Rising to the Nicholson Challenge


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Like all other industries, healthcare is being transformed by technology. More has happened in the last 60 years than in all the years back to Hippocrates – and around the world the pace of change is accelerating. Fifty years ago, the Index Medicus, the main index of medical research, ran to a couple of slim volumes. Today, millions of medical articles are published in hard copy and online every month. “If you read two medical articles a night every night for a year,” goes an apocryphal joke, “by the end of the year you’ll be 1,225 years behind.” The explosion of medical knowledge and modern technology heralds radically new ways of organising care. Indeed, information and technology are disruptive innovations.

Electronic data systems can track and aid clinical decision making and how patients progress through diagnosis and treatment. Better data will be the first step to the standardisation of processes and procedures using principles derived from other industries. In the best health systems, doctors are benchmarked against each other on clinical indicators, from how good they are at monitoring their patients and reaching out to them through to the outcomes of their treatments. The fully digital or “paperless” hospital more effectively holds clinicians to account.

For years people have been talking about patient centred care, but technology is enabling this to become a reality. In high performing systems, every possible channel is used to care for patients – a dedicated website enables them to browse for information, they can view lab results online through a secure server on the same day as the test, receive email reminders about appointments, drug dosages and more, book appointments online, by email and over the phone, and email or call doctors, nurses and pharmacists with questions.

Likewise, technology accelerates and supports the development of new models of care. Integrated information systems will allow the care of patients at the greatest risk to be coordinated. Kaiser Permanente has spent years pioneering outbound medicine for patients with chronic conditions. At any time of the day or night, patients can go into any pharmacy and have a test done. The computer will analyse the data and if there’s a problem a red risk flag comes up. Their doctor will be sent an email and call the patient to check whether, for instance, they’re still taking your drugs. This real-time tracking has made Kaiser a world leader in preventing unnecessary and expensive visits to hospital.

The technology driven transformation of healthcare coincides with all health systems facing tighter budgets. In England the NHS is facing the most demanding financial challenge in its history, and things will only get tougher. After decades of financing rising demand with increases in health expenditure, over the course this Parliament the NHS will need to deliver productivity savings of 4 per cent each year. This level of productivity improvement is unprecedented and has been famously described by Stephen Dorrell as the “Nicholson Challenge”. But even if the NHS delivers productivity savings equivalent to £20 billion by 2015, this is not the end of the matter. It is only just the beginning.

Even before the current crisis, demographic change, new treatments and consumer driven demand, meant the rising costs of healthcare were becoming unsustainable. The global economic and fiscal crisis now means that all health systems need to achieve value for money in order to “bend the cost curve” of rising health spending. When the NHS was set up Aneurin Bevan said that such a chance to make a health service ‘the admiration of the world… comes but once, perhaps, in a generation… if it is not done now it will not be done in our time.’ That opportunity has come round again. It is make or break time for the NHS: if we don’t harness cutting edge technology and new ways of doing things, the rest of the world will leave us behind.