The creation of the National Health Service seventy-five years ago was a ground-breaking achievement. Universal health services, free to all at the point of need, regardless of status or income, was a hugely ambitious and bold symbol for the nation. Society has changed significantly over the last seventy-five years, with an upward trajectory in life expectancy thanks to public health measures and continuous innovation in vaccination, medicine, and treatment.
To continue to thrive, the NHS needs to see its future at the intersection of health services, life sciences, data and digital. To achieve this, it must invest in targeted areas. It should expect to see a return on investment in improved health as well as economic growth which makes this not just sustainable or affordable but fundamental to the growth prospects of the UK.
The next ten years will be critical for the NHS and for Integrated Care Systems working with communities and partners in local government, housing, and other public services. Radical transformation is essential if the NHS is to meet the needs of a changing population. The overarching aim of systems will be a focus on increasing healthy life expectancy – the years of life spent in good health. This will require the NHS to work in new ways enabled especially by data and digital combined with advances in life sciences:
- A new social contract with the public; redefining the role of the NHS with the emphasis on supporting good health and wellness. To enable this, investment in community and voluntary infrastructure are needed to support wellbeing and social connection which is the foundation of good health. A clear national and local focus is required on addressing the growing disparities in good population health, between geographic areas and some communities with protected characteristics. Services need to be culturally appropriate and ensure parity between mental and physical health.
- A stronger focus on population health and prevention, working across council public health teams, primary care networks, community organisations. Widespread use of multiagency risk stratification and patient cohorting to target communities with specific support will be essential to reduce avoidable demand on health and care services and keeping people as healthy as possible. Universal coverage of integrated data is needed to achieve this.
- Strengthening of neighbourhood teams focused on case finding and intervention in chronic diseases including cardiovascular, metabolic, and respiratory disease. These are all conditions that could be much better treated by case finding and treatment (especially prescribing the appropriate medicine) which are functions that are best performed by admin, nursing, and pharmacist skills rather than GPs and would be best situated in neighbourhood teams. This will be critical to overcome the documented challenge of the NHS in adopting new therapies in primary care.
- Urgent and emergency care must be addressed through a combination of reducing demand as well as reducing occupancy by developing out of hospital capacity for discharge and ensuring appropriate capacity to reduce occupancy rate from 95-100% to 85% and improve overall flow. The use of digital interactions with patients to triage and steer demand and the real time flow of information across providers to meet this demand will be essential to enable this. The simplification of urgent and emergency care is also needed to enable access.
- Resilient elective care requires the full separation of elective from emergency care, as is seen in many other places in the world. Achieving both this and the recovery of elective services is fully embracing the maximum use of digital to eliminate unnecessary appointments and make maximal use of the assets that exist. It also critically means accepting that the physical infrastructure needs to change to provide optimal care.
Three in four of us will die of cancer, cardiovascular disease or dementia. Whilst cardiovascular and cancer outcomes have improved, deaths from dementia have grown steadily. Looking forward, we have the chance to address dementia for the first time whilst continuing to make strides in cardiovascular and cancer through life sciences. In addition, the opportunity exists to better diagnose and treat a wide range of rare diseases.
- Cardiovascular disease has already seen huge advances in both medicine and surgery with significant reductions in mortality. The biggest risk factors – blood pressure and cholesterol management—can be effectively treated with medicine but a staggering 70% of patients are not on any treatment when they have a heart attack. Using primary care networks with case finding through pooled data and delivery of systematic population health interventions gleaned from neighbourhood teams, will be essential in addressing cardiovascular disease long-term.
- In cancer, improved risk stratification, universal coverage of the new blood test detection, the increased use of genomics will enable far faster time to treatment and earlier stage of detection which is the key to better survival; in addition, advancement in medicine and systemic therapies promise further advances in curative treatment even at late stage. Achieving this on a widespread basis would require big increases in diagnostics as well as continued rapid adoption of new therapies, which presents the chance for precision medicine at scale to definitively diagnose and treat an ever wider range of conditions.
- Dementia innovation is critically needed and could contribute to a significant improvement in healthy life expectancy. This could include the roll out at scale and pace of new therapies targeting amyloid plaque. If detected earlier, promising evidence shows that cognitive impairment can be reduced, which holds the promise of further advancement. Achieving this would require a massive shift in diagnosis as at present only 1% of patients are diagnosed due to prevailing belief that there is no effective treatment for dementia. Hence capitalising on the opportunity for the UK to improve diagnosis and treatment will require a massive transformation in services.
- Rare diseases remain difficult to diagnose. Patients may bounce around the healthcare system for many years before being identified and treated. Improving diagnostic tests and greater use of precision medicine and new therapies presents the opportunity to address a wide range of conditions.
To achieve all this, the NHS and life sciences need to forge a partnership that recognises the mutual endeavour and the vital role each plays in innovation and delivery across both uptake of medicines and in research.
- Embracing the potential of the NHS to become the largest, fastest and most diverse system in the world to initiate new trials which requires the prioritisation of commercial trials, delivering on the exciting promise of integrated data, capitalising on the enthusiasm for patients in trials, and addressing the dull topic of enabling a single contract for ethics and trials.
- Improving the uptake of medicine: The UK needs to be able to align the science, the regulatory system, and the delivery system with the data environment to ensure the full implementation of exciting new medicines.
Data and Digital
Achieving all of this requires taking serious transformation measures in data and digital so as to reach in health services and life sciences the same level of data integration and digital services as in everyday life (e.g., groceries, travel, banking, etc.). This requires the basics to be in place:
- Eliminate paper records and adopting electronic patient records universally
- Integrate pervasive digital devices, wearables and range of patient generated data needs into the patient record
- Linked patient-level data sets at national, system and provider levels to enable the targeting patient for interventions, supporting population health management, improving evidence generation and streamlining the uptake of medicines.
- Establish the information governance to enable secure and appropriate use of this data, as well as the associated communications with the public about the explicit purposes of supporting delivery of care, managing the health system and conducting research with industry and academics.
- Investing in federated data to allow rapid and safe sharing of information from routinely collected data, which will be the key to achieving earlier and more targeted interventions, elimination of health inequalities and enabling higher levels of productivity.
- Prioritise the widespread adoption of digital interactions, including the NHS App and other digital tools, by healthcare and caregiving professionals to enhance efficiency and accessibility in healthcare delivery. Embracing these digital solutions enables seamless communication, improved patient experiences, and better coordination among multidisciplinary teams, ultimately optimising healthcare outcomes.
- Embed digital as part of the NHS identity and improve the capability to develop and assess the effectiveness of digital technologies. Part of this will be ensuring clinicians are equipped with skills to prescribe validated apps and digital products, advise patients on their use and interpret the clinical data that they generate. Addressing any pervasive anti-digital culture and behavioural barriers will also be key.
Putting these basics in place can simultaneously allow for the improvement in population health, the functioning of the healthcare system, and contributing to making the UK the best place to discover, develop and adopt medicines. This includes:
- Population health management has been much talked about in the NHS but impossible to achieve due to the missing fundamental building blocks of integrated data necessary to allow cohorting, invitation to diagnosis and health management, and monitoring; this is now within grasp and needs to be systematically enacted.
- Early Disease Detection and Prevention is made possible by analysing large-scale datasets, including patient records, genomics data, and environmental information, it becomes possible to identify patterns and risk factors associated with various diseases. This data-driven approach can enable proactive interventions and targeted preventative measures to detect diseases at an early stage or even predict their occurrence, allowing for more effective treatments and improved patient outcomes.
- Better performance in urgent and elective care and higher levels of productivity through near real time sharing across the urgent care system allowing to flex to meet demand. Using AI to support efficient scheduling and booking enables maximising capacity and putting in place digital rotas and scheduling to support workforce planning.
- Digital transformation and integration of systems, making it easier for patients to interact with and to access their services including through the NHS app which offers a point of entry to the system for secure communications with patients to schedule and confirm appointments or access care, access health records and provide consent to participate in research.
- Capitalise on Real-World Evidence (RWE) making use of the vast amount of data within the NHS. RWE involves analysing patient data, including electronic health records, treatment outcomes, and patient-reported outcomes, to gain insights into the effectiveness and safety of treatments and interventions. By utilising RWE, researchers and pharmaceutical companies can make more informed decisions during drug development, clinical trials, and post-marketing surveillance.
- Streamline Drug Discovery and Development by analysing patient data, genetics, and treatment outcomes. Researchers can identify potential drug targets, understand disease mechanisms, and design more effective clinical trials. This integration of life sciences and NHS data can expedite the development of novel therapies and improve the success rate of clinical trials.
- Unlock the potential to become the best place in the world to support the application of AI to healthcare based on the scale and depth of the integrated data and the speed and security with which that data can be accessed.
Investment & Growth
Achieving the above will not be without further spending in several targeted areas that our research demonstrate are investments in the truest sense because they deliver a measurable return on investment in the overall economy: higher spending on health in the right places can contribute to economic growth so that investment in health pays for itself. For too long the UK has suffered from a self-limiting condition that 10-12% of GDP is a noble thing, whilst accepting a level of care that is below what the population desires. The public needs to see that any investment is good value for money and hence that it needs to be made efficiently and in the right places. We believe this is now the case under the following conditions:
- New investment in hospitals is difficult to justify when spend is up, workforce is up, and activity is down; there is an urgent need to improve productivity and the key to this is leveraging better use of data. It is worth emphasising the huge opportunities in productivity that exist given that the business cases for EPR investment were in fact predicated on productivity benefits which in the main have not been measured or captured.
- Integrated community and primary care teams at neighbourhood level to drive primary care at scale, which are instrumental to population health, and which have demonstrated in our latest research to literally pay for themselves along with reducing acute demand and contributing directly to economic growth.
- Significant expansion in diagnostic capacity for existing and new diagnostics that allow earlier intervention in the areas of largest burden of disease and can hence dramatically improve outcomes and economic benefits. At present, there is a large shortfall in diagnostic capacity compared to international levels. It should be emphasised that to support the separation of elective and urgent care this investment should be focused off acute hospital sites.
- Increasing capacity to keep up with increasing demand – the NHS is running physical capacity too tightly and while this saves on capital it is not effective and is starkly different to other OECD health systems. Capacity shortages were largely responsible for the highly disruptive effects of Covid on the NHS, leading to the ceasing of elective activity.
- The value of pharmaceutical manufacturing and research exceeds the spend on medicines. Given a 44% drop in commercial trials, urgent investment is needed in research infrastructure. In addition, the UK needs to be more attractive to the life sciences industry to restore the perception that the UK is an attractive partner in the global context. This means faster uptake and reduction from the extraordinary 26.5% discount rate of VPAS to long term average discounts on medicine which are justified by the benefits delivered to the population and by the massively positive role played by life sciences in this in driving economic growth.
- As the fundamental enabler of all these advances, investment in data and digital technology and capabilities needs to be prioritised. In doing so the NHS needs to be a better customer for technology able to make faster decisions to encourage the development of a vibrant technology ecosystem.
- Greater investment is needed in management as it remains the case that we can demonstrate both that the NHS is under-managed and that better management delivers better outcomes and greater productivity. Achieving this will require a rebalancing of management resources to providers and systems, away from central resources, as well as a shift in resource in management to emphasis data, digital and commercial capabilities.
These actions will require a bold NHS and their partners to implement them – the same vision and boldness that was required seventy-five years ago in the creation of the NHS. It needs to reflect, however, a new openness to working with life sciences and data & digital, as well as a much more commercial mind set to work effectively with these partners.
All of this can be supported by a stronger focus on the fourth purpose of Integrated Care Systems – maximising the economic impact of health organisations in a locality and a recognition of the links between income and health.
Find these insights summarised in the infographic below: