Comment: Shifting the focus to enable better care

It’s well documented that in terms of patient outcomes and experience, the NHS and local authorities must become more integrated around delivery of health and social care, with GPs as the first port of call.

While the benefits and opportunities of more joined-up services may be clear, some major cultural shifts and a refocusing of attention are needed in key areas

For elderly people and those with long-term conditions, unless there is a critical episode, much of what is needed is preventative and requires monitoring in the best environment – ideally at home. As well as patients and clinicians, it’s about integrating with families and other carers to bring together a whole health ecosystem along the patient journey.

While the benefits and opportunities of more joined-up services may be clear, some major cultural shifts and a refocusing of attention are needed in key areas. Here, I’d like here to focus on just four.

As the chief information officer (CIO) at a high-profile trust recently pointed out to me; when patients leave hospital, they get services as consumers (with tools at their fingertips to book a taxi, shop and bank online).

Yet, while they are in hospital, things are very different.

People need access to the right information about themselves and their treatment, at the right time and in the right format; it’s the difference between good and poor care.

The technologies, of course, exist. This is about making a cultural shift towards treating patients as consumers of health and care services.

There is a direct parallel here with early digital banking. Just as those services started slowly – initially by sharing just account balances and top-level information – there is an opportunity to start slowly in healthcare, to break down cultural barriers, prove what’s possible, and then evolve it in line with what patients want.

Giving patients choice is crucial and links directly to integrated care by tailoring interactions for individuals. For example, appropriate test reports could be sent to patients, who opt in, at the same time they are sent to GPs. The benefits are significant: patients own results with advice on next steps delivered by text, email or app, freeing-up GP capacity by eliminating a GP visit.

Long-term conditions account for around 50% of all GP appointments. Freeing up even 10% of that time by better joining up and targeting patient services would make a huge difference

This report could trigger an action in the clinical pathway. For example, a positive BNP result, indicating possible heart failure, would generate an appointment for an echocardiogram; or a positive pre-op MRSA result would trigger a prescription for an appropriate antibiotic.

The key here, and the shift in culture, is to give patients choices, thereby driving more-personalised care plans for all.

Long-term conditions account for around 50% of all GP appointments. Freeing up even 10% of that time by better joining up and targeting patient services would make a huge difference.

Apart from severe cases, the last thing many people with problems such as diabetes or a heart condition want to do is attend their GP surgery in person. Pro-active information and reminders keep all of us healthier – and can stop people with long-term or short-term conditions going to the GP or to A&E.

The NHS intakes thousands of junior doctors every year who tend to be very open to informing the patient experience via digital tools. There is an evolving culture in the NHS, with clinicians and others entering the workplace as digital natives for whom technology is not a cost-saver or a bolt-on, but an essential and integral fact of everyday life.

Many patients will be open to using technology apps, texts, Skype, email and other messaging tools to manage their own care, because that’s what we do in just about every other area of our lives. Giving GPs these same tools will free up their time at surgeries, refocusing that time to spend face to face with, say, the 20% most urgent cases and looking after the other 80% more pro-actively by making smarter use of digital tools.

The NHS and the rest of the UK health economy is now at a pivotal point to also be able to leverage technology, investment and lessons learned from other sectors in order to redesign services and become more collaborative

Increasingly, private companies are joining forces to drive out potential from digital transformation.

The private sector brings the expertise, the experience, the capabilities, the technologies, the innovation and the funds to redefine business models, services, and new ways of delivering outcomes.

The NHS and the rest of the UK health economy is now at a pivotal point to also be able to leverage technology, investment and lessons learned from other sectors in order to redesign services and become more collaborative.

We live in an age where the public and private fiscal relationship is transparent and even allows direct investment from private companies to support innovation. These conditions, and more, enable organisations to facilitate collaboration, foster trust, promote and enable a culture of openness, and develop mutually beneficial partnerships.

The privileged relationship between the patient and their doctor must maintain its privilege as it is transformed through technology.

As patient data is enriched and consolidated, and moves into off-site storage vehicles such as cloud technology and mobile devices, attention must be focused on how data must be protected from mis-use, corruption or loss.

Once more, a shift of focus is needed.

The way forward is to invest in cyber security and data and analytics and to engage closely with clinicians to ensure they take ownership of delivering services in new ways across multiple channels

Of course data has to be secure: citizens expect and trust no less. Vast amounts of personal data are already being used responsibly in sectors such as banking.

Compromised security is not an argument for poorer or less-targeted consumer care. Steering clear of digital is not the answer.

The way forward is to invest in cyber security and data and analytics and to engage closely with clinicians to ensure they take ownership of delivering services in new ways across multiple channels.