A dose of healthy scepticism
Research Manager and Head of Health
It is perhaps the most documented phenomenon in British politics that the NHS is at breaking point. It is therefore no surprise that The Times’s much anticipated Health Commission has sought to present an ambitious programme of reform. With contributions from some of the most prolific names in public policy, it is clear the desire for reform is felt profoundly across the spectrum.
There are many things the report gets right. It is difficult to fault the problem analysis for each constituent part of the health service. What is more, boldly embracing proactive interventions on obesity is welcome, considering how far this contributes to pretty much every problem the health service faces.
However, it is worth reflecting on some of the limitations of the recommendations. The news team at The Times highlighted in particular the proposal for digital health passports. It is not that this is a bad idea, indeed it is the opposite. It is a necessary precondition for any modern health service. The fragmentation of data in the NHS is maddeningly inefficient, and the potential of this data were it to be properly utilised is enormous.
Is this a good idea? Yes. Does the technological infrastructure in the health service desperately need updating? Yes. Does a digital health passport target many of the major problems with the health service? Not really.
The problem with technological solutions is not that they are bad solutions, it is that they are sometimes disconnected from the wider problem analysis. If the source of the NHS’s permacrisis is a matter of a growing and complex demand from patients, a bias towards secondary care, workforce shortages and frustrations, productivity, funding, and misaligned incentives, then it is worth confronting the fact that the proposed passport may only lightly contribute to many of these. It would improve the patient experience certainly, but tapping into the hospital using a digital health passport is not much use if you’re still facing long delays to care, or you can’t be discharged due to poor patient management.
Second, the report opens by suggesting the health system needs a fundamental rewiring. The recommendations, if implemented, would no doubt improve the current state of play. But it is not clear they amount to a fundamental rewiring. For example, the litany of case studies included throughout were inspiring and humanising. While it is reassuring to see such good practice exists in pockets, there are clearly some substantial obstacles that stop this practice diffusing across the system that were not adequately explored.
If the aspiration is to radically rewire the system, then one must understand not just what the problems are, but why they exist. Why has the shift to prevention – widely considered among health policy experts as essential for a sustainable health system – failed to materialise despite years of consensus on what needs to be done? Why are there such promising cases of innovation in the health system that remain just that, promising case studies?
It is easy to make anything on health reform a condemnation of the NHS. But this report was not that. Despite the bleak outlook for the health service, it left me feeling optimistic. It is indisputably a step in the right direction, and should prod policymakers to think about how we can replicate some genuinely exciting examples of innovation in health care. But to really transform our health service, a more radical reimagining is needed.