The Department of Health and Social Care has published an impact statement noting the rationale behind many of the key measures introduced in the 10-Year Plan, covering potential impact, costs, benefits, and risks. Focusing in on the three shifts from hospital to community, analogue to digital, and reactive to proactive care, it tackles each element of proposed reform separately in a detailed 81-page document.
On the first shift, hospital to community, the statement looks to the development of the neighbourhood health service to cover larger geographies and approaches to service delivery designed around groups with similar needs identified in the plan as “most failed by the current system”. Proposals to achieve this include increasing GP capacity by training more GPs and freeing-up GP time from admin tasks, increasing the use of MDTs, making more services available in community settings, and activating patients to have a greater role in their own care.
Some studies have found cost savings from moving services into the community, but there are cases where this is offset by increases in service volume and the loss of economies of scale, according to the DHSC. It will thus be important that ICBs allocate resources carefully to ensure success. More work will be required around assessing funding and value for money, and a “test and learn” approach may be taken to ensure the most successful approaches are rolled out nationally.
Most GP practices already have infrastructure for digital telephony, with many also having online consultations, messaging platforms, and appointment booking systems in place, the DHSC reports, but there could be costs associated with integrating digital care navigation tools and AI chatbots. Nurses currently spend around 20 percent of their time on care planning, it continues, which is expected to be made more efficient technologies such as AI over the coming years.
Moving on to discuss the shift from analogue to digital, the DHSC highlights that whilst technology can improve outcomes and financial sustainability, it can also present “upward pressure” on costs due to increasing the scope of diagnostics and treatment. “Technology also carries delivery risks and risks of obsolescence, so careful strategy and programme management is important to achieve value,” it adds.
The single patient record will take several years, and costs will include product development, tech and data integration, delivery, implementation, and commercial costs. Investment will be needed to ensure staff such as paramedics and community pharmacists have the same access to patient data as GPs and those working in hospitals, and to maximise value, costs may also need to be considered for translating care records into plain English to be understood by patients. Costs of personalised social risk assessments, the development of data collection to the NHS App, and tools to integrate information with other datasets, are also explored. Benefits anticipated include reduced variability through automated triage of patients, enabling more informed decision making, and reducing more expensive downstream health costs. Risks cover reliance on a single provider and “de-facto vendor-lock”, as well as clinical resistance to changes in data sharing.
When it comes to AI, the adoption and scaling of new tech will mean upfront costs and funding. The DHSC shares that the government is backing three UK research projects by investing £37.5 million in a Research Ventures Catalyst programme looking at how AI can target hard-to-treat diseases and improve diagnosis and treatment. Risks include slow uptake and implementation delays due to upfront costs. Patients could benefit from increased face-to-face time with clinicians, the DHSC states, which is supported by data emerging from NHS-funded pilots with areas such as Ambient AI. “There will also be benefits to overall population health if new technologies support earlier diagnosis or more efficient care,” it says. “For example, integrated data from wearables could benefit patients through improved health outcomes.”
Finally, looking to the shift to prevention, the DHSC outlines a “strong economic case” for moving to a more preventative model, citing evidence that applying evidence-based preventative interventions earlier and on a wider scale could offer a 33 percent reduction in ill health and unlock around a £320 billion rise in GDP over 20 years. Digital and data infrastructure will be required to support the implementation of “HealthStore” and a new NHS points scheme.
If successfully implemented, the plan offers the chance to benefit the public, the healthcare system, wider society, and the overall economy, the DHSC concludes. “However, delivery of the plan will require coordinated, joined up action across multiple actors and against a complex and changing landscape of regulation, system oversight and technological innovation.”
Wider trend: NHS reform
NHS England has published its medium term planning framework to outline the priority deliverables ICBs and providers should focus on for the next three-to-five years. The framework sets out a new operating model, a revised foundation trust model, the creation of integrated health organisations, changes to the financial framework, and opportunities for greater local autonomy through a neighbourhood health approach.
NHS England has announced plans for an “online hospital” to go live in 2027, with an aim to deliver up to “8.5 million appointments and assessments in its first three years”. The service, NHS Online, will aim to connect patients virtually to clinicians based anywhere in England, with triage to be completed through the NHS App, and appointments for scans then offered at local community diagnostic centres. The initial focus will be on planned treatment areas with the longest waiting times, with NHS England planning to extend the offering to further areas if clinically safe to do so remotely. Tried-and-tested innovations already in use in the NHS, such as AI and remote monitoring, will be built and scaled in the first instance.
At the Institute for Government’s annual conference, Wes Streeting delivered a keynote speech on NHS reform, noting “modernisation can’t be dodged any longer”, setting out an approach to modernisation focused on empowering people, offering freedom to the frontline, shifting to prevention, using tech to support productivity, and spending taxpayers’ money with care.
