TECHNOLOGY
Figure 2: System collaboration and coordination are key to redefining problems and designing local solutions. This involves adjusting boundaries, building partnerships, and leveraging technology, ‘with success depending on clear agreements, inclusivity, and structured planning’.
Michèle Wheeler
Michèle Wheeler, the International Health and Life Sciences director at Lexica, has over 35 years’ experience managing and transforming health and social care services globally. She is an experienced board- level director with a clinical background as a nurse, having worked across acute, primary care, and mental health settings, as well as for the Department of Health and Social Care. In the private sector, Michèle has operated extensively in the UK and internationally across Asia, the Pacific region, and the UK overseas territory of St Helena in the South Atlantic Ocean. Her expertise spans developing and delivering over 100 projects valued at between £12 m and £5 bn across ProCure21-23, PFI, NHS LIFT, and other traditional contract forms.
set out the trajectory for a decentralised, place-based economy with strong partnerships across public services, industry, and community, to address inequalities and drive economic growth. It recognises the variations in place that shape people’s health and wellbeing, and the services they need. It also anticipates that advancements in smart and medtech, robotics, Artificial Intelligence (AI) and Machine Learning (ML), emerging technologies, and innovations, will play a key role in reshaping efficient, affordable, and sustainable, frontline clinical services and shared services, without compromising on equitable access and quality. Examining these aspects in more detail helps set the scene for the type of transformation that is possible.
Strategic place shaping over time First, there are 42 ICSs in England, established in July 2022. They are the centrepiece of the biggest legislative overhaul of the NHS in a decade.1
These ICSs cover
populations ranging from 500,000 to three million people, making them vastly different in size, complexity, and other characteristics. They collectively face a financial gap of £4.5 bn.2
The Autumn Statement reiterates their strategic
commissioning mandate to shift towards community-based services, and a lower-cost, preventative model through integration, as the name suggests. Secondly, there is the metamorphosis of single-tier
unitary authorities from a confusing, inefficient, and ineffective jumble of 317 upper, lower, metropolitan, and district authorities. This is the first reconfiguration in 50 years of local government. While it lags behind the NHS reform curve, its ambition is to simplify structures and bureaucracy, streamline services, and reduce costs. Each new council will have a minimum population of 500,000, creating the potential for future structural alignment with ICSs. This alignment makes sense, as social care and public health sit within local government, and services provided by councils cover 50% of the determinants of health and wellbeing. The third entity is the new regional mayors, who will lead discussions on the importance of place, industry, jobs, and the economy – central tenets to health, wellbeing, and growth. As these players converge in search of greater efficiency and impact, it is likely that greater integration will follow. What happens in all aspects of society affects health. With a lack of basic healthcare services in many places
globally, and a general staffing shortage expected to reach 18 million by 2023,3
72 Health Estate Journal March 2025 technology such as 5G, cloud,
AI, and LLMs (Large Language Models – a type of AI that can mimic human intelligence), are playing an increasingly vital role in offsetting these challenges. The pace of ‘tech’ innovation, and its translation into healthcare, are exponential. Innovation can take years to become embedded unless – to paraphrase Plato – necessity demands it. The ‘necessity’ created by the 2020 global pandemic
introduced a new way of working with technology, and its role continues to grow. Doctors now routinely consult with patients remotely, diagnose conditions, review scans in high definition, and collaborate with clinical experts, in remote locations. 54% of patients with chronic diseases now accept remote healthcare via telemedicine, releasing over 30% of unnecessary health resources.3 Thanks to advanced modern technology, ‘remote’ does not mean out of reach, even in emergency response. VR glasses can provide clinical experts with the same view as being in the ambulance, support remote access to global surgical expertise for surgeon training, and, with robotics, allow remote surgery itself. AI is accepted as a key technology. It is shortening screening times for drugs to one day, offsetting shortages of specialists who interpret echocardiograms to diagnose heart disease, and speeding up diagnosis by between five to ten times. It is also making hospital management systems smart, with open, connected digital platforms for real-time visual management of operations, resources, patient flows, bed occupancy, and medical device use, and can help management staff make informed decisions needed to underpin performance and outcomes. Online services offer better and safer access, less wasted time, and lower costs. With chronic shortages of medical and nursing staff, solutions like these offer a way forward. However, to use them effectively, we need to understand the challenges in healthcare from multiple perspectives – patients, professionals, and management – and co-design care models that work. For patients, this means less time away from home and work to attend appointments, offering greater empowerment, and less disruption to day-to-day life.
Invest in technology proven to improve shared service coordination For decades, a waste-versus-access trade-off has pervaded public sector coordination, with efficiencies sought through consolidation, shared services, and procurement consortia. It becomes more challenging to maintain these gains in a decentralised, place-based model. The government is signalling support for tech innovation to solve this challenge, and encouraging the use of ideas from other countries ahead of the game.4
Drones, such as
Zipline, have flown one million kilometres in Rwanda and Ghana, delivering much-needed supplies to remote areas. They now provide 35% of blood supplies for transfusions. India, Australia, Finland, and Ireland are following suit. In the GCC, medtech is increasingly central to healthcare, from smartphones to monitor heart rhythms, to pre-marital genetic screening. In 2024, the UK Research and Innovation Future
Flight Challenge funded its first national drone network in Scotland to transport essential medicines, blood, and other medical supplies, throughout Scotland, connecting hospitals, GPs, laboratories, and remote communities. Guy’s and St Thomas’ NHS Foundation Trust is currently trialling drone transport for blood samples to labs, cutting transport time to two minutes, and speeding up clinical decision-making. The potential is enormous. An enabling policy
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