Public services in the UK don’t require reform. They need transformation.
In a world in which we can set up a bank account in minutes or pay for our shopping with the tap of a phone, the era of slow and cumbersome government services must come to an end.
The UK needs to harness the power of new technologies to create a streamlined, strategic state to revolutionise the delivery of public services by putting people and their communities first.
We have the technological and scientific means to transform health and care to safeguard the founding principles of Beveridge and Bevan. Without fully embracing the tech revolution, there is no future for the NHS.
The NHS was founded on the principle that health should not be dependent on wealth. Of course, we know poorer people have a harder time living healthy lives; social deprivation begets health deterioration. But the NHS at least guarantees that if you are sick, particularly seriously sick, you’re cared for irrespective of your bank balance.
The post-war generation was liberated by the creation of the NHS and, rightly, that basic decency underpins our support for the NHS today. It made a reality of care based on need, not income.
However, over the years, other realities have emerged, and the NHS now requires fundamental reform or, eventually, support for it will diminish.
If the NHS cannot provide timely care – if waiting lists are long, seeing a GP difficult, accessing care complicated and inefficient – then people who can pay will pay. That is why in the past few years the numbers of those using private health providers have rocketed.
Despite pockets of excellence the NHS is falling further behind other health-care systems, and many services – including high-volume, low-complexity work – remain slow and unresponsive to digital transformation.
The NHS workforce feels both overstretched and undervalued; although there are record numbers of staff, morale is poor.
The result is that, as in the 1990s, the NHS must either change or decline. And funding will be tight, because of the state of the economy.
However, there are two major differences between health care in the late 20th century and health care as we get well into the third decade of this century. Both are the consequence of the 21st-century technological revolution.
The first is how people live today. They operate digitally, make choices continually and want to control their own lives rather than have others do it for them. A service that is essentially top down and paternalistic doesn’t work for them.
The second is the massive advances in life sciences and in medical treatment already with us, something that is going to accelerate hugely over the coming years as the artificial intelligence (AI) revolution takes shape and people understand fully the relationship between the accumulation of data and AI’s capacity to analyse it productively.
So, today, we need a health service that changes fundamentally the relationship between the citizen and the service; one that is open to new providers and new partnerships that operate outside the system; one where the incentives of funding and accountability are designed to encourage innovation, particularly through the use of technology; and one in which the workforce is reshaped around what makes sense today, not the traditions of a health-care system from a bygone era.
As this report sets out, we keep the principle of health care based on need not on the ability to pay – the originating principle of the NHS – but change radically the way the system works to incorporate not only what modern technology makes possible, but also the best from health-care systems around the world.
We should use digital technology to change the relationship between citizen and service. Each person will have their own Personal Health Account, delivered through the NHS App. This will be owned by the patient not the service. It will store health data, including self-testing and diagnosis as such things become available, and from wearables like smartwatches or Fitbits; it will be transferable around the system so anywhere within the NHS or with a private provider, health data, with the consent of the patient, can be accessed. The patient will be able to receive, via the app, information about new services, including from accredited private providers, and suggestions to improve personal responsibility for individual health. Citizens will be able to book appointments and, in defined cases, self-refer to consultants as they can in private systems. Those unfamiliar with or unable to use the technology will be able to access the service in the traditional way.
The NHS will step by step create cloud infrastructure to connect health data centrally. This will enable the creation of Personal Health Accounts, delivery of more sophisticated care and better resource planning and procurement, as well as the development of new data and AI applications to provide more accurate and real-time analysis of health care. These data, with appropriate safeguards and consent, can then also be used by external partners as a national asset, to help our life-sciences sector deliver world-leading research.
The proposed new structure of Integrated Care Systems – 42 in number – to replace the monolithic NHS system is right. But they should be given real freedom along with transparency of outcomes. They need multi-year budgets to be able to keep efficiency savings for redeployment in better services, to use private providers freely, and to allow patient choice across GP practices and hospitals in their region.
There should be active encouragement of new providers to enter the system, particularly for high-volume, low-complexity services, many of which can now be provided digitally. The NHS App is creating a vibrant marketplace for digital providers to enter the NHS centrally in ways that were not possible before, creating opportunities for greater choice and competition; and for partnership between the private health sector and the NHS. This can include the availability of co-payment options to expand more rapidly or offer additional features.
Finally, a lot of basic health care can be delivered through pharmacies, by employers, in gyms and in supermarkets making care easier to access.
The NHS workforce should be overhauled to make sense of what technology can either do directly or assist humans to do better. Traditional demarcations must be broken down, training reformed and the right incentives put in place to motivate staff. New skills must also be brought into the NHS, particularly for digital. No less important, investment in productive capacity, including capital infrastructure, will be essential to increase retention and reverse the drop in productivity.
The Genomic Medicine Service should be taken out of the backwoods of the NHS and turned into a full-fledged part of the system, with the aim of providing whole-genome sequencing to all patients upon diagnosis, to all newborns and to healthy populations with known risk factors including a family history of disease. This, in time, should become a vital part of ensuring the health-care system moves from a focus on sickness to supporting prevention, wellbeing and personalised care.
The NHS is not just an important part of British society. It will, in the future, properly reformed, be an economic asset for life sciences and more broadly for enterprise, offering new opportunities for the private sector, particularly with AI technology, to develop products and services.
Change is never easy and requires brave political leadership. If we do not act, the NHS will continue down a path of decline, to the detriment of our people and our economy.
Tony Blair
Executive Chairman
