Back to the future. Why patients must be at the heart of the post-COVID-19 health system
16 September 2020
Right from its very start in 1948, the NHS had the very best intentions. Operating as a centrally driven and locally delivered organisation, it has often meant that the needs and whims of government, politics and bureaucracy obscure its focus on patients. The private sector hasn’t always fared much better. The fragmented and partial services offered and provided, the inevitable prioritisation of services, medications and solutions that make economic sense has delivered a health system that serves many masters but has failed to put the patient at its heart.
Could COVID-19, and the limitations of the current health system that it has laid bare, prove the catalyst to effect real change across the health provider landscape for the benefit of the patient and society? It certainly should.
Acute to chronic
We are served by a health system (private and public) that is designed to treat acute conditions. And in most cases does that well. Patients today are characterised not by their need for isolated treatment of a specific problem, but by ongoing events linked to multiple, chronic conditions. A system that’s great at hip replacements or treating infectious diseases does rather less well when it comes to taking a holistic view of overall patient health.
But patients today are more demanding, more mobile, better informed and are living longer. Many patients over the age of 65 will have comorbidities ranging from diabetes to dementia. In the absence of the genomic therapies that will eradicate these conditions for good, we need a system that is able to take a more integrated approach to the patient. That means treating the whole patient and not just their isolated symptoms, which requires a ‘shift-left’ from curative to preventative health and improving the patient's ability to function day-to-day. This demands that clinicians and practitioners see themselves as less allied to organisations and structures and more towards patients and their progress to achieve the right outcomes. And it means putting patients in control – for example, by owning the budgets they use and the decisions that are made to manage their chronic conditions. Radical maybe.
Rights and responsibilities
Of course, a patient’s right to good health has to be balanced with their responsibility to achieve it. So-called lifestyle diseases such as obesity need to be addressed beyond a clinical setting so that patients themselves are empowered, informed and accountable regarding the changes to their lifestyle that will promote better health. Simple changes to diet and exercise can have very real impacts. What’s more, in a time of ballooning public debt, they are likely to prove far more cost effective than treating ongoing symptoms related to the underlying condition.
COVID-19 opens the door
COVID-19 has created an opportunity to develop a new approach to healthcare built more around the patient. Delivery is one big change. Before COVID-19, online accounted for approximately 3% of interactions with primary caregivers. During the pandemic, virtual interactions reached 70%, and it’s a change that’s likely to persist. It’s also consistent with the demands of younger generations, who want healthcare delivered on their terms, as conveniently as possible and technology is not a barrier for them. Technology has helped to democratise access during the pandemic. Healthcare providers in both public and private sectors need to capitalise and invest in the channels that can sustain the change and put patients in control.
The pandemic has also driven a willingness to share health data in order to secure positive outcomes. Millions of people in the UK have signed up to apps that record their daily symptoms and whether they have tested positive for the virus – along with other relevant health information. This is a chance to really move the needle. How about using the data that millions collect about their heath from wearables, integrating that with their care record and making it available to every patient? There’s a clear opportunity to build a new knowledge base that, combined with advances in genomic science and big data analysis, could be harnessed to reengineer healthcare, making it much less about post hoc treatment and much more about anticipatory or preventative care.
Press pause and reboot
Overall, COVID-19 offers the chance to press pause and put patients’ needs at the heart of the health system, both public and private. This requires leadership and a willingness to experiment and take risks. It needs change from the top down and the bottom up. We are all involved, we all have a responsibility. But there’s little doubt that the development and delivery of tomorrow’s healthcare must proceed with the patient at its heart.