There’s been a whirlwind of discussion and debate about Wes Streeting’s decision to abolish NHS England (NHSE) and integrate its functions into the Department of Health and Social Care (DHSC). While opinions are varied and lines have been drawn in the sand, I want to focus on the optimism that this change can bring.
Despite the current lack of investment, strategy around reimbursement, and emphasis on delivering the innovation that our UK SMEs are so brilliant at creating, I believe things can only improve. Our thriving innovation community fills me with pride, especially with the recent announcement of the next-gen National Innovation Accelerator Fellows by Professor Stephen Powis at Rewired. As a former NIA Fellow myself, I understand the sense of pride that comes with this recognition, even if my own celebration was muted by the pandemic in 2020.
Legacy issues
The absence of a national reimbursement strategy for digital health technologies is a well-known issue within our community. It’s been over 1,000 days since the NICE guideline for Sleepio made headlines, yet patients in England still lack access to this first-line treatment for insomnia. This situation highlights the urgent need for change.
By centralising procurement and other key functions, the government aims to achieve better deals and faster implementation of new technologies and treatments. This restructuring presents an opportunity to correct past mistakes and develop a strategy for accelerating the adoption and uptake of game-changing, efficiency-delivering, productivity-enhancing, and disease-preventing patient-facing innovations.
Overcoming the risks to realisation
While the government aims for faster implementation of new technologies and treatments, there are potential risks that need to be overcome with this restructuring:
- Transition challenges: The two-year transition period to a new stable structure poses a risk of decision paralysis, which could delay the implementation of new digital health solutions.
- Uncertainty and instability: The restructuring process may create uncertainty and instability within the NHS and investment community, potentially affecting the continuity of existing digital health projects and future ones.
- Budget constraints: While the move aims to save costs, there is a risk that budget constraints could continue to limit the funding available for new digital health initiatives and adoption.
How can these be overcome?
The government has said that the changes will give more power and autonomy to local leaders and systems, allowing them more freedom to tailor provision to meet local needs. Will this align with the plans for more centralised procurement? Enabling Digital Technology Assessment Criteria (DTAC) approval at a national level would make it easier for digital health technologies to be commissioned without multiple time-consuming assessments by individual Trusts.
Ensuring there is also adequate guidance for commissioners on the desire to drive adoption of digital health technologies, with evidence provided of the benefits they deliver, would aid decision-making to move ahead with trials and procurement and help release budget for them. There needs to be clear messaging around their multiple benefits:
- Cut waiting lists: Digital health technologies can provide rapid and effective support. Patients do not need to wait months to see a clinician and begin treatment.
- Reduce costs: With a strong emphasis on ROI and economic appraisal baked into product design, many products ready to scale have been proven to be cost-effective and scalable. Operational costs can be reduced, and the strain on our workforce minimised, thereby improving productivity.
- Enhance patient care: As well as providing support quickly, they can achieve results on par with, if not better than, traditional treatment paths and aid earlier discharge.
- Lower health inequalities: Digital health technologies often reduce health inequalities. Their very nature dictates that they’re easily deployable, cutting through traditional access barriers.
- Get more people working: Chronic pain and mental health difficulties are often barriers to taking up employment. Digital treatments can accelerate the road back to work.
Proof of their impact also needs to be provided.
Measuring the impact of digital health technologies
Demonstrating the impact of digital health technologies is vital for accelerating their use and realising their benefits. The wide-ranging potential of digital tools is already recognised and being investigated by public bodies from different angles, but these take time to be completed and yield results.
The number of people presenting with mental health and chronic pain issues has exploded in recent years and is rising. Health services are struggling to cope with demand, and these conditions are the two greatest factors responsible for economic inactivity.
Examples of evaluations and trials already underway include:
NICE: Last year, NICE published its official recommendation for their health technology evaluation of digital technologies for managing non-specific low back pain. The guidance aims to reduce inequalities in accessing musculoskeletal services across the country, with other benefits envisaged including reducing waiting lists, the number of GP and physiotherapy appointments, the use of medication, and the potential need for surgery. Five digital therapeutics were recommended that can be used in the NHS while more evidence is being generated following an appraisal via NICE’s Early Value Assessment (EVA) programme.
NHS: In December, NHS England announced a £45 million trial to improve health and economic activity in South Yorkshire, North East and North Cumbria, and West Yorkshire. The “Health and Growth Accelerators” aim to boost health and tackle conditions affecting work ability, including back pain and mental health. The trial will assess the economic benefits of various health interventions, including talking therapies and digital tools for mental health and musculoskeletal pain.
Results on the ground
Analysis of the data from Wellmind Health’s digital program for depression, anxiety, and stress revealed:
Growth mission
Despite the announcement that there is no future for NHSE, the government’s focus on growth and the important part the NHS can play in supporting this, as stated in its mandate to NHSE in January, is unlikely to change:
Digital health technologies offer a cost-effective way of helping more people, faster, to return to and stay in work.
Pathway to a digitally aided future?
Digital health technologies can play a pivotal role in improving patient care, supporting a wide range of key objectives, and shaping the future of the NHS. By reducing bureaucracy and enhancing local control, the NHS can better leverage these innovative solutions.
The 50% cuts ICBs are required to make to their running costs, while they have the potential to slow decision-making, may also prove a good thing for digital health. With the additional need to justify expenditure, only the most effective and beneficial technologies will succeed. Those with evidence and impact will thrive, creating a value-based and value-driven system, driving innovation and improving patient outcomes in the process.
Additionally, within the med tech community, investment is likely to be impacted due to the uncertainty surrounding sales opportunities. This ambiguity can make it challenging for companies to secure funding, as investors may be hesitant to commit without clear prospects for returns. However, this situation also presents an opportunity for the most innovative and effective solutions to stand out. By demonstrating clear evidence of impact and value, med tech companies can attract investment and thrive even in a more competitive and cautious market.
Let’s hope that this bold move aimed at improving efficiency and accountability within the NHS is the moment that they begin to be unleashed.
Discover more about Wellmind Health:
Wellmind Health has pioneered Digital Treatments as a Service (DTaaS) for over a decade. The company’s clinical-grade, evidence-based programs have supported over 150,000 people to better manage their mental health, pain management and addiction recovery. Their unique scalable enterprise platform provides clinicians and commissioners with real-time access to patient and clinical data through a secure management portal. The Wellmind Workplace service attends to the unmet needs of employees, job seekers and employers, supporting people struggling with mental health and chronic pain to enter the workforce or stay in work and thrive. Wellmind Health is committed to delivering high-quality, data-driven digital interventions that create a lasting impact on individuals, healthcare services, companies, and society.
