The NHS has a secret weapon. Why doesn't it use it?

Why is no-one talking about predictive care?

Two different but related stories on the NHS have emerged recently: Chris Smyth in the Times (paywall) reported  on £300m of ostensibly wasted funds from a set of tests focussed on over-40s, which operated in direct conflict with the "best available evidence." In other news, the Daily Telegraph (paywall) reported on a "time-bomb," anticipating that three in four adults will suffer from chronic disease by 2030, stressing the NHS’s ability to cope with patients as it continues to be challenged by budget constraints and a dearth of medical practitioners and support staff.

In the wake of the NHS’ recent 65th birthday, and radical recent structural reform, dealing with both of these issues form part of the broader challenge that must be met to ensure the long-term sustainability of the NHS. The organisation has to deal with severe budget constraints, and insufficient staff, and yet continues to be a jewel in the crown; one of the world’s largest employers and fulfilling the remarkable accomplishment of delivering near universal healthcare in England. An entirely different approach to healthcare is needed to ensure the NHS remains fit for purpose into the future.

What both the Telegraph and Times reports point to are issues that ultimately could be mitigated through better use of information.

In the case of the expensive and unnecessary tests the Times reports on, trials are already underway to deliver "stratified medicine" into the UK –  matching treatment with a patient’s genetic markers to assess not just the tests required, but the treatment options that will deliver the swiftest route to recovery and ultimately, improved survivability. This is already proving that we can  eliminate the need for "unnecessary" tests. The key here is that illness can be dealt with before it manifests into symptoms, at far reduced costs. After all, using a DNA test to prescribe the correct chemotherapy drugs for skin cancer raises the rate of effectiveness from 10 per cent to 70 per cent creating a significant saving in later treatments, hospital and in-home care.

Key to dealing with the staff shortages that the Telegraph writes on is shifting the overall paradigm for healthcare to one that no longer expends 70 per cent of NHS budgets on chronic disease care, dealing with illnesses including cancer, diabetes, breathing conditions and heart disease. Stratified healthcare can clearly play a role here, drawing on patient, environmental, social and genetic data to deliver the best treatment. In addition, increasingly popular advances in "body data" technology including everything from Nike’s Fuelband through to sophisticated wireless sensors deliver an opportunity to the medical profession: the correlation, analysis and interpretation of telehealth, telemetry and genomic data to treat disease pre-emptively. For example; an anomalous heart beat within someone that has a specific genetic and weight profile might be cause for pre-emptive medical intervention (avoiding emergency by-pass surgery in someone who is extremely overweight, for example); for the same symptoms in someone who had a fitter profile, it might be ignored, limiting the risk of "false positives." Similarly, this sensor data could have a dramatic impact in reducing the number of emergency hospital readmissions (that is, people who had to come back to hospital through A&E after being discharged) – of which there were 650,000 in 2010/11, a rate which has been climbing for a decade.

This transformation will need to happen in stages: the NHS will need to continue to make progress in digitising the way healthcare is managed in the UK and there will need to be better and more widespread data sharing between medical authorities, academic institutions and research organisations. Crucially, great care and thought will need to go into securing the privacy of individual health data even as it is used as a resource to provide better healthcare for others.

However – the prize – a significant reduction in the £80bn spent in chronic disease care, and a potentially dramatically improved quality of life for citizens – is one that must be sought after. And doubtless we may still face up to wasted tests or stretched wards – but hopefully this will become the exception, rather than the rule, and the NHS will endure to celebrate its centenary and beyond.

Illness can be dealt with before it manifests into symptoms, at far reduced costs. Photograph: Getty Images

James Petter is the Vice President & Managing Director of EMC, UK & Ireland

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Trade unions must change or face permanent decline

Union membership will fall below one in five employees by 2030 unless current trends are reversed. 

The future should be full of potential for trade unions. Four in five people in Great Britain think that trade unions are “essential” to protect workers’ interests. Public concerns about low pay have soared to record levels over recent years. And, after almost disappearing from view, there is now a resurgent debate about the quality and dignity of work in today’s Britain.

Yet, as things stand, none of these currents are likely to reverse long-term decline. Membership has fallen by almost half since the late 1970s and at the same time the number of people in work has risen by a quarter. Unions are heavily skewed towards the public sector, older workers and middle-to-high earners. Overall, membership is now just under 25 per cent of all employees, however in the private sector it falls to 14 per cent nationally and 10 per cent in London. Less than 1 in 10 of the lowest paid are members. Across large swathes of our economy unions are near invisible.

The reasons are complex and deep-rooted — sweeping industrial change, anti-union legislation, shifts in social attitudes and the rise of precarious work to name a few — but the upshot is plain to see. Looking at the past 15 years, membership has fallen from 30 per cent in 2000 to 25 per cent in 2015. As the TUC have said, we are now into a 2nd generation of “never members”, millions of young people are entering the jobs market without even a passing thought about joining a union. Above all, demographics are taking their toll: baby boomers are retiring; millennials aren’t signing up.

This is a structural problem for the union movement because if fewer young workers join then it’s a rock-solid bet that fewer of their peers will sign-up in later life — setting in train a further wave of decline in membership figures in the decades ahead. As older workers, who came of age in the 1970s when trade unions were at their most dominant, retire and are replaced with fewer newcomers, union membership will fall. The question is: by how much?

The chart below sets out our analysis of trends in membership over the 20 years for which detailed membership data is available (the thick lines) and a fifteen year projection period (the dotted lines). The filled-in dots show where membership is today and the white-filled dots show our projection for 2030. Those born in the 1950s were the last cohort to see similar membership rates to their predecessors.

 

Our projections (the white-filled dots) are based on the assumption that changes in membership in the coming years simply track the path that previous cohorts took at the same age. For example, the cohort born in the late 1980s saw a 50 per cent increase in union membership as they moved from their early to late twenties. We have assumed that the same percentage increase in membership will occur over the coming decade among those born in the late 1990s.

This may turn out to be a highly optimistic assumption. Further fragmentation in the nature of work or prolonged austerity, for example, could curtail the familiar big rise in membership rates as people pass through their twenties. Against this, it could be argued that a greater proportion of young people spending longer in education might simply be delaying the age at which union membership rises, resulting in sharper growth among those in their late twenties in the future. However, to date this simply hasn’t happened. Membership rates for those in their late twenties have fallen steadily: they stand at 19 per cent among today’s 26–30 year olds compared to 23 per cent a decade ago, and 29 per cent two decades ago.

All told our overall projection is that just under 20 per cent of employees will be in a union by 2030. Think of this as a rough indication of where the union movement will be in 15 years’ time if history repeats itself. To be clear, this doesn’t signify union membership suddenly going over a cliff; it just points to steady, continual decline. If accurate, it would mean that by 2030 the share of trade unionists would have fallen by a third since the turn of the century.

Let’s hope that this outlook brings home the urgency of acting to address this generational challenge. It should spark far-reaching debate about what the next chapter of pro-worker organisation should look like. Some of this thinking is starting to happen inside our own union movement. But it needs to come from outside of the union world too: there is likely to be a need for a more diverse set of institutions experimenting with new ways of supporting those in exposed parts of the workforce. There’s no shortage of examples from the US — a country whose union movement faces an even more acute challenge than ours — of how to innovate on behalf of workers.

It’s not written in the stars that these gloomy projections will come to pass. They are there to be acted on. But if the voices of union conservatism prevail — and the offer to millennials is more of the same — no-one should be at all surprised about where this ends up.

This post originally appeared on Gavin Kelly's blog