Turning the national illness service into the national health service
The journey a patient takes is in theory a simple, step-by-step process. It begins when a patient feels unwell. They go to their GP, the GP requests some tests, and the results may trigger a referral to a specialist. More tests, maybe an admission to hospital for a procedure, more outpatient appointments, and then social care to ensure a safe discharge along with ongoing community care. When no more care is needed, the journey ends – until the next problem arises.
A type of journey reflects failed care and reflective of a national illness service, not a national health service. Reactive, instead of pre-emptive. It also reflects the traditional ‘passive patient’ model, not that of an active, engaged one. It waits for problems to appear before action is taken. It doesn’t make use of the active, digitally enabled patient. So how can we change course?
To start with, we have to think of the journey in terms of the patient themselves, not in relation to their condition. Patients are individuals with medical histories that spread across decades of life and multiple locations, and sharing access to that medical history will allow for the preventative care that they should get.
Barriers to prevention over cure
The healthcare system presently operates in silos and the records systems that support that care are reflected in data silos. Efforts are underway to start to build electronic records that illuminate the patient’s full history and show us a patient’s journey spanning past, present, and future. Systems silos are just the beginning of a myriad of challenges the healthcare system faces if it is to turn towards forward-thinking, preventative care.
There are systemic and financial limits on implementing solutions that break down data silos. Technical limits are imposed by vendors who aren’t required to adhere to standards, having the effect of placing a huge cost on liberating the data from their siloed systems. Some behave commercially as if they believe that all of this data belongs to them.
Pathway reform can be complicated. Consider specialist services that never get joined up with records of local ones – all about the same patient journey and all separated. So, a reform to an end-to-end pathway might be economically attractive overall, but actually be unattractive to the separate agencies play a part in it, sometimes unseen by the other players.
For some local commissioners, this redistribution of money is unaffordable, current contracts restrict such a fundamental level of change, or it simply isn’t worth it for them. For such a system to change, barriers remain rife. Add into the mix: just when you think you’ve illuminated a whole patient pathway, you discover other bits to it. After all, people’s health and well-being journeys are complicated. They don’t walk predictably from one service to the next in the same locality for their whole lives.
Person-based illness prevention is already known to be investible, but pursuing prevention and leveraging joined-up records could offer so much more – and this could be an entire other story.
Empowering the patient to prevent illness
So how do we make this fundamental shift? I believe we can look to digital solutions to empower patients to make use of services that prevent illness. Enabling active patients through the use of apps that integrate and become part of the ecosystem of the patient’s journey, would allow them to manage their own care to a far greater degree, spotting problems sooner, and preventing crisis - in partnership with their GPs. For the management of asthma, there are apps which can be used to monitor a patient’s peak flow readings and relieve inhaler usage day-to-day, issuing alerts when the patient is at risk of an attack. The effect can be lifesaving, and reflective of a true ‘health’ service as opposed to an ‘illness’ service, which might not treat the patient until an attack occurs.
These apps could become a staple part of the patient journey, beyond the pathway of one particular condition, and they allow both patient and clinician to have a view of the patient’s history to date, as well as keeping an eye on the future. The apps could be prescribed. They could have access to a shared record and feed into it. People are complex and have many differing needs, their healthcare system needs to reflect that – and fully integrated longitudinal records with such patient participation would be the backbone of a true National Health Service.
Future vision of population health management
Take public healthcare, and apply it to person-based illness prevention. Take existing collective systems and apply the data to the person. It changes the dynamic of the patient journey from being focused on the extremes of acute illness to being about health – the whole cycle. There are so many examples you can think of where this might work, from asthma to diabetes, and we need investment in this area to make it happen. That’s a true National Health Service.