When Sir William Beveridge produced his seminal report in 1942 that laid the foundations of the welfare state, he set out a new vision for the 20th century. Despite its revolutionary nature, it was also an idea whose time had come and even 80 years later, the idea of the NHS it proposed still holds. Yet Beveridge was a man who remained committed to radical ideas until his dying days – and would be the first to say the NHS cannot serve the needs of the 21st century. So as the country emerges from Covid-19, we need a system fit for the modern world.
A Turning Point for the NHS
The NHS is at a unique juncture. The pandemic has helped cause a crisis on a scale never seen before. A record 6 million people are waiting for elective care; hospital bed occupancy rates consistently exceed safe levels; ambulance response times are perilously long; workforce vacancies stand at over 110,000; and staff morale is at an all-time low.
But the pandemic is not the sole cause and many of these difficulties are just the latest symptoms of systemic issues that Covid-19 has merely exacerbated. The NHS has been on an unsustainable trajectory for more than a decade. Health outcomes have been stagnating or declining. UK life expectancy has fallen for the first time in decades, after plateauing for the last 10 years. The number of years we spend in sickness has increased – UK males can now expect to live 16.5 years in poor health, women a staggering 20 years. Cancer survival rates continue to lag behind those of comparable European countries. And health inequalities have widened, with life expectancy varying by up to 27 years across the UK’s regions.
As outcomes deteriorate, costs have rapidly risen. The NHS alone will account for 44 per cent of all day-to-day public spending by 2024, up from 27 per cent in 2000. Meanwhile, household spending on private health care has almost doubled in the last decade and is fast approaching that seen in the US. The situation is only set to become more acute. Declining birth rates and an increasingly ageing population will continue to push health-care costs higher against an eroding tax base.
The dire situation in which we find ourselves is the result of chronic underinvestment and piecemeal funding that aims to manage rather than solve issues, a system that is designed to treat sickness instead of optimising health and, importantly, a failure to fully embrace technology.
Technology Offers a Wealth of Opportunity
Despite the distressing picture, there is reason to be optimistic. Over the past two decades, rapid advances in biotech, computing power and artificial intelligence (AI) have given us unprecedented capabilities. Alongside reforms, modern technology offers the opportunity to dramatically improve the quantity and quality of life, and deliver a more sustainable health system. The question we now face is: having so profoundly felt the impacts of wide-scale health risks, how do we turn urgency into action?
The starting point is to truly harness the technologies we already have at our disposal – and those of tomorrow – to make health care more predictive, more preventative, more personalised and more participatory. Architecting this future requires new operating models and new principles. This means integrating systems to build population-level insights, but also giving more autonomy to the individual.
This new model, which sees a much greater symbiosis between humans and technology, requires thinking about data as a digital specimen. New tools of engagement, recording, collecting and structuring information must be the foundations for systems of intelligence to provide the insights we need to transform health. Establishing the new model will mean:
Using new technologies to make the health service more efficient, more personalised and more democratised. This includes mainstreaming the NHS App and greatly extending its functionality, normalising telemedicine and online services, expanding decentralised diagnostics and remote-monitoring devices to reduce burdens on both patients and providers, and championing wearable technologies that can enable us to personally track our individual health metrics.
Accelerating the NHS’s digital transformation to provide the supporting infrastructure. This will mean investing in network capabilities, cloud computing, interoperable health-record systems and patient-centred communication tools across the whole of the NHS. Building on the success of the UK Biobank and Genomics England, the new model will extend genomic sequencing across the population, and invest in multi-omics to revolutionise our understanding of the molecular causes of disease and our individual risk profiles.
Building intelligent systems that will decode and utilise data to drive clinical progress. First, this will mean using AI and machine learning to improve diagnostics, drug discovery and back-end processes, freeing up vital time for doctors and nurses. Second, we will need to create new commercial models to incentivise the development of novel gene and cell therapies to cure debilitating and rare diseases. Third, we must capitalise on the groundbreaking opportunities offered by robotics and 3D printing, and invest in smart hospitals.
Building the Tech, the Infrastructure and the Trust
We stand at a privileged point in history. The potential for technology to transform public health is greater than ever before. But we remain a long way from delivering on its promise and this future is far from inevitable. It is only by investing in, developing and adopting technology that we will be able to transform health care in the UK. This will require the right policy choices and levers as well as the right political will.
In particular, the government must commit to a long-term approach that places data and technology at the heart of transformation – and on a greatly accelerated timescale. This requires initial strategic investment that will reap rewards in time, ultimately making health care more affordable and sustainable.
Second, to enable this vision, the government must focus more systematically and strategically on delivering the foundations for a tech-enabled future of health. We must rapidly complete the construction of underlying digital infrastructure and networks, address the workforce skills gaps of today and of the future, and proactively drive digital literacy in the patient population.
However, while utilising technology and data are a necessary condition for a modern health-care system, they are not sufficient. Transformation on this scale will require a new public-service reform model that provides more autonomy for innovation and overcomes the centralisation of Aneurin Bevan’s NHS. It will also need to address the considerable trust deficit in relation to health-care data-sharing, working with citizens to co-develop the rules. But here too technology has a critical role to play in breaking down data silos and empowering patients.
Finally, we all must share responsibility for our health. Health is not something the state can “do” to citizens but something that must be done with them. This means using technology to not only take more responsibility for our own health, but also to play our part in shaping the system. Most importantly, although the predominant barriers to reform have been institutional and political, we as a public have tolerated stasis for too long and been too focused on protecting the idea of the NHS. It is time that we demanded a service that works far better for us in the 21st century. Technology can give us both the greater autonomy and the louder voice that we need to do this.
The NHS remains Britain’s beating heart, but it's sorely in need of new ideas, new life and new blood. Technology can facilitate that, providing the tools the NHS needs to radically improve the service it can offer and the quality of health we can enjoy.