- Brendan Shaw
The NHS 10-year plan: more artificial intelligence, less pigeon resuscitation
This week the British Prime Minister, Theresa May, announced the new 10-year plan for the National Health Service, with the claim that it could save up to 500,000 lives over the next decade.
It's ironic that on the very same day this week as the announcement, ambulances in London were queuing up 12-deep at London’s hospitals because Accident and Emergency (A&E) wards were all full.
Patients were waiting on stretchers in corridors for hours waiting to be admitted.
Not only is this bad for patients needing care, but the cost of having ambulance crews and their vehicles sitting around queuing with their patients must be enormous.
The new 10-year plan is welcome and comes with an injection of additional funding of £20 billion.
The plan is a comprehensive document and, in the broader international context of implementing universal health coverage, provides a good reference document for UHC systems based on publicly-funded and delivered healthcare.
Some of the main changes coming from the new plan include:
Commitments to improve the early detection of cancer through better testing, namely increasing the proportion of cancer cases caught in early stages from the current 1-in-2 people with cancer to 3-in-4 people by 2028. This is a good target, as cancer detection isn’t something the UK has excelled at compared to other European countries
Greater use of personalised medicine and genome testing as standard, including initiatives to improve the timely availability of new medicines
Quicker emergency hospital visits (particularly appropriate given the events on the day of the announcement) by providing alternatives services for other patients, such as the elderly that sometimes puts strain on the A&E departments
A greater focus on healthy lifestyle programs and preventative health, particularly for people with chronic conditions
More community care with a view to preventing hospital care and helping patients be discharged from hospital quicker
Greater use of digital technologies like online GP bookings, video consultations, digital online management of prescriptions and artificial intelligence to interpret CT and MRI scans, and
A big push for new mental health services – more than 10% of the £20 billion funding injection will go to mental health services.
While welcoming some of the good intentions in the plan, the reaction to the plan has been varied.
The British Medical Association called for the ambitious targets to be matched with resources and implementation, while the Association of the British Pharmaceutical Industry welcomed the new initiatives to improve the use and timeliness of new medicines.
One issue is the possible funding shortfall, with the Nuffield Trust suggesting that the headline £20.5 billion funding increase only equates to a 3.4% per annum increase in real terms after adjusted for inflation – less than the 4% per annum the Trust argues the NHS needs.
A 3.4% real annual increase is arguably just a continuation of the current long-term trend growth.
Source: BBC. 2019. "Will NHS long-term plan deliver the goods?", 7 January, https://www.bbc.co.uk/news/health-46783621, accessed 8/1/2019.
As well as a shortfall in funding, another critique has been the ongoing shortfall in people.
There are currently 100,000 unfilled vacancies in the NHS, in part influenced by the uncertainty over the work rights of EU citizens in the UK under Brexit.
Sorry, I tried not to mention Brexit today, but failed.
For example, 10,000 doctors, or 10% of all doctors in NHS England, are EU nationals while NHS England has 20,000 nurses and 100,000 social care staff from EU countries.
With the uncertainty after the post-2016 Brexit referendum already affecting recruitment of NHS staff such as nurses, resolving how Brexit will affect EU work rights is important.
The uptake by the NHS of new technologies has been patchy at best, as demonstrated by its continued reliance on fax machines and pagers.
The NHS is the biggest purchaser of fax machines in the world largely due to “stubborn resistance” to adopt new technologies.
That statistic still just floors me.
Then there are the pigeons.
It turns out that there are numerous examples where the NHS could be saving money and identifying waste has become something of a national pastime in the UK.
Of course, there are the stories of the “emergency” ambulance calls that aren’t really emergencies, such as when people have called to have a light bulb changed, their pot noodles heated up, they’ve lost their trousers or need the TV channel changed.
But the highlight for me was the ambulance that was called to resuscitate a pigeon.
Apparently, yes, someone did indeed once call an NHS ambulance to resuscitate a pigeon.
The issue here may be that many people across the UK do not have to pay a charge for an ambulance visit at all through the NHS.
A possibly overly-callous economist might suggest that a £100 fine for non-emergency ambulance calls would soon fix these problems, but that’s probably a debate for another day.
Then there are the figures which show that it apparently costs the NHS £216 million each year from people not keeping their doctors’ appointments.
That is, people who make appointments to see a doctor, but then don’t actually turn up for the appointments and don’t cancel them.
This happens 15 million times each year.
Again, on the NHS people don’t pay for doctor appointments.
To put this into context, £216 million a year would fund an additional 2,325 doctors for the NHS or 225,000 cataract operations or 58,000 hip replacements or 216,000 drug treatments for Alzheimer’s Disease or 8,400 full-time nurses.
Or perhaps 5,847,000 pigeon resuscitations.
The NHS, in a very British way, has politely said that “patients can do their part by letting the NHS know if they can’t make their slot”.
One suspects a £100 fine also imposed on people who miss these appointments might see the number of these ‘no-shows’ drop dramatically as well, but again that might also be seen as a bit harsh.
The 10-year plan is a good step forward for the NHS and it is overdue for a major structural injection of new funding.
But the proof will be whether the plan can succeed in eliminating the scene of ambulances queued outside metropolitan hospitals on a cold winter’s night because the hospitals are all full.
That would be a metric worth cooing about.
(British comedian, Russell Howard, gave a very funny pre-Christmas sketch on the dedication of NHS staff and the system’s inefficiencies (including the pigeon) – but be warned it is quite rude and has lots of ‘adult’ references. Don’t watch this if you are easily offended.)
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