Money is tight – the next government will need to be creative
- 6 June 2024
With a general election looming, Vijay Luthra considers how digital in healthcare has fared under the Conservatives, and asks whether things really are about to get better
The NHS’s problems – underfunding, staff shortages, surging demand – were not made by this government but they certainly haven’t been helped by it either. Rishi Sunak’s farcical election announcement, held in the pouring rain and with New Labour anthem Things Can Only Get Better by D-REAM playing in the background, was perhaps a fitting metaphor for much of this government’s interventions into public policy, including health.
But let’s cast ourselves back five years: Theresa May was still Prime Minister and many of us thought having someone in 10 Downing Street who had a chronic health condition [diabetes] might make the NHS more of a focus. And for a time, it seemed that would be the case with the creation of the NHS Long Term Plan – an expansive vision but at least a starting point for a more strategic approach to digital health. What none of us bet on was the arrival of a global pandemic, only a little more than six months after May’s successor, Boris Johnson, had secured a whopping majority of over 80 seats in the December 2019 general election.
The Covid inquiry will hopefully tell us what we want to know about the conduct of the government during this time. While the goings on at 10 Downing Street have also been the subject of press scrutiny and even TV drama, in the NHS there were positive developments: barriers to digital technology were breaking down. The cliché that ‘necessity is the mother of invention’ became more of a mantra. The procurement and deployment of telehealth platform Attend Anywhere by NHSX, demonstrated that digital health could be sourced and deployed rapidly and at scale. But since then, we seem, perhaps, to have gone backwards.
Ambitions stifled
The pandemic exacerbated a number of existing challenges in the NHS such as staff shortages and elective care backlogs; it also highlighted how outdated IT estate hampers adoption of new technology. Nor was their time for upskilling staff to harness the potential of technology, something the NHS Long Term Workforce Plan is intended to address. But with its focus on leveraging digital and technology, it certainly seemed like the government was moving in the right direction. Unfortunately, the NHS’s biggest problem – constrained finances – is likely to stifle these ambitions as the funding to train clinicians and other staff is, arguably, not there.
The same issue applies to the NHS Digital Health and Care Plan, launched in June 2022 by Sajid Javid, who was health secretary at the time. Another plan that seemed ambitious in scale, in reality it promised little new money. While the improvements to the NHS App it funded were welcome, these were arguably pretty mundane.
Disruption in the centre of the NHS hasn’t helped either. Tim Ferris, hired to great fanfare as national director of transformation in May 2021, departed in September 2023 (although he now possibly appears to be back for another go). Ferris managed to energise a programme of EHR implementations before departing. Many of these programmes seem to have gone awry – in some cases creating extensive patient safety issues.
Progress and controversy
On the plus side, but not without extensive controversy, the Federated Data Platform got off the ground. There were no surprises that the contract to deliver FDP went to data giant, Palantir. Palantir’s track record as a defence and intelligence provider, and concerns over data privacy, have attracted considerable criticism; on a more pragmatic note, others have questioned the use of a platform that excludes GP data.
Extensive cuts at NHSE driven by a ‘transformation’ and merger of NHSD into NHSE, have perhaps exacerbated some of the (understandable) post-Covid inertia.
The most recent tranche of funding for the NHS came in the Spring Budget 2024. With a chunky £3.4 billion in funding for NHS technology and transformation announced over three years starting from April 2025, this seemed generous; in fact, it was a real terms funding cut.
A real indicator of how much health has been prioritised, can be seen in who’s been in charge. Not only have we had six health secretaries in four and a half years, but most have attracted controversy in some way.
The last four and a half years haven’t been great for the NHS or for digital health. If, as we all expect, Sir Keir Starmer arrives in 10 Downing Street on 5th July and Wes Streeting becomes secretary of state for health and social care, what can we expect? It’s been said that Streeting has been taking advice from a range of health policy luminaries – including former health secretary Alan Milburn and former NHS chief Lord Simon Stevens. And the NHS brand is irrevocably associated with Labour. Labour’s Nye Bevan created and nurtured the NHS. So, can we assume that a new Labour government will put the NHS at the centre of its programme?
What to expect from Streeting
Streeting has been tight-lipped about his plans, only more recently using carefully orchestrated opportunities in the press to focus on key pre-election messages. We know that Streeting confesses himself an advocate for digital health so can we expect more investment? With fiscal conditions tight, it’s unlikely there’ll be new money. The one exception to this will possibly be for the elective backlog. Streeting has indicated he wants to use private sector capacity to reduce this at pace.
What does this have to do with digital health? Well, a significant part of the backlog is people waiting for diagnostics. It’s conceivable that Streeting may seek smart ways to harness digital health to triage those waiting. He has professed admiration for the ‘family GP’ model that exists in Singapore and wants to bring technological innovation into the NHS faster. Close observers of Singapore’s health system will know that the level of technological enablement is extensive. For Streeting to realise his ambitions, some creative thinking will be needed so that routes for digital health interventions can be brought forward at pace and scale.
