When Prime Minister Keir Starmer addressed his cabinet in February this year, he told them that they had a choice: either be the disruptors or risk being disrupted. It is likely that no one felt this message as keenly as Wes Streeting, the health secretary. In fact, the first chapter of the government’s new ten-year health plan for England makes it very clear: “It’s change or bust [for the NHS]. We choose change.”
However, disrupting an entire industry is a tall order, especially when that industry is dominated by one provider. So how does an organisation like the NHS disrupt itself?
Disruption occurs when an innovation in technology leads to an innovation in the operating model, meaning customers switch from an incumbent to a new provider because the service is faster, cheaper and/or better. It implies choice for the customer and mobility of custom, and means the provider is able to make money from the new service. Uber is a great example: it offered a more convenient service, switching providers was easy and the money followed the customer.
There have been many attempts by the NHS to offer choice and let the money follow the patient, but very rarely has it led to disruption. Often the choice isn’t meaningful or the innovation isn’t rewarded, so adoption and spread of that innovation slow as a result. Take general practice: there are hundreds of software companies with tools to support population health management but practices are not incentivised to adopt them, which leads to variations in outcomes across the country. In other words, the operating model has changed but the supporting business model has not – until now.
Clearly there are some services for which choice is not the right mechanism of change; for example, no one wants five ambulance numbers to choose from in an emergency. But there are some NHS services - those closest to consumers and furthest from acuity – that are ripe for disruption. Arguably the most obvious areas to target would be prevention, planned electives and chronic-disease management.
We are optimistic on this front, because the ten-year plan seems to acknowledge this opportunity. At the heart of the document is a commitment to quality, transparency, choice and innovation, and a promise to rewire finances to align incentives and shift funding. The catalyst for this approach will be the NHS App, which has the potential to disrupt the NHS operating model from the inside out. No wonder, then, that it is all over the ten-year plan.
With the app, patients will be able to view outcomes, exercise choice and gain access to cutting-edge treatment through clinical trials. Increasingly it will also become the tool with which they can access third-party services that have been certified and reimbursed by the NHS.
This latter point is critical: if the NHS is to remain at the forefront of innovation in the era of artificial intelligence then it must partner more effectively with private enterprise. It cannot possibly hope to develop the necessary range of digital services in house. Again the ten-year plan is encouraging on this point, providing details of the centralised procurement of digital technologies that will be made available through the NHS App. This has the added advantage of providing a national offer when the plan is for much of the rest of the service to be devolved.
Underpinning all this is, of course, data. Two Tony Blair Institute for Global Change policies on data have been included in the plan: a single patient record, or digital health record (using data to impact direct patient care), and a health-data research service (using data for R&D).
Like the NHS App, the digital health record (DHR) is a golden thread running through the plan, as are the three shifts articulated within it: migrating care from hospitals to the community, from analogue to digital and from treatment to prevention. The DHR is therefore critical to delivering on the disruptive potential of the app. However, to ensure success there must be sufficient patient engagement, user-focused design and steady implementation to avoid the pitfalls of previous attempts.
Past national IT projects have suffered from letting perfect be the enemy of good. The first iteration of the DHR should be useful and effective on a small scale, and implemented as soon as possible; it does not need to be all things to all people immediately. And it must be clear on use case, given that the traditional argument for a DHR has been that doctors need all information in one place to treat people appropriately in an emergency situation. However, in the AI era, the emphasis should also be on the DHR’s ability to empower self-care, the use of digital pathways and prevention.
Another critical ingredient for disruptive delivery is intelligent navigation: the use of AI to support patients access the right care first-time when unwell. This is another TBI policy that has been adopted in the ten-year plan. Initially for use in the triage and navigation of patients seeking care, this feature could eventually become the proposed “doctor in your pocket”. This would elevate care quality as well as reducing inefficiency, supporting patients in their self-care, and empowering them to find and access new and innovative services.
One of those services should be obesity management. TBI has consistently argued for the accelerated rollout of weight-loss medications such as semaglutide and tirzepatide, not only to improve individual health outcomes but also to lift productivity and reduce long-term pressure on the NHS. In our reports Anti-Obesity Medications: Faster, Broader Access Can Drive Health and Wealth in the UK and The Case for Weight-Loss Drugs: Unlocking the UK’s Health and Economic Potential, we show how these treatments could be a public-health game-changer if deployed at scale through the app, with equity in mind.
The government’s commitment to expanding access to weight-loss drugs (including offering them through pharmacies without GP consultation) is hugely welcome. This is a preventative policy that will increase workforce participation and improve – indeed, save – the lives of millions. We are glad to see this shift in approach and urge the government to go further in ensuring fair and fast distribution across the country.
The ten-year plan is not perfect. It has been suggested that it is more of a vision than a plan, in that most of it is unfunded and most of the delivery relies on bodies either being axed (NHS England) or severely cut down in size (integrated care boards). But there is much to like, not least the emphasis on quality, innovation, prevention and productivity.
The most effective thing that the government could do now is prioritise delivery of the NHS App and the DHR. This would be a transformative endeavour that is achievable within the next four years, meaning it could be intricately associated with the competence of the government. The vision is in place – now is the time to put disruptive delivery into action.