Opinion: An NHS fit for 2030 – Delivering value to citizens

The NHS is one of the most efficient health systems in the world and delivers more activity per unit of funding than many other similar systems. 

It is also a product of its age. Ideated in the late 1940s and having been through countless reorganisations, it remains an institution whose focus is the curing or amelioration of illness.

As we move to a health and care system which is more based on personalised interventions which also encompass wellness and more active personal involvement, it would be useful to describe what the NHS would look like in this new world and how it would differ from the old NHS. In this context , it would also be useful to describe this from the perspective of both hospitals and primary care as well as local government as in essence all would be driven to achieve the same aims, albeit the financial metrics to drive each this convergence of purpose would differ.

Changing the focus of care

The NHS today is measured and assessed on the things that are considered to be important. Thus, for example, in the case of hospitals, activity and case mix as well as various quality metrics are routinely collected and constitute prominently in the press, especially where there is evidence of adverse variance. The drivers to ensure breaches in targets are avoided are thus very high in the minds of both administrators and staff that drive the system.  

The new NHS may well look the same in terms of the institutions delivering care and the staffing, however the focus of care will be different.  Prevention of ill health and incorporation of wellness will form part of what an NHS would be expected to deliver to satisfy the new financial metrics driving the system and the activities of the service would mirror this. The activities within primary care and secondary care would also be more similar in breadth rather than different and the focus and emphasis around care would be very similar. Thus in the case of cardio metabolic non communicable diseases, the importance of risk reduction would be highlighted with equal importance, the need to self manage would also be considered to be as important as the treatment of disease.

The new NHS will adopt a life course approach to health and wellness and concentrate on encouraging wellbeing, managing inequalities with the same weighting it adopts around managing ill health. The fact that new unified financial metrics will govern the way it operates will encourage primary secondary cooperation where because of their nature as outcome based metrics, these will drive interdependence and cooperation based approaches. Interoperability and access to medical records by patients as well as their involvement in their own health and care will be essential aims for the system to encourage since both of these factors drive better health and wellness outcomes.

Increasing patient access

The 2030 patient would have access to their customised care and wellness record. This would be populated by their unified Electronic Medical Record as well as their own health and wellness data and other pertinent data. They would be in contact with the NHS on a regular basis specifically around assessment of bio markers which they would be using to assess their wellness and better manage their risk factors. The NHS would be working in concert with local government offering them curated personalised support and be utilising techniques like gameification to better motivate behavioural change in citizens.   

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