By Ellie Glover

I’ve heard many first-hand accounts of how the NHS saves our lives and keeps us all healthy. As the daughter of a clinical professional who has spent over 30 years working for the NHS, in a building with no heating, and still hand-writing patient notes, I'm also very aware of how frustrating it can be to work for a chronically underfunded and extremely inefficient institution/system. Over the last decade, the NHS has taken steps to try and address these issues – in part, with the creation of NHS Digital back in 2013. It provides data and IT systems to clinicians, as well as improve the patient experience with apps and virtual services to ease the burden on front-line staff.  

But is that enough? 

There has been criticism from within on whether these fixes are just a band-aid, whether the NHS is keeping up with technological advances, and if IT systems are creating more work than reducing it. 

Dr Owen O’Sullivan, of West London NHS Trust, explained the “mushrooming admin tasks” to maintain electronic patient records (EPRs):

“Whilst some of these may be important on an organisational level, on a user level there is neither marshalling of any boundaries to this with respect to clinicians’ workloads nor is there consideration given to cohesive and intelligent user interface design to support these tasks’ completion in an optimal manner.” 

In order to understand where tech can truly make a difference, we need to take a step back and understand the biggest challenges faced by the NHS - the biggest over-arching theme being their restricted budget. (The tech bit is coming, I promise.)  

Admin- The necessary evil

The sheer volume and cost of administrative tasks and staffing is quite incredible, with 47.5% of England’s NHS workforce being in administrative and support roles, without even factoring in the 1-2 hours per day clinicians need to write up notes (source: my mother) if they don’t have the right tech. If you consider that 45% (or £66bn) of the total NHS England budget is allocated to staffing, you’d naturally look there for places to start making adjustments.  

In order to free up staff time, natural language processing (NLP) could be utilised not only in the creation/update of patient records but also for information retrieval. The National Institute of Health and Care Research, along with University College London Hospital, is currently testing the Medical information AI Data Extractor (MiADE) to help convert free-text clinical notes into a structured format which conforms with the EPRs hospitals use. This could revolutionise the admin process, and provide clearer structured information for diagnosis and treatment between shifts, or if a patient is transferred elsewhere.  

Also from UCLH, with King’s College Hospital, CogStack was developed as an AI/NLP platform to extract information from multiple sources of unstructured patient data such as Word documents, images and PDFs which could allow for faster analysis of patient outcomes, disease registration, and research studies. 

Another tool to save employee time is Purple.ai’s asset tracking and location services platform. It’s estimated that nurses spend 1 hour per shift searching for critical equipment with average asset usage at only 35%; Purple helps staff locate equipment and medication at any time, provides directions, and even notifies you if it leaves a certain zone. It can also notify you if an Alzheimer’s patient (of which 60% have a risk of wandering) has left a pre-determined area. With an ageing population, this could be a handy time saver in years to come, while also keeping an eye on patient safety. 

Big spender- The cost of good care

Some of the other biggest expenditures for the NHS come from specific diseases themselves - obesity, cancer, diabetes and mental illness all sit at the top. 

A record 320,000 people received cancer treatment in the UK last year. Genome sequencing – the study of the genes in our DNA – has been increasingly useful in the treatment of cancer patients, largely driven by Genomics England which was set up back in 2013. You may know 23andMe as a well-established consumer example of genetic testing to identify predispositions for certain diseases. Interestingly, the UK has some of the richest genomic datasets in the world, and over £1.9bn in venture investment. It has also seen 12% YoY growth between 2011-2020.  

Genomics England explains its impact well: “In cancer, the tumour cells have developed a different genome to the healthy cells. Comparing the normal and cancer genomes may give clues about ways to treat cancer. We may be able to link particular patterns with whether people are likely to become ill and, if so, how severe their illness is likely to be.” 

Genomics could also have an impact on obesity, which costs the NHS £6bn a year, but this is still in its research infancy and scientists have only seen meaningful impact with niche or rare cases. The current digital solution on offer for weight management is a 12-week online course, although the NHS might need a more radical or personalised focus than simple weight management apps and online courses. Microbiome testing could certainly tick that box.  

Simply put, a stool sample sent to a biotech company like Atlas Biomed can tell a lot about your health. The gut microbiome (your community of micro-organisms) has an impact on nutrient metabolism and energy expenditure, and conversely, methods of obesity management have shown a change in the diversity and composition of the gut microbiome. Certain supplements such as probiotics can also alter hormones and neurotransmitters which can prevent food-related triggers.  

Israeli health-tech startup Lumen created a device and app to “hack your metabolism” for enhanced fat burn and to lose weight naturally. It works by analysing your CO2 levels via a hand-held breathalyser, which can indicate whether your body is currently burning fat or carbs. Lumen also provides nutrition plans, sleep analysis, and optimised workout plans based on your body. 

Preventative care- A stitch in time

Alternative solutions focus on preventative healthcare, the idea of more routine care to maintain good health and diagnose medical conditions before they become a problem. The most common form of preventative care you’ll know is vaccinations. Research from 2016 estimated that 75% of all healthcare costs stem from preventable chronic health conditions such as diabetes, hypertension and obesity. Preventative care doesn’t just save money, but lives. Digital (private) GP appointments on platforms such as Babylon Health, at-home testing kits like Sexual Health London, or even mental health platforms like Calm, have made wellness more accessible day-to-day, but one could take it further.  

We all know how much data Apple Watches can discover about your health. These days there are also glasses, bracelets or rings which can monitor your blood pressure, oxygen levels, activity, and even your fall risk as you age. The preventative healthcare market is estimated to be worth $345bn by 2029, perhaps a drop in the ocean compared to global healthcare spending overall, thus the savings could be immense. 

There are countless cutting-edge technologies which could revolutionise medicine – 3D printed organs and a knife that ‘smells’ tumours as an example - but in order to meaningfully transform the NHS, realistic changes need to be implemented rather than the sexier solutions one might see in a sci-fi movie. The 1% improvement principle applies here, where transformational savings could be achieved if many overlooked areas could be improved by just 1%. 

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