20 YEARS OF CS J
NHS is still on a mission to drive forward its ambition for the digitisation of patient records and the integration of medical device technologies. We have a lot of work to do to eliminate manual transcription of vital patient data, integration of medical technologies, sharing of patient records across care pathways,18
and ensuring the confidence of
patients in the security of their data. However, the pandemic demonstrated how digital transformation can be achieved at a staggering pace. It is fair to say that the pandemic rushed through some of the biggest changes the NHS has seen. In 2016, I attended the launch of the three-year ACT@Scale EU-project, led by Philips Healthcare, which aimed to investigate the potential to “scale up telemedicine”. Among the key findings, on conclusion of the project, was that “in order to scale-up the programme, stakeholders must be convinced of the added value of the programme. Without the support of all stakeholders, it limits the ability to achieve sustainability.”19
It took a global pandemic to convince many stakeholders of the value, however. Due to COVID-19, telemedicine is no longer just an ambition, but a reality – and not just in remote parts of the UK. Prior to the pandemic, around 80% of GP appointments took place face-to-face. As of June 2020,
Shifting ideologies In addition to MedTech changes over the years, I have also witnessed the NHS under the leaderships of two opposing political parties, and a coalition. There were major political and ideological changes during this time. We saw the publication of the NHS Constitution, setting out rights for patients, public and staff for the first time. There was lots of discussion around delivering ‘high quality care for all’. Lord Ara Darzi – a pioneering surgeon – was tasked with developing the vision for the NHS. A clinician was in the driving seat at last and politicians were listening. At least, that’s how it appeared to an outside observer. It felt exciting.21
The vision placed an emphasis on clinical leadership, more personalised and integrated care, and innovation. There were financial incentives for delivering better outcomes and quality care. It enshrined the right of patients to choose where and how they were treated and aimed to help people take greater
this had fallen to just under half, with around the same amount taking place over the telephone. This change also occurred outside of primary care – around 10% of outpatient appointments were classed as telemedicine in March 2020, compared to just 3.5% in March 2019.20
control of their own healthcare.22 The health service began to talk more about the ‘patient experience’ – with a cultural shift away from ‘doing things to patients’, to the patient becoming a more active participant in decisions about their care. We saw huge reductions in rates of MRSA and C.difficile, as healthcare moved away from seeing healthcare-associated infection as inevitable, towards zero tolerance. I also witnessed significant changes in investment, as the NHS went from a period of record investment, to the toughest austerity measures, and I have listened to repeated calls to do ‘more for less’ – the consequences of which were fully realised when the NHS was tested to the extreme by the arrival of COVID-19, which laid bare shortages of PPE, hospital beds, vital equipment, and staff. I have seen the NHS go from hitting 18-week targets, to a 7 million backlog. In recent years, I have observed the enormous pressures placed on the health service and its staff, not just due to the impact of the pandemic, but as a result of years of underinvestment and failures to tackle staff shortages. ‘Good news’ has become harder to find, but I want to end this article on a high note.
There is no doubt about the commitment of the many healthcare professionals that strive to deliver safe, high-quality and
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