Oli Hudson, content director at Wilmington Healthcare, explores the issues around the NHS’ attempt to come through the pandemic in a better shape than before.
Alongside the three Rs of the NHS Roadmap – Restoration, Recovery and Re-Establishment – another R seems to have taken hold – Reset.
The Royal College of Physicians has issued nine key points about the resetting of services; The Academic Health Science Networks – charged with leading on the adoption and diffusion of new technologies and techniques in the NHS – have launched their own Health and Care Reset programme, and the NHS Confederation has also used the word in a recent campaign.
This seems a significant change of emphasis. To many commentators it has been obvious that the new normal would not simply involve going back to the way things were. But recent moves from key bodies seems to formalise this, and the game is now to assess what elements of health services will be rebooted in a different form to the one industry is used to.
The NHS Confed’s plan is made plain on their campaign site:
“NHS Reset will seek to influence upcoming national strategies, including from NHS England and NHS Improvement, and their priorities for a reset with services, as well as looking to guide local systems through their own planning processes to ensure they can maintain the beneficial changes they’ve already realised.”
These changes include addressing health inequalities, governance and workforce issues – which the pandemic has highlighted rather than resolved – but the resets most likely to affect medtech will be in integration, whole system thinking, clinical practice and innovation.
Whole system thinking has taken root and the idea of ‘system by default’ well-established. Medtech will this year begin to face a new raft of integrated customers, including ICSs (integrated care systems) and trusts banding together or working with primary care to form ICPs (integrated care providers).
On the clinical practice front, rapid discharge and agile relocation of services – real headaches for NHS planners in pre-COVID times – are now things the NHS seems to excel at.
But this reset movement has by no means been cheered by all – some cynicism that the root causes of the failures of the system are still not being addressed is apparent.
It is also evident that what improvements have been made are masking a vast undercurrent of unmet demand, and the strategy during the pandemic is addressing different patient numbers than the ones it will have to confront in the near future.
For example, Oxford Clinical Commissioning Group has made clear that it is facing a vast non-COVID backlog, with stroke, CVD and cancer particular worries, given it will be faced with less resource. Oxford has begun to manage this by targeting the highest risk groups – although difficult choices will have to be made between ‘long waiters’ and ‘those most at risk of harm’.
And perhaps most pertinent for industry, there are a number of hurdles to surmount before anything like ‘improvement’ can return to surgery and elective care, with the RCS pointing out that aside from COVID-specific issues such as R-rate, testing and PPE, there needs to be the safe restoration of perioperative services such as diagnostics, anaesthesia, critical care and sterile processing.
As I’ve gathered material for Wilmington Healthcare’s regular White Papers on NHS policy changes during the pandemic it is apparent that there is a fine balance of optimism that things can be made better, and a cynicism that things will get worse. The story is no different with industry colleagues; just as some are looking forward to different ways of working, for example by developing new pathways involving new products and techniques with integrated care and negotiating value-based contracts via procurement towers, some are wary that efficiency will once again trump quality, reliability and long-term value, even if it looks likely that products offering greater patient safety will stand a better chance of being adopted than before.
The plus side for industry seems to be the NHS is talking more than it ever has around innovation, and on several fronts, delivering. Having been a tokenistic word for some years, genuine innovation, notably digital transformation involving remote consultation, AI and e-rostering, has taken hold at a blistering place.
On the other hand, innovation can of course be disruptive. Moves towards care in primary, community and social care settings and out of hospitals potentially shifts some of the customer base out of medtech’s traditional comfort zone. Industry would be advised to situate its solutions in the full knowledge of what these new pathways look like.
Nothing is straightforward about this pandemic – and there is no simple ‘reset’ button.
Wilmington Healthcare explores this subject further in its new whitepaper Roadmap to Recovery: Supporting NHS customers to reset, restart and renew. We draw on our extensive experience of engagement with the NHS, via HSJ, our consultancy team who are actively engaged in building new NHS pathways, and our unique data covering stakeholders, activity, policy and documents.