Fit for the Future? How Do Government Plans for Our Health and Wellbeing Shape Up?
Dr Sean Wheatley, MSc, PhD. Science and Research Lead
Sean.Wheatley@xperthealth.org.uk
July has been a big month for anyone who likes a health-related plan or policy paper, a fan group that I’m sure stretches far and wide.
Amongst other things, this month saw the publication of Fit for the Future: The 10 Year Health Plan for England and the UK government’s food strategy for England.
This blog takes a brief look at the former of these, and next month’s blog will cover the latter.
Preamble
Before getting into it, it is worth noting that much of what is covered in these publications is beyond the scope of what we tend to focus on at X-PERT.
National-, international- and business-level economic and logistical matters, for example, are largely outside of the bounds of what we cover in our programmes and resources. As such, these areas will not receive much attention here.
That’s not to say these things are not important (they are), or that they do not have an impact on the things we do provide information on (they do). We have to draw a line on what we cover somewhere though, and so we prioritise things that have more immediate practical implications on an individual level.
With that in mind, let’s get into it…
What are the Headline Proposals?
The 10 Year Health Plan for England focuses on “three radical shifts”: hospital to community, analogue to digital, and sickness to prevention. Each of these is explored further below.
Shift 1. Hospital to Community
What is the intention?
This focuses on trying to shift most of the care people receive into local settings, allowing people to easily access the services they need in their own community. The ultimate aim is for care to be provided “digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, in a hospital if necessary”.
First impressions?
The intention is good (in my opinion at least), but this is a huge shift from where we currently are! With so many professions currently underfunded, understaffed, and overstretched it is difficult to see how all the necessary parts of an effective multidisciplinary team would be brought together. It is even more difficult to envisage how this will be achieved in enough locations for everyone to have access to what they need in their own local area. And that is even before you come to the challenges of bringing these professions together into a cohesive unit, with effective information sharing and referrals between them.
Where does the workforce come from?
This starts to get into the logistical concerns that I have already said are beyond the scope of what we (X-PERT) usually focus on. It is however clear that the plan only works if there is a workforce (with enough appropriately qualified professionals) to deliver it. This seems a long way off, particularly with the significant economic challenges that provide a backdrop to these ambitions.
Plans to achieve this whilst also reducing international recruitment (“to less than 10% by 2035”) adds further challenges. Within the plan there are stated aims to create 1,000 new specialty training posts and 2,000 more nursing apprenticeships over the next 3 years, and to expand medical school places (though without any specific targets provided). These speak to how the overall aims might be achieved to some extent, but there are still plenty of gaps to be filled.
Shift 2. Analogue to Digital
What is the intention?
This shift aims to harness the power of digital solutions. Much of this (from a patient’s perspective) revolves around the NHS App, which is intended to be “a full front door for the entire NHS” by 2028. The aim is for the NHS App to become a ‘doctor in their pocket’ for patients, as well as to allow management of things like appointments and prescriptions.
First impressions?
In general, it is difficult not to be sceptical about these digital ambitions. This pessimism is largely based on the current state of play, where records are often not even joined up between different NHS organisations (sometimes even within the same area; your hospital may not be able to access all of the records your GP holds, for example).
To have faith in this plan, you therefore have to believe that organisations that could not get relatively basic digital infrastructure right up to this point are going to effectively identify and implement the right tools for the planned revolution.
Is AI the answer?
The intention to utilise artificial intelligence (AI) to support healthcare professionals (HCPs) is interesting, though brings a number of concerns too!
In theory, this technology could have great applications for supporting decision making and for helping HCPs to save time. Overall, the plan is quite reliant on AI helping to bridge some of the gaps between our current reality and the vision for the future too. But therein lies the problem, as this also means the government are relying on external companies producing sufficiently reliable (and affordable) tools.
Based on the limitations of current AI models – which often get things wrong, and are prone to making things up when they can’t find an answer – this seems a little bit of a gamble.
Any other concerns?
Considering this planned shift more broadly, there are other risks that come with an overreliance on technology. Although digital literacy is likely to increase generation by generation (as more and more people will have grown up usings digital devices), there are still people for whom digital tools are not an entirely appropriate option.
There will always be people who cannot (or will not) engage with support, information or interventions provided in any particular form, digital or otherwise. Any healthcare options that are only provided digitally will therefore risk alienating a subgroup of the population. These divisions often mirroring existing drivers of inequalities too (e.g., based on factors such as disabilities, sex, age, race, education status and/or socioeconomic status). There is therefore a risk of exacerbating existing health inequalities if this shift is not considered carefully.
What do we like?
There are other elements that seem promising, such as the focus on wearable technology such as continuous glucose monitors (which have already been used to such great effect for many people with diabetes).
It is however important to note that technology on its own is not enough; the information it provides is often meaningless without appropriate education and support to help people make informed choices and sustainable changes that are right for them. It is therefore essential that these additional elements are also included as part of this shift.
Shift 3. Sickness to Prevention
What is the intention?
This shift focuses on trying to make people healthier before they start to experience ill health, rather than simply trying to treat people once health problems have occurred.
This would largely be achieved through trying to support improved lifestyles (e.g., better diets and increased activity levels) and reduced exposure to things that can cause problems (e.g., nicotine products and alcohol). Successfully achieving this would reduce the risk of health problems occurring, and of them advancing to the stage where people need to receive the types of treatment that are usually provided in hospitals (and/or other specialised facilities).
The overall goal is to “halve the gap in healthy life expectancy between the richest and poorest regions”, and to increase healthy life expectancy “for everyone”.
First impressions?
First and foremost, I like the focus on healthy life expectancy rather than “just” life expectancy. The benefits of living longer are somewhat tempered if you spend most of your later years in ill health, potentially being in pain and discomfort and/or with limited independence for much of it.
A focus on living more years in good health, to allow a greater opportunity to have a meaningful quality of life, is a worthwhile goal.
But…
To carry on a slight theme of pessimism, plans to focus on prevention rather than “just” cure are nothing new. Whether previously stated aims to do this have translated into any meaningful progress are debatable though.
The general issue with plans that focus on the long-term is that they do not fit within the timelines that are important for political parties (i.e., timelines that allow for claims of improvements to be made when the next general election comes along).
There have been some attempts at providing preventative interventions though, such as the National Diabetes Prevention Programme. But with rates of type 2 diabetes soaring to record levels, the previous comment about it being debatable as to whether any meaningful progress has been made stands.
The role of technology
There are plans to harness cutting edge science and technology to support this shift, with sophisticated techniques such as genomics slated to provide a part of the solution. Tools like this, theoretically, can increase our ability to identify people with an increased risk of certain conditions. This, theoretically, helps to target interventions and resources. However, current techniques are relatively limited in their ability to accurately do this.
Similar to my previous comments on AI, there therefore seems to be plenty of hope being placed on what technology might allow us to do in the future, rather than plans being made based on what it can reliably achieve today.
There are also significant ethical concerns around the use of some of these predictive techniques. Just because you have an increased risk of something, that does not mean that it would actually have happened. Some people may therefore undergo medical procedures that they might not have needed, and/or experience unnecessary psychological distress. Balancing the pros and cons of any screening programmes is a delicate act.
It is also important to remember that improved risk identification on its own is not enough. Much like with the technology discussed earlier, the information this provides is only valuable if we can act on it. High quality education and appropriate support is again likely to be central to achieving this, as this allows individuals to make sustainable changes to help reduce or mitigate the identified risk.
Additional thoughts
There are other elements of the plan that I thought were noteworthy, including the intention to speed up recruitment for clinical trials to support the UK’s role at the forefront of science and innovation. This is another laudable aim, but it is important that any changes made to facilitate this do not compromise patient safety or study quality.
It is also important that better decisions are made regarding which programmes and interventions are funded. Processes should be open and transparent, and only options with clear evidence of effectiveness should be implemented. This has not always been the case, as we outlined in a recent blog that explored the limitations with the NHS Healthy Living programme.
Lastly, as a charity focused on education you will not be surprised to hear that we strongly believe appropriate education needs to be implemented as part of all of these shifts. This should be the case at multiple levels within the system too, including for the HCPs working within it, and for the patients, who should be supported to make informed choices based on whatever information is available to them. Some specific cases were noted in previous sections, but this need stretches further and wider than these points.
So, what’s the bottom line?
There are plenty of laudable aims, and no lack of ambition. There are therefore reasons to be hopeful – if the government, the NHS, and other related services and organisations can deliver on this plan, then it stands to make a significant difference to people’s health and wellbeing.
That is a big “if” though. At this stage, the plan is perhaps big on hope but light on specific details as to how it can be delivered. Previous plans have (evidently) failed to translate into meaningful, tangible improvements in the health of the nation (and the state of the NHS) too. It is also therefore important to maintain a healthy scepticism.
Ultimately, only time will tell whether or not this plan is a good one or not.
