#17. W/c 6th January '25
Alastair Allen
Partner, Head of Healthcare Technology at EY | Board Member at openEHR UK | Health and Social Care Council Member at TechUK
Happy New Year! In this week's newsletter: the NHS is at risk of paralysis waiting for Wes Streeting's reforms, while NHS England unveils a plan for elective care reforms. Patients in Northern Ireland face lengthy ED waits, while analysts propose how virtual and in-person care can converge for a healthier future. Finally, Dr. Eric Topol highlights the promise and challenges of generative AI in healthcare.
Reforming elective care for patients
NHS England has unveiled a comprehensive plan to reform elective care, focusing on reducing waiting times and improving patient experiences. The initiative aims to tackle the rising number of people on waiting lists, ensuring that 92% of patients receive treatment within 18 weeks by March 2029. The strategy prioritises empowering patients by offering more choice and control over their care, supported by improved information and communication channels, such as the NHS App.
The reform includes expanding diagnostic and surgical capabilities through new centres and enhancing the use of technology like AI to boost productivity. The plan also outlines greater collaboration with the independent sector to reduce bottlenecks in specific areas like gynaecology and ENT.
Efforts will be made to deliver care in the most appropriate settings, potentially outside hospitals, and integrating digital solutions to streamline operations and enhance patient interactions. This includes optimising referrals and ensuring more services are available directly in community settings.
Financial and performance management reforms will ensure that funding follows patients and incentivises improvement across the NHS. The plan involves robust performance oversight to support underperforming providers, with the NHS working towards a more integrated care network that aligns primary, secondary, and community care.
Read more: https://www.england.nhs.uk/long-read/reforming-elective-care-for-patients/
NHS at risk of paralysis while waiting for Wes Streeting’s reforms
The NHS is in the middle of another 'winter crisis', marked by long waits and increased mortality, and it is predicted to be the worst on record in terms of performance. Compared to a decade ago, the number of people waiting over 18 weeks for elective care has increased twelvefold, and those waiting over four hours in A&E have risen significantly.
While the NHS strives to maintain patient safety with additional beds and staff, systemic issues require a long-term reform. The Secretary of State for Health and Care, Wes Streeting, advocates for a 10-Year Plan for Health, promising comprehensive reform but recognising immediate concerns may overshadow these efforts. Moral among staff is a concern, stemming from years of austerity and rising demand. To successfully reform, a dual approach is needed: addressing immediate needs while preparing for the 10-Year Plan.
IPPR suggests three steps to create a 'bridge to the future'. Firstly, clear winter priorities should be established to overcome uncertainty. Leaders should not wait for the 10-Year Plan to act but align with governmental goals of prevention and community-based care. Secondly, local staff engagement is crucial. Empowering staff locally can foster morale and inspire initiatives, as seen with NHS staff boards in the example cited as Barking and Northumbria Trust. Finally, a shift from national micromanagement to local empowerment is essential, encouraging belief in staff's ability to effect change. These steps aim to transition the NHS from crisis mode to a proactive, empowered institution, ready for the 10-Year Plan and capable of flourishing across the country.
How virtual and in-person care can merge for a healthier future
Health systems are being urged to integrate virtual, home-based, and in-person care to establish a sustainable and efficient model. This hybrid approach aims to optimise resources, reduce costs, and enhance patient outcomes by ensuring care can be delivered flexibly according to patient needs and preferences.
Central to this integration are digital platforms that unite data, allowing proactive and data-driven healthcare delivery. Features such as digital command centres and remote health monitoring, assisted by AI, can provide seamless care. These systems allow health professionals to monitor patients at home, maintaining their health and preventing complications. Virtual care avenues like telemedicine and remote triage can connect patients to suitable care settings, reducing the necessity for expensive urgent care services.
The experience in places like Canada and Australia shows the potential benefits of this model in rural and resource-constrained areas. However, successful integration requires a shift in workforce roles, enhanced telehealth infrastructure, and a focus on both patient and clinician experiences to ensure digital tools are embraced. As health organisations move towards this integrated care approach, patient data and preferences must guide the transition to ensure the care is both effective and patient-centred.
NI emergency departments: Elderly patients spend five days in hospital ED
Emergency departments in Northern Ireland are facing severe challenges, with elderly patients spending up to five days in the Royal Victoria Hospital's emergency department due to overcrowding. On a particularly busy Monday, over 1,052 individuals were present across the region's nine emergency departments, with 349 waiting more than 12 hours. Issues include a lack of suitable community care, resulting in medically fit patients occupying hospital beds and delaying the admission of new, unwell patients. Claire Wilmont, lead nurse at the RVH, described the conditions for vulnerable elderly patients as "intolerable."
Staff at emergency departments are "struggling" with rising flu cases and limited space, with treatments occurring in non-traditional spaces like unused tea rooms due to capacity issues. Dr Ian Carl, an acute medical consultant, revealed that hospitals routinely operate beyond capacity, sometimes reaching up to 140%. The normalisation of corridor care was criticised, and the need for broader social care solutions echoed by medical staff.
The health committee at Stormont is addressing these pressures in an emergency meeting, with Health Minister Mike Nesbitt updating members on current waiting times. Criticism has been directed at the executive for its perceived late and inadequate winter preparedness plan. Amid the challenges, medical professionals, such as Dr Joanne McClean, stress the importance of flu vaccinations, citing the decline in vaccine uptake as a contributing factor to increased respiratory infections. The Department of Health identified sustained investment and reform as crucial long-term solutions.
Dr. Eric Topol: Generative AI Studies Boast Promising Results, But Real-World Challenges Remain
Dr Eric Topol, a prominent cardiologist and researcher, highlighted at a recent meeting of the Radiological Society of North America that while initial studies on generative AI in clinical settings show promising results, these findings might not translate effectively into real-world clinical practice. Despite AI demonstrating superior performance in tasks such as differential diagnosis in certain studies, there are concerns about its application outside controlled environments. For instance, OpenAI’s ChatGPT achieved a 90% diagnostic accuracy compared to physicians' 74% in a study published in JAMA. However, Dr Topol suggests this should not lead to conclusions about AI's superiority as many studies are conducted under controlled conditions using simulated data rather than real patient data. Only a small percentage of AI-related healthcare studies use real-world data, making their applicability questionable.
Dr Topol identifies several reasons for AI's seemingly better performance. These include potential physician bias against automation, unfamiliarity with AI tools, and the artificial nature of test environments. While ambient notetaking AI models, used in documentation, are already enhancing workflow efficiency in hospitals, the applicability of other AI tools in real-world clinical scenarios remains uncertain. As such, while the future for AI in healthcare is potentially bright, these preliminary findings should be cautiously interpreted until further real-world validation is conducted.
Partner, Healthcare Consulting - EY Canada
8moAlways look forward to your weekly updates. Thanks Alastair Allen