Like the first scent of autumn, there’s a hint in the air that a change of government is coming. It was palpable in the keynote speeches to this year’s NHS ConfedExpo 2023, which also suggested health tech will be part of the election debate on the future of the NHS. Lyn Whitfield watches the livestreams.
There is a point in the life of all governments – and it can be months or even years before they fall at a general election – at which it becomes clear that it’s over.
The Cabinet runs out of things to say. Policy makers stop analysing policy announcements and start pitching ideas to the opposition. Departments mark time. Ministers find they are less of a draw. Audiences start laughing at their opponents’ jokes.
Prime minister Rishi Sunak doesn’t have to go to the polls until January 2025, but watching healthcare politics in action at NHS ConfedExpo 2023, it felt like this shift is well underway. And, perhaps surprisingly, health tech looks set to be one of the areas on which it plays out.
Hooked on AI
Sunak was out talking up technology, a couple of days before the NHS Confederation’s annual conference and NHS England show. The PM has said previously that he wants innovation to be at the heart of his government, to boost growth, modernise public services, and deliver new skills.
His latest idea is that the UK could become a leading force in the field of AI regulation. But when it comes to the NHS, his list of innovations has tended towards things that it is already doing, such as introducing automation, or robotic surgery, or drones, or new models of working, like community diagnostic centres and surgical hubs (speech to the CBI, 2022).
Ten year funding call
Up in Manchester, NHS Confederation chief executive Matthew Taylor suggested the NHS would need more than that to complete its recovery from the Covid-19 pandemic and address the pressure coming from an ageing, unequal population.
In what sounded less like a plea to the government and more like a plan for a new administration, he laid out five “shifts that, I think, if we can make them, will carry the NHS into the next phase with real confidence” (Health Service Journal interview).
The first was a new health policy – not just a strategy for the NHS, but “a national strategy to improve health” that includes other departments. The second was the investment to make it happen: the Health Foundation has suggested £40 billion over ten-years, plus capital to invest in facilities and IT (Financial Times report, 2022).
The third was an “upstream” shift towards prevention, which, he said, would take a shift in resources to deliver. The fourth was action to build on Patricia Hewitt’s review of integrated care systems, to empower local leaders and communities.
And the fifth was a new “social contract” with the public, in which people would be recognised as partners in their care, but would also take more responsibility for it. The Confed has just published an Ipsos poll with Google, arguing that technology could have a significant role to play in self-management, as long as patients have a role in its design.
The wheels are turning
If Taylor had his eyes on the future, NHS England chief executive Amanda Pritchard was focused on rallying conference attendees to keep facing up to the huge pressure that the NHS is under, until it can arrive. Or, as she put it, they have managed to “keep the wheels turning” and they just need to keep on doing the same.
Pritchard built her speech to ConfedExpo 2022 around 5 “Rs” and her good news for ConfedExpo 2023 was that they have been delivered – mostly. So, she said, there are signs of recovery, with very long waits down and ambulances in recovery – although she acknowledged that “A&E is under pressure, because of the heat, and industrial action” by junior doctors, who were staging a noisy protest outside the hall.
There has been reform, with integrated care services coming on stream, and a focus on digital and data that has led to “all ICSs having a shared care record” and the NHS getting to within “touching distance of 90% of hospitals having an electronic patient record” – although that does feel questionable, as the frontline digitisation programme stutters on.
There has also been action on resilience and respect, with more staff recruited, and a new focus on retention – even if Pritchard herself said she “wouldn’t want to gloss over the findings of the latest staff survey.” “All of these would be remarkable achievements at the best of times, but in these tough times, they are remarkable,” Pritchard told her audience. “We are moving forward. The wheels are turning. And that is because of your hard work.”
Taking pot shots at the Tories
Shadow health secretary Wes Streeting is a regular on the Confed programme, although it sounded as like he had a significantly bigger audience this year. And he was in Manchester to have fun.
“I showed my speech to Matthew [Taylor] and he said it was far too political,” he said, cheerfully, before telling attendees that he wasn’t going to make any apology for that when it’s politics – in the form of 13-years of Conservative administrations – that have left the NHS “in the worst crisis in its history” and “the public finances broken.”
“I want to offer hope at the end of the tunnel,” he said. Although he wasn’t exactly bought into Taylor’s agenda of cross government health-policy or billions in cash. Instead, he took a series of swipes at specific government policies, many of which involved IT.
Health secretaries from Andrew Lansley onwards had promised to sort out electronic records, he said. Yet a senior doctor had told him he had to log into seven systems in the course of a single patient consultation. Jeremy Hunt had promised to make the NHS “paperless by 2018.” And was rewarded for his failure by “being put in charge of the Treasury”.
Hunt’s successor, Matt Hancock, had promised to remove faxes and pagers from the health system, yet both were still in use. “If Sunak cannot axe the fax or purge the pager,” he asked to laughter, “how can he hope to seize the benefits of the technology that is coming along?”
NHS App: don’t laugh
Health secretary Steve Barclay, who gave a very short speech on the second day of ConfedExpo 2023 and refused to take questions that weren’t filtered through Taylor, didn’t care for these digs. He said he was totally committed to making sure that patients could get treatment quicker.
And “contrary to what one speaker said yesterday” tech innovations like the NHS App are one way he’s doing that. Streeting said he’d shown the app to some Israeli health experts and “they laughed.” But Barclay insisted downloads are great and appointment bookng is helping patients.
Cloud telephony and GP triage systems are also helping to “end the 8am rush for appointments” and getting people to the right treatment faster, he added – although they might get diverted to a non-GP member of the primary care team, or to Pharmacy First.
He also claimed to be protecting the NHS tech budget (digitalhealth.net report) and – inevitably – saw huge potential in AI to speed up diagnosis and treatment decisions. “The NHS has changed massively over 75 years, and Covid showed us that it can move fast when necessary,” he said. “Innovation gives us a strong foundation for the next 75 years.”
Waiting for what’s next
Barclay is unlikely to be in charge for many more of those years. In response to questions, he was unable to say what, exactly, Sunak means by “getting waiting lists down” when he lists his five priorities for government.
Or when the much-needed and much-delayed workforce plan will be out. Or why the government has more or less rejected the Hewitt Review’s recommendations. Or whether it’s worried about inequality – although he did say he’s in favour of prevention, as long as it means advice apps and screening and not “banning things.”
Clearly, the more interesting question is getting to be what Streeting will do, if Labour get into power, and if he becomes health secretary. He had a clear message to deliver, which is that while Labour is once again committed to saving the NHS, it will also expect reform.
He was light on detail. But health tech will have role. Streeting said that while finding and retaining more staff will be a priority, he also wants to make best use of their time, by making sure they can use technology that supports instead of frustrating them.
He also said he wants to see the NHS making use of its “single payer” status to roll-out innovation at scale, and even had a few ideas for how that could be achieved that sound like he’s been talking to somebody in the industry: a single front door for innovators, fewer pilots and less bureaucracy to encourage uptake, an NHS App that people don’t laugh at.
His conclusion was a warning and a promise. “We need a vision of reform and modernisation,” he said. “I understand the fear [caused by big political plans] after Lansley [and his shattering 2012 reforms]. And I know it’s tough after Covid. But we have to reform if we are going to avoid the NHS becoming a poor man’s service. And because the prize for innovation is huge.”