NHS: Performance and Innovation

Lord Markham Excerpts

Thursday 15th June 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank the noble Lord, Lord Scriven, and all noble Lords for what I found to be a very thoughtful debate. I hope to answer in the spirit engendered by all noble Lords but particularly the noble Lord, Lord Scriven. I will not be defensive, so I will not try to answer point by point but will try to lean in.

I will try to summarise the approaches, and I think there are a number. The first, as pointed out by the noble Lord, Lord Addington, is getting upstream of the problem. It is about prevention and how we can use primary care, be it through the example of Salford, mentioned by the noble Lord, Lord Turnberg, or Westminster, mentioned by the noble Lord, Lord Crisp, or Redhill, where, as I saw the other day, they are trying to identify those who need the most help and care in order to get ahead of the problem. Real prevention is better than cure.

Secondly, there is innovation. Yes, it is about technology, but it is also about people and culture and what we can learn. By the way, I think that is the hardest one. Thirdly, there is approaching this issue from the perspective of outcomes. When looked at from that end of the telescope, you often come up with a different approach; in that respect, I love the drone example. Fourthly, again as the noble Lord, Lord Addington, said, there is taking a holistic, society-wide approach to health. The saying that strikes me most in that regard is that health is one of the things we all take for granted, until we lose it. This leads on to my fifth point: what can we do to help people take control of their own health? It is so important to our whole welfare. What can we do to enable people to take control?

In my speech, I hope to talk through some of the thoughts, ideas and approaches that we are trying to adopt as a Government. I hope to offer some of those glimmers of light that the noble Lord, Lord Allan, mentioned. I will not pretend that it is a panacea that will solve everything, and I accept the challenges that the noble Baroness, Lady Merron, brought up. She will probably be pleased to know that I will not try to give a point-by-point defensive rebuttal, because she probably hears enough of that from me in Questions every day.

In the spirit of what we are trying to do, first, I completely agree with a number of speakers, particularly the noble Lord, Lord Allan, about contextualising the issue. We are already spending 12% of our GDP on healthcare. With an ageing population, where a 70 year-old patient will need five times the amount of treatment of a 20 year-old, and the fact that that population has grown by 33% in the last five years as a proportion, and with the problems of obesity and comorbidities, we know that that 12% will just go up and up unless we can really get ahead of the issue. As the noble Lord, Lord Allan, mentioned, we have to run fast to stand still. I fundamentally believe that, if we cannot transform and innovate, we are really going to struggle to see the NHS model being sustainable right the way through the 21st century; it really is that fundamental.

The good news is that we do have some early glimmers of light, so to speak. We have done a really good digital maturity assessment to see the state of different hospitals: to aid the rolling-out, we need to know what our start point is. We see that the most mature digital hospitals actually have 10% more output and are more cost efficient, and that is just things today; I will come on to talk about the new hospital programme later and how that can improve things further.

As for what we are trying to do as a Government, I want to talk through six things that we are trying to do to set down platforms to enable. The first thing is to support small companies to develop and deploy the new medical technology. I have seen many examples of the AI that the noble Baroness, Lady Merron, mentioned, and she is absolutely right. We know the scale of what it can do: we see a whole category of cancer-reading MRI AI-type devices that we are putting through their paces at the moment, for want of a better word. I will come later to how we will try to scale those up.

We are doing a number of things to support these small medtech companies. As I say, we have put £123 million through the AI Lab on 86 projects. Through the small business research initiative for healthcare, we have funded 324 projects for £129 million, and there is some early promise there. We are trying to back them early on, as I will come on to, but the problem is often not the original innovation or idea but its widespread adoption. I am sure we have all heard the joke that the health service has more pilots than British Airways, but how do we seek to roll things out?

First, we are backing small companies. Secondly, dare I say it, I am going to mention the app, in that we have a £32 million platform, as the noble Baroness, Lady Merron, mentioned, that offers an opportunity for companies and different solutions to reach the population. I announced just this week what we are doing in the space of digital therapeutics, with mental health apps and musculoskeletal apps that will be available to everyone, but what is also vital in this space, I firmly believe, going back to one of my early themes, is that the app allows people—excuse the saying—to take back control of their health. For me, that is a fundamental thing that we need to enable people to do. It is not just about booking appointments; it is absolutely about getting patient records.

To be honest, we need help there, because we do have opposition from some of the medical profession to giving access to patient records on the app. We have 25% of our GPs who are currently doing it, so you see certain areas where they are definitely benefiting from it all, but we see others where we still need to win them over. Let me put it politely that way. I firmly believe that what we are doing with the app—and we will see a series of new features being launched over the coming months—will give more and more functionality and power into the fingertips of the individual to really take control of their health in a way that people do with some of the financial apps. That is a fantastic opportunity that should really make a difference.

Thirdly, as the noble Lord, Lord Scriven, mentioned, I want to talk about the new hospital platform that we are building. It is not just about buildings; it is actually about the whole processes and technology. We are planning a parliamentary day on 18 July, where we will be inviting everyone to see the plans for what we are trying to adopt for the whole systems and processes. We call that Hospital 2.0. I know that the noble Lord, Lord Allan, thinks we could have been more creative with that title, so we are open to new ideas. As I mentioned before, the digitally mature hospitals are 10% more efficient. We believe that these hospitals will be at least 20% more efficient. That is not just 20% more productive, but probably most important is the reduction in length of stay that they can make as well. One of the statistics that struck me the most is the fact that older people lose 10% of their body mass each week that they are in hospital. In respect of some of the comments made about the importance of social care by the noble Lord, Lord Turnberg, of course the best solution is having people in hospital for as little time as possible so they can go straight back to their home environment. Around that, some of the innovations on the same-day emergency care, where as many as 85% of people treated that way, show a very good example of that.

With the new hospital plan, where we are looking for productivity gains of 20%-plus, my sincere hope from all of that is that, rather than us asking the Treasury for more money to build these hospitals, it will see those sorts of productivity gains and will be encouraging us—“How quickly can you build them? How many more can we have?”—because they really will have that transformational approach.

Fourthly, again, as mentioned by a number of noble Lords, including the noble Lord, Lord Allan, the 50 million patients we have are providing a data platform. Regarding a secure data environment, the plan is that the data will always be held securely in its place, but people doing clinical research will have access to that environment, so they will not be able to take it away but they will be able to do it in that environment where they can conduct the clinical research and start to see the results. Again, I see our job very much in terms of innovation, with us providing that secure data platform for others to be able to do their research on.

The fifth area—and I think this is particularly relevant to the AI field—is the regulatory environment and support. Again, we all know that AI has fantastic opportunities for innovation, but we also know that, without it being done in a safe and ethical manner, there are challenges there as well. We also know that it is a complex field, with the MHRA, NICE, CQC, HRA—we have an alphabet soup of regulators—to navigate your way through. We have tried to launch a one-stop shop web service so people can really understand how to navigate their way through and have all the information in one place.

I now come to the sixth, and probably the hardest, part in all this: how we get innovation adopted and scaled up across the system. There are many advantages to having 120 different hospital trusts, 42 ICBs and thousands of GPs, and that freedom can often bring innovation, but there are also many disadvantages in the scaling up and rolling out. We have seen many examples where you have a promising new technology with a small start-up company, and you say, “Well done, it’s great. Here’s the telephone directory—good luck”. A small company especially just does not have the resources and time to get out and scale up.

For certain technologies, we are trying to bring them to a central buying point and process. There are examples of where we are doing that already. Noble Lords will often have heard me mention the Maidstone flight control system, which arms the clinicians with information about what is happening across the hospital, what the 999 calls coming in are, where they are likely to need beds and what they need to free up, so that they can make on-the-spot decisions. We are scaling that up and rolling it out across multiple hospitals. We are looking to do that in a number of areas, where we think we can do things better from the centre. I do not pretend for one moment that we have all the answers, because rolling out and scaling up are some of the most challenging areas. One of the first things I learned on taking up this role is that the word “national” in National Health Service is probably not apt.

The rollout of the buying points is a key thing that we hope to do. We are also seeing the rollout of virtual wards, as mentioned by the noble Lord, Lord Crisp. On new technologies, I have seen things where you can monitor the electrical usage in the homes of people who need more support. This is particularly relevant for dementia patients. If you normally see a spike in their electricity usage at 8 am because they turn on the kettle to make a cup of tea, when that suddenly does not happen you have an early warning. Have they suffered a fall? Is there something we need to investigate? That technology lends itself to mass scaling, and those are the sorts of things we see promised in those early technologies that we look to roll out across the system. That is one of the biggest challenges.

I hope noble Lords can see in my response that I am not pretending we have all the answers but, taking on the spirit of the debate, we are trying to adopt and innovate. I thank all noble Lords for their contributions.