Can technology save the UK's National Health Service?

The National Health Service (NHS) is in crisis. Despite contrary ideas about why this is and how it should be addressed, most experts on both sides of the political spectrum agree that it cannot withstand the pressure it is under indefinitely. Leveraged as a political tool of late, the future of the NHS is uncertain, and while there are no quick fix solutions, many agree that technology does present options to address at least some of the difficulties.

David Downing, Director of Health at SAS UK, describes the NHS as a relentless producer of data – patient, performance, clinical and administrative – and says that this is where the answer to some of its most pressing challenges lies. The NHS must place data at the centre of the organisation, in Downing’s view. SAS UK’s research with the Centre for Economics and Business Research shows that big data and the Internet of Things (IoT) will add £15.8bn ($20.25bn) to the healthcare industry over 2015-2020. Yet it’s predicted that only 52% of healthcare organisations will have adopted big data by 2020 and just 26% will have adopted IoT by 2020.

It is not for lack of trying, though. NHS England’s initiative was abandoned after the national data guardian for health and care Fiona Caldicott launched a review and concerns were raised about the sensitive nature of the data. The idea was to extract patient data in anonymised form from GPs to a central database held by the Health and Social Care Information Centre (HSCIC). The heart of the controversy centred on an opt-in system, with Caldicott recommending an eight-point system. The review also raised issues around data protection and the need for better data security. Despite this setback, healthcare analytics can offer a wealth of benefits for the NHS and its patients.

“It’s critical that the NHS finds a way to boost patient value by changing the way that services are organised, delivered, costed and measured. Ultimately, care needs to be delivered around the needs of the patient,” Downing says. He adds that this means making better use of the resources available and facilitating greater integration between primary care, ambulance services, urgent care centres, community pharmacies and mental health teams so that services can be delivered closer to the patient.

“NHS vanguards must also make better use of the clinical insights available to forecast demand, plan new care pathways, eradicate duplication, model treatment plans and continuously analyse patient outcomes and values. Only then can the right services be delivered at the right time and in the right place to reduce emergency admissions and cut waiting times,” he says.

By putting data at the centre, the NHS can address these challenges. Downing cites the example of how data analysis can assist in the case of an elderly patient with a specific set of conditions, determining whether such a patient can receive treatment in the home, thus opening up the possibility of predictive planning and reducing strain on frontline services.

This, in turn, would allow the NHS to reduce A&E waiting times due to unnecessary visits and help identify the underlying factors contributing to higher admission rates. “Through incremental changes, the NHS will achieve the resulting efficiency savings it needs and start to address recent failings in patient outcomes.”

Alex Yeates, Medical Director at Advanced and Nick Wilson, MD – Public Sector, Health and Clare at Advanced explain that the NHS is under increasing pressure with reduced budgets and spiralling demand, but there is also a major staffing problem facing the NHS. In 2015, Jeremy Hunt said the plan was to increase GP numbers by 5,000 before 2020 – however this doesn’t look promising for two main reasons. 

First, they say, more General Medical Practitioners (GMPs) are leaving than joining the NHS. There were 49,162 GMPs in the UK in September 2015. Since then, new NHS Digital statistics based on the workforce minimum data set, between April 2015 and March 2016, showed that 832 GMP contract holders joined the NHS, compared to 1,342 who left. “That’s 510 more leavers than joiners thus the need to increase the number by at least 5,510 to reach the 2020 target. Furthermore, Brexit will impact the shortage in staffing,” Yeates and Wilson say. Figures show that 57,000 of the NHS’s 1.2 million workforce are EU nationals, and the Institute of Public Policy Research (IPPR) believes the health service would collapse without them.

They believe that technology can address this challenge, too. “Technology can deliver a better patient outcome and drive efficiencies – not take people’s jobs, but transform roles and free up skilled staff to enhance care,” say Wilson and Yeates.

For the two, technology offers the opportunity to empower patients to self-help rather than contact a service. For example, Advanced’s Odyssey technology has been helping the NHS assess patient safely for many years. Now, it is allowing patients to assess themselves prior to calling the free 111 hotline service. Around 13 million people ring 111 in one year – based on early trials, indications are that around 25% of callers are safely directed to self-care, avoiding a call to 111.

It can also aid in upskilling other staff to take on some of the work being done by more experienced staff. In addition, using IT with proper Clinical Decision Support will allow them to do it safely. East Midlands Ambulance Service uses Advanced’s Odyssey solution, clinical decision support software which uses a unique Bayesian approach, to guide clinicians in providing the right treatment. It has addressed problems by streamlining consultations (16% of the daily emergency calls are now able to be appropriately managed over the phone) and reducing unnecessary ambulance journeys (saving 320 ambulance journeys each day). 

Healthcare technology can also improve mobilisation, getting patients out of hospital and into the community, as well as making sure they are cared for appropriately with access to medical records at point of care. In addition, mobilising the workforce with data entry at point of care – mobile technology reduces admin, giving back carers nearly one hour per shift [PDF] to spend with residents.

Shantayne Augustine, marketing director at Fuzzy Logix, an in-database analytics company, says that there could be multiple benefits to the NHS embracing a more analytical approach to its healthcare technology use.

Augustine cites the example of disease and illness prediction and prevention. In the UK, five million people are at risk of developing Type 2 diabetes, for example. “It’s a staggering number with an equally staggering price tag, but a price tag that can be significantly reduced by the use of truly actionable data to help detect those that are likely to develop diabetes,” she says, adding that the earlier that doctors can identify patients in a pre-diabetic state, the longer they can delay the onset of diabetes—by as much as ten years. This results in a better quality of life for patients and significantly lower medical costs for the NHS.

“The key lies in the quality and efficiency of data analytics to identify whether a person – or type of person – is more likely to be diagnosed with a disease or illness, either due to genetic predisposition, lifestyle or environmental factors,” she says.

Access to improved data analytics also has the benefit of improving organisational efficiencies, which in turn can save or better allocate costs. This includes using patient and service provider data in geographic, or health, issue areas to better understand what services or treatments are needed, or being appropriately accessed. “This spans from whether an area needs more or less post-natal or health visitor services (an increase in GP diagnosis of post-natal depression, more parents being referred to social services, more cases of schools referring concerns to social services, and so on) to whether a hospital cafeteria is under-used and running at a loss and could be downsized,” she says.

Digitised patient self-management is also made possible through healthcare analytics. “If patients with a long-term treatable illness or disease such as diabetes, arthritis, HIV, can self-manage electronically the important updates and regular testing of their illness that don’t necessarily require a GP or nurse in attendance, such as logging blood sugar levels, instances of pain decrease or increase, then the NHS can achieve cost, time and resource savings of fewer hospital / GP appointments,” she says. “In addition, this patient data can be used to research illness/disease trajectory and prognosis.”

Smart Tech can be used across the NHS, Augustine believes. With the use of speech recognition software to take electronic notes, analysis of those notes can be used to identify patterns across treatment areas. Patient data loaded onto wristbands that can Bluetooth patient notes directly onto handheld devices increases treatment efficiencies and ensures critical information is noted and stored electronically (no more missing files, illegible notes).

Imaging analytics, obtained through scanning MRI, X-ray data, patient notes, and so on to identify patterns, anomalies, hard-to-find or time-consuming information can also improve efficiencies.

Augustine warns, though, that healthcare tech investment in the NHS appears to have taken place in a disjointed, uneven and inconsistent manner. “Some trusts have invested more in tech resources, knowledge and equipment and are trialling, to great success, analytics, smart tech and digitised solutions,” she says.

“Others, however, are not investing at all, or not as much. It’s too disparate and achieves only isolated, siloed areas of benefit. Initiatives such as Patient UK are not communicated or utilised as planned, was scrapped due to the poorly executed communication and education plan of the initiative.”

She adds that one of the issues with tech investment within the NHS is the simple fact that most of the staff are medical, research or social focused and, although they may have an interest – even a desire – for more digitised, analytical thinking or way of working, they do not have the necessary technical or mathematical skills, and nor is this their job. “Unless the NHS invests in the correct resource throughout the organisation, the healthcare tech revolution is still a way off,” she says.

Change is happening, though. Downing explains that while, historically, the NHS has always been a data rich but insight poor institution, in recent times great strides have been made thanks to wise investments in technology. He cites the example of the Royal Brompton & Harefield Foundation Trust which is demonstrating how investment in big data analytics can transform the decision-making process to deliver real improvements for costs and care. As a specialist heart and lung centre, the Trust had accumulated vast quantities of clinical data down the years. However, the data was difficult to access and integrate, spread across over 400 data systems and 20 critical clinical data sets. 

“To capitalise on this treasure trove of information, the Trust used SAS analytics to build a Clinical Data Warehouse (CDW) as an easily accessible and privacy protected central store of all data from across its operations,” he says. Using analytics tools, clinicians are now able to access and interrogate this data pool to reveal previously unknown correlations. “Before the solution went live, a cardiologist would have needed the help of several junior doctors to review some 400 case notes on paper. Now the hospital can perform this analysis in less than five minutes,” Downing adds.

Eileen Haggerty, Senior Director Enterprise Business Operations at NETSCOUT, agrees that there is a suite of technologies available to help make the NHS more efficient and cost-effective while still delivering great patient care, but she emphasizes that security is a vital concern. “These networks cannot be breached as they hold incredible amounts of sensitive information. The network can’t be allowed to suffer performance issues either. Otherwise those same applications that doctors and nurses have come to rely upon won’t function like they should,” she says.

“Ultimately, patient care delivery relies on the efficient and secure flow of information, and that depends on having service assurance technology built into the network. After all, like healthcare itself, regular monitoring of the network may uncover a problem in its early stages. That’s often the best time to address an issue so that it can be resolved before it has time to do lasting damage.”



Also read:

What will health tech mean for ordinary people in 2026?
Sophia Genetics quietly drives the next wave of personalised medicine
Nuance prescribes voice cure for doctors’ notes
Speech recognition tech still poised to ‘transform’ healthcare


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Bianca Wright

Bianca Wright is a UK-based freelance business and technology writer, who has written for publications in the UK, the US, Australia and South Africa. She holds an MPhil in science and technology journalism and a DPhil in Media Studies.

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