR represents a huge opportunity to reduce wait times over the next five years. It’s also a means of delivering on the other promises set out in the government’s plan: greater use of the private sector, greater choice of provider and a shift to a more community-based model. Such a model would be more realistic with the advent of a shared record. For example, the majority of community diagnostic centres established in recent years have been underutilised; a shared record would allow them to realise their potential and release hospitals’ diagnostic capacity, saving it for those who are acutely unwell.
Polling conducted by Deltapoll, commissioned by TBI and published today shows that this drive towards patient choice is overwhelmingly supported by the public, with 60 per cent in support of patients being able to choose where they are referred to for treatment and fewer than one in ten opposing the idea – and those results are only the tip of the iceberg when it comes to clear public support for a digital transformation of the NHS. The polling reveals that about three-quarters of those surveyed said they would welcome the use of their digitised and anonymised health records by the NHS if it provided faster, safer and more efficient care as a benefit. More specifically, about 60 per cent of dissatisfied NHS users believe better use of technology could enhance services and the majority are willing to share anonymised data to achieve this.
A majority of Britons who are dissatisfied with the NHS also see an opportunity for tech to improve its performance
Source: Deltapoll for TBI
Nearly seven in ten Brits are happy to share their anonymised data for a wide range of benefits
Source: Deltapoll for TBI
One of the most significant tech promises the plan makes is to ensure that the NHS App is interoperable with 85 per cent of NHS trusts by March 2025. This is a commendable step, but while more than half of Brits have downloaded the current NHS App, only around a third of people say they have actually used it. The app would need to be radically upgraded to make it relevant to citizens and deliver the user experience they are accustomed to from online products and services.
Low engagement rates suggest that the NHS App needs upgrading to make it a useful and appealing tool
Source: Deltapoll for TBI
Globally, there are some great examples of modern patient portals for the UK to draw on. In India, Apollo 24/7 offers access to medical advice, online pharmacies, doctor consultations, the ability to book diagnostic investigations (such as blood tests) at a range of sites and digital tools to manage chronic conditions. In the US, MyGeisinger offers complete integration with digital therapeutics such as the EDGE app, which provides personalised advice to help asthma patients manage their condition. And in Finland, the Helsinki University Hospital has worked with partners in primary and community care to redraft clinical pathways – incorporating digital tech at every stage – and created Terveyskylä, also known as the Health Village.
What makes these portals so slick is their relentless focus on the customer experience and integration with wider services. In Finland, features such as virtual assistants, symptom reviews and chatbots work alongside digital health tools to integrate patients’ online experience with their real-life health teams – clicks and bricks – to create what’s known as an omnichannel experience.
To have the same impact in the UK, the NHS App needs to stop being seen as an interesting add-on to the service and instead be viewed as the fulcrum of an entirely new NHS operating model. An all-singing, all-dancing app would also negate the need for individual hospitals to invest in the roll out of patient engagement portals and support the delivery of remote monitoring and long-term condition management. At the moment, waiting for the results of an investigation is a passive experience, yet the majority of patients will be told that their results are normal and their symptoms are the result of lifestyle factors such as obesity, alcohol and smoking. There is no reason to delay offering these patients support in managing those issues while they wait to hear if any further intervention is required.
In October 2024, TBI hosted a session with industry to understand ways in which existing and emerging tech could both reduce the elective waiting list in the short term and transform elective care in the long term. It quickly became apparent that tech can improve the process at every stage, from reducing the number of referrals to enabling rapid access to specialist opinion.
The industry summit revealed some other key lessons.
This is a system problem, so the system needs to own it. We heard that financial incentives as they stand are perfectly designed to generate a long waiting list. There is little support, and few penalties, for GPs referring up to secondary care, and very little incentive within trusts to invest in efficiency. We heard from a technology provider who had made outpatient care 15 per cent more efficient in one hospital, but was dropped after national funding was rescinded – the benefits weren’t cash releasing, so did nothing for the bottom line of the trust. It is not unreasonable for providers to optimise operations to meet the targets they are given, but it is the responsibility of systems to determine the right targets and set the right incentives.
When you change the operating model, you change the business model. Current operating models are baked in by existing contracts. It should go without saying that when you change the balance of work, you also need to change the balance of payments. For instance, if there is a desire for trusts to deliver more outpatient appointments, a payment-by-results mechanism would be more appropriate than block contracts. If there is a desire for providers to invest in technology, then recovery agreements with tech suppliers could be considered, or a change to the way tariffs and capital payments are differentiated. If there is a desire for primary and secondary care to collaborate, then gain-share agreements or bundled cohort payments should be considered.
There is a clear need to optimise the tech that the NHS already has. By the end of the session, it was clear that a lot of the data and digital technologies required to address the waiting-list challenge have already been procured in pockets across the NHS. What is lacking, however, is a coherent approach to their use, a mechanism for adoption and spread, and some proper utilisation metrics. A failure to critically appraise the current tech stack is also an issue.
Speed, clarity and efficiency are crucial in the procurement of new tech. We heard from trusts and integrated-care systems that there is a firehose of new tech that they do not have the capacity to do due diligence on. They talked about the value of a new body that would conduct centralised appraisal for new entrants to the market and their relative return on investment over and above other products (in a similar way to what NICE does for drugs). They also expressed a desire for clarity over which technologies are best commissioned nationally versus regionally and for change-management support to embed those technologies. Finally, there was a recognition that not enough is done to decommission old technologies, even paper mail and phone calls, when new tech is commissioned.
The government needs to show far more ambition with regards to the role of tech, digital tools and data in transforming elective care. People use technology to manage almost every aspect of their lives; they are right to expect to see it used to improve treatment and patient experience in the health service.
It is time the government started providing 21st-century solutions to 21st-century problems.
Methodology
TBI commissioned Deltapoll to undertake a survey of UK voters’ views on the future of the NHS. Deltapoll interviewed a representative sample of 2,002 adults in the United Kingdom online between 29 November and 2 December 2024. The data have been weighted to be representative of the UK adult population as a whole by age, gender, education, 2024 general-election vote, 2016 referendum vote, political attention and social grade. Due to rounding of the polling data, data visualisations and figures may not add up to exactly 100 per cent.
Explore the full polling data set on the Deltapoll website.