Emerging stronger and smarter: A three-stage strategy to help clear the NHS backlog and build operational resilience post-lockdown

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As the UK steels itself for potential further waves of COVID-19, we are still calculating the toll on our health service. With NHS resources significantly consumed by the pandemic, what will be the impact on healthcare provision in the medium term, and how can technology help alleviate the pressure?

A new Ipsos MORI online poll of over 2000 UK adults aged 18-75 commissioned by IBM[1] has revealed the extent of the challenge:

• Among those who needed routine treatment since March 2020 until 3rd July, 76% claimed that either they personally delayed or cancelled treatment (31%) or had their treatment delayed or cancelled by their healthcare provider (48%)
• Among those who needed treatment for new or recently changed conditions during this same period, 65% claimed that either they personally delayed or cancelled treatment (23%) or had their treatment delayed or cancelled by their healthcare provider (42%).
• And among those who needed dental treatment during the same period, 82% claimed that either they personally delayed or cancelled treatment (28%) or had their treatment delayed or cancelled by their healthcare provider (56%).

Respondents were asked to rate their online experience (in terms of their overall personal experience using websites and apps) with companies and organisations across six sectors on a scale of 0 (very poor online experience) to 10 (very good online experience). A mean score was calculated and healthcare (6.98) along with education (6.94) lags significantly behind other sectors, in terms of users’ online experience (with users rating it only 6.98 out of 10 on average). Banking and finance was rated most highly (8.00), followed by retail and entertainment (both 7.89) and travel and tourism (7.34). Nearly 3 in 10 (29%) of respondents said they never use apps or websites for healthcare purposes, compared to 5% for banking and finance and 4% for retail, suggesting there is work to be done to maximise the potential for tech in healthcare.

Many of these industries have already made the shift to enabling collaboration and innovation through more agile models of delivery by embracing technologies like artificial intelligence (AI), internet of things (IoT) and/or flexible and secure forms of hybrid cloud storage. Health, on the other hand, until now has introduced new technologies with the objective of improving existing pathways and service delivery models.

The NHS’ response to the pandemic has been phenomenal, boosted by the rapid adoption of new ways of working and digital technologies. These statistics, however, illustrate the monumental challenge ahead. To emerge stronger from the most severe public health crisis this country has ever faced, we believe the service needs to embark on full scale digital transformation, aligned with a three-stage strategy to rebuild operational performance and re-establish full healthcare provision:

1. Understand the impact of COVID-19 on healthcare and treatment for other conditions
2. Design new recovery and treatment plans to clear the backlog of patients
3. Devise a long-term strategy that embraces new ways of working for the ‘next normal’

Stage 1: Understanding the impact of the virus

To plan a way forward, we need first to assess where we are in terms of population need – not only will many patients have had treatment delayed, but new conditions will have developed. Our research indicates that there is significant ground to be made up. According to the study, 31% of respondents said either they or someone else in the household required some treatment for non-COVID-19 related reasons during lockdown (March – July 2020). Of those, 45% was for treatment or advice for a new illness or condition that was not necessarily serious, 42% was for routine healthcare (such as check-ups, screening tests, appointments about chronic/ongoing conditions or pregnancy, or vaccinations) while 14% was for a serious illness, such as heart disease, cancer, lung disease, serious mental illness or stroke. Most worryingly, only half (49%) of those who needed healthcare for non-COVID reasons were able to get all the care required.  

Despite these challenges, however, the NHS managed some outstanding work – only 15% of respondents where they or other members of their household received all or some of the healthcare they needed were dissatisfied with their experience of getting healthcare during this period. This suggests overwhelming public understanding for the adversity the NHS is facing. However, we cannot rely on such goodwill forever, especially if COVID-19 continues to impact capacity. The backlog is significant, to address it requires creative models for mobilising resources, leveraging expertise and insights across teams, and using a combination of some short-term and some more sustained solutions.

There are well established processes that have shown to deliver fast responses in similar situations. These include user-centred design methodologies and ‘garage’ style sessions that bring strategy, design and technology together to accelerate the solving of an identified problem or need.

Rory Deighton, Regional Lead North West, NHS Confederation agrees: “Looking forwards, the big question is capacity, how we manage risk and how we recover core NHS services safely. Firstly, we have to be really careful that we support staff appropriately. But we also need to recognise that newer hospitals are often easier for infection control, not all hospitals are like that, and recognise that the availability of 1 hour turnaround testing capacity will influence how quickly we can recover core diagnostic and elective services. We will need real leadership from government to be honest about this and to help manage public expectations. And we’ll need to trust local NHS leaders as the people best placed to make decisions about how to deliver safe services.”

Stage 2: Redesigning treatment plans and reinstating access

The crisis has created a unique opportunity to introduce new models of healthcare, redesign treatment plans and evolve how people access services. But this won’t happen overnight. While video consultations with a medical professional have been cited as a one of the major successes of the lockdown, our research suggests their use has been limited, with only 12% of where they or other members of their household received all or some of the healthcare they needed for a non-Covid-19 reason accessing healthcare services in this way, versus telephone (67%) and in-person (44%) consultations.

The data does, however, indicate support for greater emphasis on remote consultations. A majority of respondents said they would personally prefer this part of the healthcare offering “only” or with a mix of in person consultations: 58% for primary care and 54% for secondary care. Of those, most favour a blended model (56% for both primary and secondary care), suggesting in-person consultations will remain the norm. Indeed, a third preferred that consultations remain in person only (34% for primary care, 38% for secondary), with these groups more likely to be an older demographic.

Over the summer we saw areas of the NHS innovate to handle the unprecedented flood of patient requests and adopt virtual agent technology to improve access to authoritative advice about COVID-19 to both staff and the general public. A great example is Cwm Taf Morgannwg University Health Board which launched an English and Welsh speaking virtual assistant named CERi to support healthcare workers, patients and the general public in Wales who have questions on the prevention and management of COVID-19 post lockdown. Another example is Royal Marsden, a London based specialist cancer treatment hospital, which launched Maisie to ensure key workers have immediate access to the latest COVID-19 HR related information and policies as well as updates on the hospital and evolving workplace guidance. IBM was delighted to be able to support the hospitals on both projects.

The NHS has managed in this short time to build the digital capabilities and capacity required to deliver these changes. The speed of this is an incredible achievement when you consider that, pre-COVID, it would have taken several years to create the support for such a transition.

Stage 3: Rethinking healthcare provision for our ‘next normal’

When asked what changes, from a given list, people would like to see in healthcare, flexibility and integrated care models came top of the agenda. 47% said they would like to see more flexible, 24/7 healthcare instead of Monday-to-Friday, 9-5 hours, while 37% would like more flexible appointment booking and admissions systems. 32% wanted more joined-up health and care services, with better collaboration and communication across different services , and 28% want to see more care delivered in the community through GPs and health centres as opposed to hospitals. 17% selected more access to support services available remotely at home. Patient-facing online and digital tools were deemed less of a priority, with only 22% requesting more access to video consultations and 14% remote diagnostics. Unsurprisingly, a larger number of older respondents were in favour of community focussed solutions, while younger age groups expressed greater interest in the technological approach.

These findings point towards a clear desire for transformation in healthcare, particularly in favour of enhanced flexibility to individual needs, as well as reduced barriers between services. To achieve this, the NHS must become more personal, more participative, more integrated and, ultimately, more digital.

Prof Kiran Patel, Chief Medical Officer and Consultant Cardiologist, University Hospitals Coventry and Warwickshire NHS Trust supports these findings: “There are no good reasons why we can’t explore the opportunity to deliver a 24/7 integrated care model, optimised through real-time data insights. If we can develop these capabilities, we will improve population health management and incentivise better health.”

Embracing technology for an agile NHS and improved outcomes

There can be no doubt that technology has a clear role in facilitating the transformation required of the NHS in order to ensure enhanced operational resilience, but there is significant work to be done in order to achieve these aims. Critically, this is true on both sides of the NHS/public relationship. Whilst, when compared to other sectors, there appears to be less enthusiasm for the adoption of consumer-facing digital tools in healthcare provision, this may be due to the relatively poor experience users have had to date. Healthcare providers will need to work closely with technology suppliers to change these perceptions.

According to Sarah Wilkinson, CEO, NHS Digital: “Individuals are creating more data than ever—smart watches are pretty sophisticated machines. As we deploy solutions like virtual wards for COVID-19 we want, initially, to get patients more comfortable with using devices such as pulse oximeters. Before long, tracking your own health with apps and wearables and commodity medical devices will become as common as using a home thermometer has been for some time.”

Our findings point to the need for a true digital transformation in healthcare to create an agile, learning system which equips the country to both recover from the pandemic and improve future outcomes for patients and the NHS alike.

To continue reading on this important moment in time for the healthcare industry, from IBM and industry subject matter experts and leaders click here: https://www.ibm.com/uk-en/marketing/emergingsmarter-rethinkinghealthcare/

The research was carried out by Ipsos MORI on behalf of IBM.

Ipsos MORI interviewed a sample of 2,152 adults aged 18-75 in Great Britain. Research was conducting using its online i:omnibus between 1st July – 3rd July 2020.  Data has been weighted to the known offline population proportions for age within gender, social grade within gender, region, and working status within gender. 

The survey findings reported include a number of sub-samples.

1015 needed treatment for Routine healthcare (such as check-ups, screening tests, appointments about chronic conditions or pregnancy, or vaccinations) since 23^rd March-3^rd July 2020

695 needed treatment for Necessary healthcare for diagnosis or treatment of a new or recently changed condition since 23^rd March-3^rd July 2020

1223 needed Dental check-up/treatment since 23^rd March-3^rd July 2020

688 said they or someone in their household needed healthcare since 23rd March 2020 for a reason other than suspected or confirmed COVID-19 and received the healthcare

572 said they or someone in their household needed healthcare since 23rd March 2020 for a reason other than suspected or confirmed COVID-19 and received all or some of the healthcare they needed

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[1] An Ipsos MORI poll of 2,000 adults in England, Scotland and Wales. Lockdown period understood as 23rd March to 1st July.