Allowing the future to change us

A culture in the NHS of risk aversion and maintaining
the status quo stops Britain adopting new te

If necessity really is the mother of invention, then the NHS must be entering its second trimester. By the time the general election is over in May, we can hope to see a crib full of bouncing baby ideas, ­although the wails could be coming from the doctors. Spending on health care has tripled in Britain since Labour came to power, rising from £40bn in 1997 to £120bn last year - a rise that has taken it from 6 per cent of GDP to 10 per cent. Some 60 per cent of that budget is paid to staff, including 180,000 doctors, whose salaries have also tripled.

Does this generosity at the taxpayers' expense mean we are getting treated three times better? Sadly, no. The Office for National Statistics calculated that NHS productivity fell 0.4 per cent a year during Labour's first decade, compared with a 2 per cent annual rise in private-sector productivity. Despite bushels of cash and a plethora of targets, the health service has, on average, been getting worse.

If throwing money at the NHS hasn't improved things, perhaps a bout of austerity will. Although both Tories and Labour have pledged to maintain NHS funding in real terms, it might be difficult, given the huge deficit - the largest ever in peacetime - racked up since the start of the financial crisis. John Appleby, chief economist at the King's Fund, a medical think tank, said last year that “the NHS is facing the most significant financial challenge in its history". Faced with an ageing population and a frozen or shrinking budget, NHS managers will have no choice but to look - possibly at the risk of discomfiting a few consultants - for innovative ways to be more efficient.

And ways do exist. Take waiting times in emergency departments. The government's target is four hours, and some hospitals have come up with a variety of ruses - such as the 765 records that were reportedly falsified at Queen's Medical Centre in Nottingham - to hit it. In principle, the idea of setting a goal and letting hospitals experiment with solutions sounds like a good way to solve a problem. In practice, though, long waiting times are not the cause but a symptom. And symptoms, as the purveyors of patent cold remedies can attest, are easily masked without curing the underlying illness.

The Washington Hospital Centre in DC had a similar problem in the 1990s. The average waiting time in its emergency department was eight hours. Dr Craig Feied, now a professor of emergency medicine at the Georgetown University School of Medicine, was brought in to deal with the underlying mess. He found that doctors were spending 60 per cent of their time on information management - getting the patient's medical history, tracking down missing scans - and only 15 per cent on patient care.

“We often knew what information we needed, but it just wasn't available in time," Dr Feied told Steven Levitt and Stephen Dubner, the authors of Super­freakonomics. "In a busy emergency department, even two minutes away is too much." The hospital had more than 300 sources of information, he found, from handwritten notes to streaming video from cardiac angiograms, none of which could talk to the others.

Dr Feied designed a new computer ­system that brought all this information together on one terminal in the emergency room, allowing doctors to get at ­patient information quickly. The time they spent on information management fell by a quarter, while that spent on treatment doubled. In consequence, waiting times fell to two hours.

The NHS's troubled attempt to create an even more ambitious, over-centralised, nationwide computer system, the National Programme for IT (already more than 400 per cent over its original budget of £2.3bn), is at least nodding in the right direction. But it is likely to be chopped back in the next Budget in the interest of maintaining front-line services. Even if it is completed, it will still be behind cutting-edge developments in medicine. This is a pity, because information use is one of the most promising areas of innovation in medicine today.

The amount of data that can be generated about a patient is growing fast. A range of devices, from hand-held ultrasound kits to large MRI scanners, can provide insights into what is happening inside a patent. A one million per cent increase in the power of MRI scanners made it possible last year for doctors to see living, breathing lungs, in real time and in 3D, for the first time.

Future technologies will be even more impressive. Early screening will make it possible to spot diseases before they become difficult, or impossible, to treat. DNA tests will predict which treatment will work best on individual patients, ­allowing doctors to write tailor-made prescriptions, rather than trying one drug after another in an attempt to find one that works. Sophisticated scans will show not only the large-scale structures of organs, but the microscopic proteins and enzymes as they react with the agents of disease, drugs, and other treatments. Follow-up images will check that all is going according to plan.

If introduced and used properly, the new range of medical technologies could revolutionise the NHS, cutting costs and improving patient outcomes. Technology offers simpler improvements, too, such as reducing the number of missed appointments. For the forgetful or disorganised, a text message or automated reminder call made a day or two before a visit to the doctor is far more effective than a formal letter weeks in advance.

Adopting new technologies will not be enough. The NHS needs to find innovative solutions to delivering health care on a larger scale. As surgical techniques improve, for example, the number of nights a patient needs to spend in hospital falls, a trend that can only gain momentum with the spread of robot surgery, already used to assist with procedures as complicated as kidney transplants. But as fewer beds will be needed, it will make sense to concentrate resources in centres of excellence - or teaching hospitals as they used to be called. Polyclinics, particularly if they take walk-in patients, could fill the gap between a personal GP and a teaching hospital.

Change is never popular with everyone, and messing with the NHS is particularly risky. Managers don't want their empires to shrink. Doctors don't want to yield clinical power. Patients don't want to travel an extra mile. Critics can always claim that patient care is being put "at risk". Perhaps the toughest innovation will be to find a way to persuade people that the status quo is not satisfactory, and that the NHS, while not the worst system in the world, still has plenty of room for improvement.

 

Paul Rodgers is a freelance writer on science, medicine and technology

 

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