Swindells: politicians are fighting a 40 year-old battle over the NHS

The general election battle over the NHS is focussed on its buildings and employees and has, therefore, never been less relevant to the the health and care of the nation or to an NHS defined as “services free at the point of use”.

The Conservative guarantee to create an “NHS visa” is welcome as a partial antidote to the the damage Brexit and a “hostile environment” is causing the to the NHS’s ability to provide care, but overlooks the need to staff the hundreds of industries on which the NHS depends. The Labour commitment to roll back privatisation may be deliverable in narrow terms, but becomes rather more suspect when thinking about the hidden private services like GP practices, community pharmacies, high street opticians and outsourced IT and engineering services.

Politicians are currently fighting a 1970s battle over the NHS rather than grasping what is happening to the NHS in the 21st century.

We have all seen the way in which digitisation has transformed the music industry, high street retailing and financial services. Many have asked why healthcare hasn’t been transformed in the same way. Well, change in health is harder and takes longer.

However, at this very moment you can see the primordial swamp bubble begin to surface.

For generations healthcare has been a clear “vertical market” where the payers and providers are known and barriers to entry are high. The growth of spend on healthcare around the world, the shift from acute to long-term interventions and the opportunities created by the fourth industrial revolution – connectivity, genomics, AI – is causing many industries to consider whether they should be in the healthcare business.

The health insurance industry has noticed that its primary driver – rapid access to consultations and surgery, will soon be replaced by a demand to support their customers’ wellness, long-term conditions and mental health. Their major payers, employers, want to keep their workforce healthy, productive and at their desks. Companies like Lark and Livongo are building huge new businesses in this sector.

The wider insurance industry wants to know how it can turn its statistical expertise to supporting people to stay healthy for longer. They see the life expectancy going up but healthy years diminishing. That’s not good for their industry, so maybe interests of profitable business and society are aligned in this case.

The life sciences industry is agonising over how to guide patients through precision medicine in a way that gets the best outcomes from their drugs and shortens the development to adoption lifecycle.

High street pharmacies have noticed that footfall on the high street is diminishing and home delivery of medications is taking off, but they have space and a highly-skilled workforce who could be providing far more services, whether that is swift access to private healthcare or helping the NHS alleviate pressure on GPs and accident and emergency, and improving access to screening and vaccination. This is being encouraged by the new NHS pharmacy contract and innovative partnership with clinical commissioning groups. You see these bold shifts first in the US with CVS buying an insurance company and Walgreens partnering with another and launching FindCare – their equivalent of nhs.net, but whilst the payer structure in the US is different, the problem they are addressing is a global one.

Grocery retailers are looking at whether their business would benefit by turning their marketing expertise to wellness and gearing up their stores to support people trying to manage their health through their diet. Walmart has launched Care Clinics in their stores, which they describe as “your primary medical provider”. Walmart stores cater to the poorest segments of society and they own ASDA …

The big logistics companies are asking themselves whether healthcare deliveries might be a unique and rapidly growing market segment. If you are delivering medications or medical devices you can’t just drop them on the doorstep and hope they don’t get nicked or take them away to be collected at the weekend. What is the model which combines the benefits of home delivery and collect from the store that can work at scale?

Media companies are interested in whether increased connectvity could reliably turn every home into a smart health home at a fraction of the cost of purpose built facilities. At least one is looking at offering ambient health sensors in the device it provides to connect you to cable TV.

And so on …

The common feature that ties these innovations together is digital technology. 24x7 mobile connectivity, personal medical and home monitoring devices, increasingly smart algorithms in an app, ever closer to electronic medical records that can be shared by the patient, instant connectivity between a trained health adviser and the appropriate medical professional, near patient lab testing, affordable telemedicine equipment. Put these together with a global need for health system to move from “always there for you, if you know to ask” to “support, predict and prevent” to respond to ageing populations overwhelming healthcare staff and facilities and cash rich and time poor families wanting to invest in support for their loved ones and the conditions are there for the next wave of healthcare transformation and it will be a multi-industry partnership.

Perhaps the most important health policy of the campaign was the one that apparently had nothing to do with the NHS - Labour’s commitment to nationalise Openreach. The impact of rolling out wifi to every home and business could be the catalyst needed to unleash a transformation in healthcare by eliminating the digital divide, allowing technology to reach those most in need and creating the space for innovators to support the NHS in its shift to focusing on health and wellness.