The Darzi Report: Opportunities for change

When I talk about Products or Systems, I often find myself referring back to the Skeleton song. “The thigh bone's connected to the hip bone, the hip bone's connected to the backbone…”

It’s a memorable reminder of the interdependent nature of products and systems. The Darzi report echoes a familiar tune, alluding to an oversight of the ‘whole’ picture in solving problems within the NHS – or for want of a better phrase, treating the ‘symptoms’ of those problems (waiting times or hospital capacity) rather than investing in interconnected causes.

Take capacity and resource, for example, perhaps the most ubiquitous issue facing the NHS and felt by patients and clinicians alike. Despite treating the ‘symptom’ by increasing staff headcount or beds, hospital staff have remained overburdened with admin, with time increasingly spent on looking for beds rather than providing care. An underlying ‘cause’ exists outside of the hospitals.

A shortage of social and primary care resources means that many patients are unable to access treatments until they are ‘bad enough’ to receive care in the system, perpetuating a growing list of patients with higher-severity conditions. The same issue exists on the other side of the care journey; underfunded community-based care means that patients spend longer durations in hospital, with 13% of NHS beds are occupied by those waiting for social care or alternative settings; patients are first not deemed ill enough to be treated, and not well enough to be discharged.

The systemic or skeleton song view might suggest that the solution lies less in capacity of the service and more in solving flow of the healthcare system.

Opportunities for change

With the September budget pledging an extra £2.7 billion in funding to the NHS for 2024 and 2025 (the largest increase in NHS spending since 2010), what can we learn from previous efforts to resolve NHS pressures, and where should efforts be allocated to produce meaningful change to patient flow? Within the Darzi report, three main shifts emerge as necessary paths forward:

• Reactive to Preventative care

• Analog to Digital

• Hospital-based care to Community-based care.

Progress has been made to date in each. Digital and Telehealth for patient triaging is increasingly widespread, and Preventative Health has seen successes in HPV vaccinations and obesity campaigns. Despite this, their effect on the big picture has been relatively limited. In addressing flow, these shifts shouldn’t be treated as distinct, but as a combined movement to drive meaningful change in the way we interact with our health and the healthcare system.

What can we learn from our successes in this space, and how can a more system-oriented view drive more meaningful change?

Digital enabling preventative and community-based care

Inflow The increasing use of virtual consultations to support chronic condition management reduces patient in-flow in a straightforward impactful way, reducing the need for in-person visits. Now, a rising number of digital platforms are becoming available, pairing virtual consultations with managed care plans for conditions such as insomnia, anxiety, and stress management. Treating conditions in this way is an example of using preventative measures, avoiding conditions from degenerating further and faster, and keeping patients out of hospitals. The opportunity will continue to grow if digital care plans can be enriched with wearable data to unlock more personalised, preventative care. A good example might be in DexCom’s partnership with WellDoc which provides real-time diabetes management programme supported by CGM data.

Outflow Telehealth and remote monitoring might also be used to improve rehabilitation and re-admission. Tech that intersects the Wearable and Smart Home space can bring together a shift that is Digital, Preventative and Community-Based in enabling opportunities for smart environments that might promote independent living. This might be in the small every-day moments, such as automated pill dispensers with timed alerts, or in emergencies where Wearables (eg. Apple Watch’s fall detection) or home motion sensors can detect a fall, verify the location, alert emergency services, and automate property access for emergency responders. Through harnessing existing technology in line with these shifts, we can empower our elderly to remain living at home for longer, and provide reassurance for relatives living further afield

Community-based care enriched by Digital

Inflow In viewing our NHS less like a ‘service’ and more like a ‘system’, we create opportunities to invest in local care provision, infrastructure or partnerships to create a wider ‘system’ of health. An early example of this is Specsavers, who I was fortunate enough to be working with during the launch of Enhanced Optical Services (EOS). EOS supports the NHS and patients with shared care services that treat acute eye conditions. From 2019 to 2023 the number of EOS appointments held at Specsavers doubled, with 80% of patients being treated and discharged from the practice, preventing over 2 million GP or hospital visits.

Patients are seen effectively, quickly and locally to home, whilst hospital practitioners have greater capacity to treat severe conditions sooner in hospital environments. Replicating this model to other forms of care, and enriching it with shifts in Digital could mean improved, integrated communications and data sharing between hubs and hospitals, creating an opportunity for a decentralised, effective and ‘local’ system of spaces for receiving care.

Outflow Social care remains an integral part of our health service but is also constrained by low resources. Limited integration between hospitals and social care services creates further inefficiencies and exacerbates the bottleneck of patient flow. Bridging established Community-Based Care with Digital opportunity can help reduce this friction, such as introducing integrated, administrative and care tools to smooth handovers between different points of the system. Were such tools to exist, patients could be discharged from wards to the appropriate next level of care, directed and monitored by doctors and administered by social care professionals who feel empowered and supported with the complete information they need.

Companies such as Healthify are already exploring this space, addressing social factors by connecting patients with community resources to help them transition smoothly from hospital to home.

Barriers: Regulation & Funding

Whilst it’s a simple and exciting job to conjure future visions of Health-Tech, the reality is that progress is notoriously slow. Typically, the hindrance isn’t technology, but the realities of taking products to market.

Stringent regulatory requirements must be met before digital health tech can used by the NHS. Despite the potential for consumer wearables in remote and preventative care, unless your Apple Watch is a medical device (it isn’t) its data can’t be used by medical professionals. Similarly, new treatments must undergo clinical trials to prove their efficacy, a process that can be incredibly lengthy and costly; start-ups looking to launch innovative, digital based treatments face an uphill climb in taking products to market and remain on the backfoot to established big-pharma. Even the realm of mobile self-management treatments (such as CGMs) face barriers; despite being used in everyday environments, they are regulated to the same usability standards as those in a controlled device lab. This makes it difficult to evaluate usability in the unpredictable real-word world outside of the clinical environment.

Health tech design standards and regulations evolve slowly compared with emerging technology. The opportunities in Preventative, Digital and Community-Based care will depend heavily on evolving regulatory frameworks (as set out by the MHRA) and providing funding to support the development and GTM process to provide a more suitable environment for developing, validating and launching innovations in health tech.

What's next?

A deeper understanding of the problems felt by the NHS is the first step in creating transformational impact. Darzi’s revelation of its inner workings and root issues provide clues as to why efforts to solve at the location of the symptom, rather than the cause, haven’t yielded substantial and lasting results. Creating meaningful change in healthcare is dependent on a strong understanding of underlying problems, and an environment to solve for them. In order to truly benefit from the opportunities of Health Tech, innovation efforts must be rebalance from focusing too greatly on new technology, to innovating in regulation and in creating the environment for those new technologies to thrive.

Finally, a positive future for the NHS and healthcare requires us to view it less as a service and more of a system, in the way that we use, interact, fund, structure and innovate for it.

That means adopting systemic approach to both problems and solutions, taking shifts towards Digital, Preventative and Community-based care as interconnected principles by which to build a more meaningful vision of health upon: to shift care from hospitals in a service-model to homes and communities, supported by digital tools as part of an end-to-end care system that provides high quality care at all stages of treatment.