This image is a derivative of “Anenurin Bevan, Minister of Health, on the first day of the National Health Service, 5 July 1948 at Park Hospital, Davyhulme, near Manchester“, used under CC BY 2.0.

The NHS was created as a universal health system, built on the principles of meeting the needs of everyone; free at the point of delivery; and based on need, not ability to pay. Now 70 years old, these principles have never been under such strain. I’ve been following how the NHS is changing, and I’ll be looking at some of these changes over a series of blogs. In this first one I’m going to consider how a universal health system can be relevant in 2018.

The pressure of changing expectations

Like many people, I started 2018 by reading a bunch of predictions for what the year ahead will look like. There was an awful lot about the growth and evolution of personalised customer experience. Less about standardisation or universal services. This is because many areas of our lives such as personal banking and food shopping can be largely managed using websites and apps, and digital is designed to be different for everyone, not universal. Digitally mature companies know a lot about us, have been building personalised relationships with us and are continuing to build upon these to enhance our brand experience.

So, when we are customers of the NHS we now expect more than a uniform experience. We are also more informed and increasingly we have new providers offering us alternative health services. This is changing our behaviours and attitudes. This is also a big change for the NHS. For much of its 70 years it has operated in an almost monopolistic market, where it decides what is on offer to the UK population. In 2018 the NHS still unites us because we all use it, whatever our lot in life and whatever our financial status, but how we experience it has to change if it is to survive.

Healthcare’s turn for disruption

The landscape is changing. Today I can subscribe to Babylon Health for £5 per month. This AI-powered chatbot is always on hand to triage me, provide advice and if necessary and direct me towards medical services. If I’m at risk of developing diabetes or managing it, I might pay for a personalised lifestyle change programmed from OurPath or Nujjer. These programmes put the patient at the centre, support them with connected activity trackers, smart weighing scales, continuous feedback, and an expert health coach provides personalised advice. Oh, and my prescriptions might be delivered by Amazon soon.

These companies are infiltrating health care like Netflix entered entertainment. Previously we just paid our TV licence fee and watched or listened to the programmes offered by the BBC and free-to-view channels. Now many of us pay our licence fee plus a subscription to Netflix. If you’re anything like me, you’re also paying for other services like Amazon Prime, Spotify and Audible. But I still want to watch and listen to the BBC. The BBC should still exist, I’ll pay for it. It’s just that there are other providers and I want access to them as well. This situation is good because competition pushes organisations to be better. It’s why the BBC is now available on-demand through iPlayer.

How the NHS is starting to change

What I am seeing from NHS Digital is also good and I’m encouraged by the digital transformation that is taking shape. I’ve been particularly struck by how NHS Digital is opening itself up to collaboration with the best providers, how it is applying some of the principles used by the best digital companies and its appetite for change.

For example the NHS Test Beds Programme has been testing innovative technology, like sensors that have been designed by Intel and are used by NASA to help prevent falls remotely. Through experimentation with new technologies like this, the Test Beds are redesigning care pathways with the aim of improving patient outcomes and experience. Meanwhile, the Diabetes Prevention Programme (DPP) initiated a digital work stream because the NHS acknowledged that new digital providers such as OurPath and Nujjer offer opportunities to reduce the burden on clinicians, whilst providing a better experience for patients. The DPP is currently evaluating five external providers in eight regions across the country and will report back soon. If you’re a company or developer of tools and services rather than a patient, then there is a growing community and support available. The new Health Developer Network for example, provides information and tools to help potential suppliers build software that the NHS might purchase one day.

The strategy is clear. The NHS is no longer trying to build everything itself. Instead it is mobilising and engaging with new types of provider and with pharmaceutical companies who offer high quality patient support as a value-added service. By identifying the best tools and services at a national level, the NHS is making it easier for health care commissioners to provide high quality digital services to patients locally. They are also building platforms to make it easier for patients to operate independently by creating access to health records, providing better online information and by directing people towards trusted tools and services. Together, these initiatives should stimulate the market to develop a wider range of tools and services that address real health care problems.

If NHS Digital can deliver against this strategy then it will not only have modernised how it operates, it will have changed how we as customers behave towards it, engage with it and consequently how we experience it.

So, can a universal health system be relevant in 2018?

Universal health is what the NHS brand is built upon and it’s a sentiment that still unites us around it. The way care is delivered might need to evolve but what is most important is that the NHS continues to care for us based on our needs and not our ability to pay. The NHS transcends healthcare in Britain and its brand can be a powerful source of cohesion not just for the public but for the new commercial health care providers who are also seeking to meet our needs in new, disruptive ways.

In Part 2, I’ll look more closely at some of the changes being brought in by NHS Digital and the challenge of getting us to change our habits and switch to new digital services.