Oli Hudson, content director at Wilmington Healthcare, explores some of seismic changes happening in the NHS, looked at through an industry lens.
Sea changes in the way the NHS customer environment is operating are happening right now as a result of the pandemic.
In a recently published white paper by Wilmington Healthcare, COVID-19 and the NHS customer environment, I look at all of these.
A rapid pace and a huge scale are the twin hallmarks of these developments, which are affecting NHS structure, organisation and integration, NHS finance and budgeting, long-term conditions management, the NHS’s relationship with the private sector, changes to care pathways, NHS digital transformation, acute care reconfiguration and of course industry engagement.
My colleague Dave West, deputy editor at Health Service Journal, recently told me of his confusion at questions around ‘a return to normality’, as in his opinion the NHS we knew before the pandemic has moved to a permanent ‘new normal’.
What could he mean? There is not one specific thing to point at but many; the assumption that treatment should take place in a hospital is an obvious one, as many outpatients specialties are moved wholesale to community, district, primary and home settings, with widespread adoption by both patients and clinicians of digital consultation providing the catalyst.
The impact on commissioning
The way NHS England is operating is another facet; before, there was an emphasis on ‘horses for courses’ and what is appropriate for local systems; now, NHSE is acting as a centralised commissioner, taking on a number of CCG powers and as the single commissioner for the private sector, having bought up almost all of its capacity.
Another example is afforded by what we are seeing in London; although the capital still has five integrated care systems (ICSs), a recent story in HSJ relates that they will effectively act as one; look at their population and its health management needs as one; and create workstreams on what to do with healthcare resources as one.
Six London-wide programme leads have been appointed to take charge of capacity, digital, workforce, regulation, clinical improvement, and specialist services across the whole city.
One eye-catching element of this is where services will run from in cancer, paediatrics, renal, cardiovascular and neurology will be determined from the centre. Some hospitals will have to remain as COVID centres with operating theatres and wards both given over to pandemic services. Non-COVID patients will have to be accommodated elsewhere.
Measures like these will likely have an extremely disruptive effect on the medtech stakeholder map as it will be more challenging to assess which patient cohorts will be going where for which procedures. Specialist hubs will be formed, and many clinician customers will have to work from these rather than their previous healthcare settings. Relationship management, local intelligence and up-to-date, agile CRM systems will be required to manage all this.
Even if we do consider areas that are expected at some point to return to ‘normal’, such as the issue of elective surgery – obviously of huge interest for medtech – we find predicting the future difficult.
Elective has been more or less postponed wholesale, creating the prospect of a huge backlog in the months to come. Although the NHS has been encouraged to engage with this issue, with some hospitals beginning to create ‘green’ areas, free from COVID patients, where surgery can take place, and some areas have ‘cold’ sites already dedicated to elective, many capacity gaps will have to be filled by the private sector, creating more new stakeholders here and more disruption to what we knew as normal.
Those involved with diagnostics (other than those involved in testing for COVID-19) are also likely to see disruption as NHS screening and diagnostic programmes face delays and an inability to process patients onto the next stage of the pathway.
NHS finances and tariffs
Finally, if we consider NHS finance, the bedrock on which hospital treatment is based, payment by results, has been cancelled, replaced with emergency block contracts and even a mechanism to ensure hospitals are reimbursed even if they overspend. Where does this leave procedures using devices on tariff? Where does this leave the status of a hospital as a revenue generator? And what about activity? Or value propositions from medtech based on the activity and reimbursement from the tariff?
Coming out of the pandemic will be a long hard and most likely confusing road. Hospitals will need to focus on what is immediately in front of them. The mantra for industry will be to help the NHS get through this, and be extremely sensitive to the manifold challenges – and changes – it currently faces.
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