(Re)-building healthcare - by properly joining it up

Do you remember those little play tables in doctors waiting rooms with the little green Lego mat on? That was the best bit of going to the doctors for me when I was growing up. As I write this, I wonder if I might have been sitting at one of those tables when I decided that I wanted to be a paediatrician. There is something about the way everything properly fits together that makes building things a joy.

Healthcare is of course much more complicated than building bricks but that doesn’t mean that we can’t aspire to the magic of things properly fitting and there is no doubt that properly joined up care (termed “integrated care”) would lead to an NHS that is more equitable, accessible and sustainable.

We know what we want: the clinician you are seeing having the right information about you in front of them, active encouragement and guidance for patients with long-term conditions whilst they are at home or work and proactive interaction from our team of doctors and nurses to stop us getting badly sick whenever possible.

We could do all of this today with the technology that we carry around in our pockets. If my taxi driver knows my name and favourite genre of music, why can’t exactly the right information pop up just before my patient comes into the consultation room. If my music player can convince me to try out new podcasts, then an app can encourage me to make better health choices. And if my banking app can alert me to look at my accounts right now, then it stands to reason that I can be notified of impending illness with the right call to action to stop any potential slide that would result in needed a hospital stay.

Because of constraints on funding in recent years, together with the growing demand from an ageing population that’s increasing in size, the NHS and healthcare services in general are under extreme pressure. We must do something now. It’s clear that the UK’s current model isn’t working and isn’t fit to meet future demands, so the solution doesn’t lie in providing more of the same.

It lies in doing things differently. And I’m delighted that we, Babylon, have committed alongside the Royal Wolverhampton NHS Hospital Trust (RWT) to do things differently, join care up and make things better.

With RWT we will be able to offer more care in people’s homes and in the community, foster greater collaboration between service providers and build on the already innovative RWT model of vertical integration (which means RWT has GP and hospital services and staff all within the same local organisation) we can link GPs, hospital doctors and secondary care operators like never before.

Imagine the benefits to patients when health practitioners and social care workers can act in concert, improving the patient experience, achieving better health outcomes, and use mobile phones to meaningfully tackle lifestyle-related risk factors like obesity at the source.

Integration allows for greater efficiency, prevention and transformation across the NHS, which is explained in more detail below.

Integration means efficiency

At present, there are huge gaps between services, leading to administrative errors, time lost as a result of repetition, and faults arising from miscommunication. Because of a lack of integration, services aren’t as efficient or effective as they should be. My NHS colleagues and I whole-heartedly agree, with just 8% happy with the current arrangements between primary and secondary care according to a BMA study. What’s more:

• 94% say collaboration between primary and secondary care doctors will improve the quality of patient services and experience
• 93% say GPs and hospital doctors should work together more directly in a collaborated and coordinated manner
• 92% say there should be shared pathways across primary and secondary care, with resources fairly directed to where care is delivered
• Only 9% thought that patients experience coordinated care between hospitals and general practice

At best, a lack of integration is frustrating and disruptive for clinicians and patients. At worst, however, it’s a patient safety issue. In the same BMA study referenced above, 60% of doctors say that quality and safety of patient care is being compromised due to barriers between primary and secondary care. GPs were particularly likely to feel this way (74% vs 52% of hospital doctors). There is vast scope for improvement on this front.

Integration means prevention
Secondly, beyond the practical benefits of Integrated Care, its delivery has much broader potential. For patients, it could facilitate a shift in mindset, and a move towards a more preventative, long-term approach to health. For clinicians, it could mean the design of a system that’s both person-centred and entirely future-fit.

This is much needed. The Kings Fund stated in its 2018 report that, ‘The NHS...needs to give greater priority to the prevention of ill health by working with local authorities and other agencies to tackle the wider determinants of health and wellbeing.’ Indeed in its own literature about Integrated Care, the NHS explains that it’s about, ‘moving away from episodic care to a more holistic approach to health, care and support needs, that puts the needs and experience of people at the centre of how services are organised and delivered’.

Technology and a commitment to operating ‘digital-first’ services are vital here. Babylon is working with a number of NHS trusts and patient participation groups to develop broader ‘digital-first’ services covering, as a starter, mental health and urgent care.

Integration means transformation
In short, the case for Integrated Care, and the importance of technology in its delivery, is irrefutable. The NHS considers it vital to its future success and to this end, has committed to delivering joined up care across England by April 2021, as part of its Long Term Plan. Where it has started to put the plan into action, it is seeing encouraging results.

Alsongside innovations like Ask A&E, which we have already launched with University Hospitals Birmingham NHS Trust, the NHS is championing new initiatives across the UK. In Somerset, for example, a ‘Homefirst’ scheme offers patients deemed healthy enough the opportunity to finish therapy at home, and has dramatically reduced the length of hospital stays. Overall, the scheme helped patients avoid 7,500 nights in hospital and freed up at least £2 million for other services. Similarly in Sandwell, 17,000 hospital nights and £7m have been saved through an ‘iCares’ scheme, which flags people with long term conditions at high risk of hospital admission to a dedicated team.

Here at Babylon, as a proud partner to the NHS as well as a number of other healthcare-related organisations, we too are committed to providing Integrated Care and, as a digital-first operator providing a continuum of services across different interfaces, we’re well-placed to provide it. Our model starts with AI, connects to a clinician virtually when needed, meaning patients can talk to a clinician through their phone 24/7, and arranges in-person examinations and interventions when clinically necessary at our physical clinics.

We transition patients to the service that best suits their needs, and their clinical record is constantly updated and consistently available to clinicians. This makes for an efficient, holistic and seamless experience, with less room for administrative error and wasted time. In short, by harnessing the potential of technology, we’re able to offer Integrated Care in the fullest sense, in a way that few service providers can.

This technical ability coupled with motivated acute care providers expertise and patient support can only lead to more integration, more of the bricks clicking satisfyingly together, and we are passionate about using these partnerships to build a healthcare system that is fit for the future.

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Dr. Umang Patel is Director of NHS Services at Babylon health and a practising Paediatrician at Frimley Health NHS Hospitals Foundation Trust.