Cabinet Meeting At 10 Downing Street In London
As in other developed nations, Brits are getting older and there are fewer of them adding to the tax pot. That’s a problem for the U.K.’s overstretched National Health System. It’s been ranked the best in the world but still spends 7% of its GDP on giving every one of its 66 million citizens access to free healthcare.
The country’s top health official and former digital minister, Matt Hancock, is touting technology as one of his top three priorities. “We need technology that can run basic tasks and processes more efficiently,” he says in a recent speech. “This will save the NHS money and free up staff time—money and time that can be better used to provide great care.”
Hancock hasn’t clarified what his targets are for cost savings, but one plan from elsewhere at the top of the NHS is to save an extra $12.6 billion (£10 billion) by 2020 with technology solutions. That includes providing free WiFi to all hospital users and allowing people to book an appointment with a doctor on an app rather than calling a number.
As part of that vision, the U.K. government was scheduled in December 2018 to roll out a new NHS app, a single place where people could book appointments and order repeat prescriptions. The app is still in beta and being tested at several GP practices in England, according to an NHS spokesperson. But some are wary of claims that such tech can lead to cost savings.
One of the main benefits of technology is that it simply allows more people to be treated, according to John Appleby, a leading economist at Nuffield Trust, a healthcare think tank that is unaffiliated with private healthcare provider Nuffield Health. He’s “skeptical” that new technology necessarily saves money for healthcare systems.
“Improving access is a bit like opening another lane on a motorway,” he adds. People often think that will ease traffic congestion. "What it tends to do is allow more traffic to travel.”
Similarly, the NHS has tried to make it easier for people to access care in different ways, with its NHS 111 advice line, partnerships with a range of app makers for automated symptom checking and telemedicine, and the NHS Choices Website. “That tends not to divert people away from hospital,” says Appleby. “It tends to, interestingly, increase the flow of people seeking treatment.” Appleby could not cite studies offhand that support this.
Meeting the health needs of larges swaths of people isn’t like maintaining an electricity grid or delivering mail; there’s effectively no fixed stock. At the margins are people who might not have used the NHS at all if an app hadn’t been presented to them as an option. “Making it easier to access care means maybe less serious things becomes medicalized, or get into the system,” says Appleby.
That’s no bad thing, he points out. “Maybe that's a good thing that we’re meeting a need that wasn’t met before.” Whether technology can help save money is the open question. A study published by the British Medical Journal in 2013 showed that using a tele-health service, which included having medical data transmitted to hospital staff remotely, had higher costs than the usual care.
The study involved looking at 965 patients with diabetes, heart failure or chronic obstructive pulmonary disease and found that with added tele-health equipment, healthcare for those patients cost $116,000 (£92,000) a year on average. This was two-thirds higher than a government-recommended threshold, according to the study.
Part of the problem is that hospitals often struggle to make the most of the technology they already have, writes Sophie Castle-Clark, a fellow of Nuffield Trust. So what of the grand plan to save $12.6 billion (£10 billion) by 2020 with help from new technology? The NHS is still a long way from becoming a digitally enabled service, she says. “The estimates of potential savings appear unrealistic.”
