The NHS crisis will spur innovation

With the Pfizer and Oxford vaccines being rolled out across the nation, thousands of retired GPs, surgeons, physicians and nurses have stepped up to administer the jab. Tens of thousands more would have done so but for the extraordinary bureaucracy involved in filling in the dozens of online training modules in subjects ranging from conflict resolution to fire safety.

As you can imagine, there was uproar about the unnecessary bureaucracy and time-wasting at such a critical moment in the vaccine roll-out. Many of those put off by the form-filling took to Twitter to call the measures “nonsensical” and “convoluted”. The outrage prompted Tory backbencher, Sir Edward Leigh, to challenge Matt Hancock in the Commons to “cut through all this bureaucratic rubbish” so that more retired health professionals could volunteer. But the Health Secretary was on the case, assuring Leigh that he had already removed a series of “unnecessary training modules” from the requirements.

Yet the controversy has revealed a far deeper issue within the NHS. Indeed, one senior hospital consultant working in the North of England said the ludicrous form-filling was just the latest example of an over-centralised and managed NHS. “Bureaucracy is a systemic issue that goes back many years, which impacts on the efficiency of the NHS, and also how equitable it is,” he says. “There are lots of levels of bureaucracy which get imposed centrally by various committees or by ministers… and they don’t have to think ‘What are the unintended consequences? Are they still needed? Are they proportionate?’”

For example, the consultant cites the overly prescriptive NHS accreditations and bands system. On asking a phlebotomist if they could insert cannulas into a patient to speed up wait times, the consultant was told phlebotomists aren’t allowed to perform this procedure, despite its similarity to their prescribed role.

“You’ve got to have done training, demonstration and for something to be within your particular domain,” the consultant said. “And that makes things much less efficient – that’s the sort of culture you’re dealing with.”

The NHS is aware it has a problem. In November, the Department for Health and Social Care released a ‘busting bureaucracy’ document, which sets out its plans to streamline healthcare processes. In the foreword, Matt Hancock acknowledges that excess bureaucracy “reduces the time that staff have for care” and “hinders staff and leaders from deciding how to manage risk”.

On a more positive note, the document also acknowledges that Covid-19 has shown the benefits of streamlining bureaucratic processes, and that now is the time to capitalise on these changes. The goal has been met with enthusiasm by healthcare providers.

Professor Martin Marshall, Chair of the Royal College of GPs, said that during the pandemic the College had seen a reduction in bureaucratic and compliance work to free up GP time to deliver care to patients with both Covid and non-Covid-related health concerns.

“The College has long been calling for a move away from ‘tick box bureaucracy’ and a greater trust in the profession,” he said. “GPs have demonstrated that they are able to continue delivering high quality patient care without the need for a heavy bureaucratic workload during the pandemic, and we would like to see the current reduction of compliance and bureaucracy workload continue post-pandemic.”

The other major change set out in the DHSC report is the unprecedented adoption of digital healthcare during the pandemic. In December 2019, NHS Digital reported that just 15 per cent of 23 million primary care appointments that month had taken place by phone or online. By April 2020, 49 per cent of appointments were by phone or online.

As Marshall explains, remote consulting has both pros and cons: “We have seen that consulting remotely has benefits – some patients find them convenient, and others have reported feeling more comfortable consulting remotely. But we also know some patients, and GPs, prefer seeing patients face to face.”

It is also imperative that patients who require close physical examination, or are unable to access the relevant technology, continue to have access to face-to-face appointments.

“Post-pandemic, the College does not want to see a totally, or even predominantly remote general practice service,” Marshall said. “What we want to see is patients being able to choose how they access GP services, based on their needs and preferences.”

A few years ago, patients might have been hesitant to embrace these new technologies, but as Consultant Surgeon Professor Shafi Ahmed found during the pandemic, attitudes are changing.

“We’ve always assumed we know best for our patients,” he said. “And actually, patients are now demanding a change… I think we realised how digital the patients are, and how quickly they can respond to changes in healthcare.”

Ahmed says this shift in mindset will make it easier to implement digital innovation going forward. “Technology is fine, you can throw the technology at something, but that’s not the problem. The problem is changing the perception of society, and how they adapt and respond to those technologies and use them,” he said.

Another shift that has accelerated digital healthcare is the streamlining of processes and regulations. One of the recent success stories is the NHS ‘Attend Anywhere’ software, which allows patients to attend video consultation appointments. The software was rolled out following a rapid tender process that allowed telemedicine companies to apply to become part of the UK network.

“We’ve always talked about this word ‘collaboration’ in the past and it has always been a kind of aspiration,” said Ahmed. “Now we’re seeing really close collaboration between industry partners and the healthcare system… it is becoming easier to engage and work with those partners, which I think is essential for the healthcare system.”

Looking ahead, Ahmed is optimistic about the role of new technologies in the areas of remote therapy, monitoring and healthcare training, the latter of which he has already made good use of during the pandemic.

Over the past year, medical students across the globe have been denied the opportunity to attend clinical placements, so Ahmed found a new way to get them there – via an augmented reality headset.

Over the course of a few weeks, Ahmed invited his students in small, socially distanced groups to watch him live-stream a clinical visit in a lecture hall. Wearing Microsoft’s HoloLens 2 augmented reality glasses, Ahmed went to see patients and did ward rounds as he would normally for teaching. But instead of being shadowed in person, he was able to stream his experience remotely to the students, who could then ask him questions in real-time through a moderator.

VR and AR cannot replace face-to-face placements in healthcare training. Yet such technologies do give students the opportunity to learn more about clinical processes, and could be an invaluable addition to standard placements going forward.

“I think these technologies will augment our educational practices and offering,” said Ahmed. “Given at the beginning we started with papyrus and paper, then we went to online platforms, VR and AR are just an extension – one of the new ways of teaching people, and we’re learning all the time.”

Going forward, Ahmed believes the attitude and regulatory shifts seen during the pandemic will pave the way for more innovation. “What I think will happen now is that it will be easier to implement change much faster, both at a local level and at a national level. We are seeing a change in people’s perceptions, ideas, and we are also seeing the framework and the environment for health innovation changing.”

In around 375 BC, Plato wrote: “Our need will be the real creator.” Today, the saying is probably best translated as ‘out of crisis will come innovation’, and the sentiment still rings true.