How everyone can improve health care

A more informed discussion would focus even more on why it has proved so difficult to make the system more efficient, therefore getting more services for the same amount of money.

And it turns out that some of the biggest gains will happen not through bureaucratic change but by citizens themselves taking more personal responsibility for their wellbeing. 

The productivity of the health service across the UK has increased by just 1% per annum over the past 35 years. This, to say the least, is underwhelming. Contrast the car industry where productivity increased by the same amount over just five years between 2010 and 2015. It becomes even more disappointing when you realise that this improvement is largely off the back of pay restraint rather than any improvements in the system. 

Every government, both at Stormont and Westminster, has aspired to improve productivity. Every one, to date, has failed – perhaps because the targets tend to be too generalised and the health service is so vast.

Analysis by the King’s Fund suggest that dramatic improvements are possible, so long as managers accept that transformation does not happen overnight and that the focus is on specific areas. Where this approach has been adopted the results are clear.

Take just one example. Back in 1976 80% of drugs prescribed by doctors were expensive branded drugs. Today around 85% are chemically identified, much cheaper generic drugs. By 2015 it was estimated that across the UK this had saved £7.1 billion. Further savings will be made. Currently some pharmacists are still giving out branded drugs despite generic prescriptions but this is continuing to reduce.

As a result the UK is a world-leader is prescribing generic drugs and the cost benefit is considerable.

So as we lurch towards yet deeper crisis for the health service, where else could we improve productivity and thus do more for the same cost?

The King’s Fund has done several separate pieces of research on this: the landmark Better Value from the NHS, published in 2015, and several further analyses - many of the most recent looking at new technological solutions.

It concluded that there were not just a few areas where improvements could be made but many: “There are examples of overuse (when unnecessary care is delivered), underuse (when effective care is not delivered) and misuse (when care is poorly delivered leading to preventable complications and harm) of care across the NHS, which, if tackled, could deliver better value and release resources.”

There is much to be done. Yet not all of the improvements are solely the preserve of health managers.

Real change will happen when people start to take more responsibility for their own wellbeing. For example there is overwhelming evidence that exercise can prevent the development of many common, serious conditions:  dementia, type 2 diabetes, some types of cancer, depression and heart disease – by between 20 and 50 per cent. 

The Academy of Medical Royal Colleges estimates that increased physical activity – which it defines as 30 minutes of moderate exercise five days a week – could save the health service up to £18 billion per annum.  

To achieve this doctors would need to get into the habit of prescribing exercise as a treatment. This requires a significant cultural change – not just for doctors but for the rest of us as well. And it implies much more needs to be invested in public health campaigns, in sporting and other organisations that support healthy exercise.

There have been some encouraging developments in this area of late. An excellent example is the NHS Couch to 5K app. This is designed to support people of all ages and levels of unfitness to take up running and the associated forum on HealthUnlocked offers peer to peer support for everyone taking up the challenge. Contributors demonstrate that running is not the preserve of athletes but a natural, achievable and enjoyable activity for everyone.

Improving general fitness is a huge challenge. It will take time, perhaps a long time, but the benefits – and cost savings – are enormous.  

We could also collectively do a lot more to prevent wastage. Many medicines prescribed are not taken as recommended or not taken at all, resulting in missed opportunities to improve people’s health, wasted drugs and resources, and increased demand for health services.

The figures involved are staggering: between 33 per cent and 50 per cent of drugs prescribed for long-term conditions are not taken as recommended.

For some individual conditions, schizophrenia is a good example, treatments associated with poor medicine compliance are estimated at £100 million a year. And every 12 months at least £300 million worth of drugs are thrown away, unused.

Technological solutions are being developed. The US company Proteus Digital Health has created a sensor so small it can be swallowed in pill form. When activated it transmits data to a smart phone app which can show how well the patient is keeping to the prescription. And at the Massachusetts Institute of Technology (MIT) scientists are going one stage further. They are developing an implantable device with hundreds of tiny, sealable reservoirs (enough doses for ten years) that open when a small electric current controlled by an embedded microchip is applied. This is intended for both contraception and long term illnesses.

Another area which would significantly improve the productivity of the health service is to support patients to manage their own health.

Evidence from across the world shows that where people have the knowledge, skills and confidence to manage their long-term conditions they are more likely to stick to treatment plans, have healthy lifestyles and as a result have improved outcomes. This means that they use the health service less and save money.

There are some outstanding examples of this.

A group of patients with type one diabetes became so fed up with how slow technology companies had been in developing solutions to their health care that they formed the #Wearenotwaiting -  a global movement to take matters in their own hands.

In 2014 US woman Dana Lewis developed her own artificial pancreas and has shared the technology so that others can build their own devices. It is not recognised by any regulatory body but is proving very popular with those savvy enough to build their own. It is an early example of how patients can lead research and development to improve conditions.

And at the self-dialysis unit at the Ryhov regional hospital in Jönköping, Sweden patients operate self-dialysis machines at the unit, on their own and at the time of their choice, monitoring all the operations and cleaning the machines after use. If problems arise, patients liaise with the unit staff to find a solution.

Helping people to manage their own conditions will take time. It will require training. Not everyone will either want to do it or be capable of doing it. Yet it will lead to better outcomes and evidence suggests that those who practice it already have very high satisfaction levels.

Improving productivity in the health service is a massive task for the whole system. History tells us that where specific areas are targeted properly big improvements can be made over time. Many of the biggest savings can be made collectively, by all of us.