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Andrew Jones on the next big shift in healthcare

Andrew Jones

Andrew Jones

I often wonder what will drive the next quantum shift in healthcare. If we ran a poll today, world class commissioning or the Darzi review would probably top the list. These ideas are fine, but it seems to me that they represent an incremental nudge rather than a quantum shift.

No, for an idea to qualify as a quantum shift, we would need to see the sort of transformation we have seen in the computing, retail, leisure, financial services and utility industries over the past 25 years. 

People do not put up with poor service in these areas any more: they select their service carefully, compare prices and features, complain in droves and move their business when dissatisfied or when something better comes along. 

"Consumers in just about every other business want control and choice, so I reckon health will be no different"


So it beggars belief that people put up with the waiting, inaccessible appointments and service restrictions that go on every day in healthcare.

No doubt the political policy environment, liberalisation of markets and regulatory shifts have helped overcome problems in other sectors and may do the same for health.

Taking control

But there is one factor that is almost certain to overtake central reform. My prediction revolves around the internet and the concept of the personalised health record.

New technology is now allowing patients to go online and book appointments, request repeat drugs, view their health file summary or email their clinician.

But far and away the most exciting and enabling consequence of all this will be the development of personalised health records. Consumers in just about every other business want control and choice. It works well if you are downloading music, comparing insurance or booking a flight, so I reckon health will be no different. 

Third parties will surely start to offer electronic space to store individual health records, facilitate interactions between providers, offer information, and develop online communities and support groups for patients with similar health problems. 

Naturally, comparative information on cleanliness, quality of service and outcomes will follow as a development of good governance.

How far off is all this? Simply put, it is happening already. Microsoft has launched HealthVault, a system that allows people to store their health records online, and Steve Case, former chief executive of America Online, is backing Revolution Health, an online service that offers information on health and helps users find doctors in their area. Am I just following the trend or can I walk the talk? I've just spent a few hundred grand to find out, so I will let you know.

  • Author: Andrew Jones.Dr Andrew Jones is group medical director of Nuffield Hospitals and health policy adviser to Andrew Lansley.

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Reader Response

Added: Tuesday, 29 April 2008 05:37 BST
jacky davis, london, United Kingdom

O dear - can I deplore the current fashion of referring to patients as 'consumers'? Health care is by and large not mobile phones or 4 x 4s, and those needing it often not in a position to go trawling around on line for the best buy. Patients would be best served by the abolition of the market, the attempted introduction of which has not been a success.

Consumers can continue to shop til they drop...

JD


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Added: Monday, 28 April 2008 15:58 BST
Bob Smith, Shefford, United Kingdom

We need a revolution, particularly in healthcare. Firstly, increasingly we will see rationing more and more. And the way to counter this is to ensure that cold 'elective' procedures become means tested. A large number of our population can afford to do this.
Secondly, we should pay those who work with people a much higher wage/salary. This is where the challenges are - much of management is reducing to systems and processes that work well and do not need many highly paid staff to administer.


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Added: Sunday, 27 April 2008 17:50 BST
george richardson, plymouth, United Kingdom

THE NOTION THAT I REALLY CARE IF Y HAVE ONE LEG OR THREE; FRANKLY NOBODY DOES. INSURANCE COMPANIE MIGHT TAKE ADVANTAGE OF MEDICAL PERSONALISED KNOWLEDGE AND THAT NEEDS TO BE STOPPED BEFORE WE CAN OPEN UP THE NOTION OF PUBLIC HEALTH. I HAVE VISITED SOME 250 POOR HOUSEHOLDS (LIITLE MONEY AND THE UNDERSTANDING ABOUT MONEY) AND ALSO WHERE THE HOUSHOLDERS WERE INTELLECTUALLY CHALLENGED. Y NEED TO UNDERSTAND HOW THEY CHERISH THEIR HEALTH RECORD - MOST OFTEN MORE CLOSELY THAN THEIR ................
TRY TO INTRODUCE CHANGE IN A SMALL WAY. CREATE A FUSS ABOUT CHANGE AND CREATE MOMENTUM OTHERWISE THE TOP OF THE NHS WILL NEVER HEAR ANYTHING. GO ABROAD AND SEE HOW THEY DO HEALTH.//RICHARDSON


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Added: Tuesday, 22 April 2008 17:52 BST
Nicholas Davies, Halifax, United Kingdom

I'd answer none of the above suggestions in the article.

How about GPs paid well, to deliver accessibility and quality in pleasant surroundings? NHS direct, the ambulance service and A+E access regulated via the GP surgery with its well organised information bank.

Scrap PBC and PBR. Make information transfer between primary and secondary care quicker and clearer. Give GPs better access to CT and MRI scanning.

Get patients seen quickly and accurately, and with clear follow up and follow through plans.

Get bureaucrats out the way of achieving this.


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Added: Tuesday, 22 April 2008 13:25 BST
Anonymous, Malvern, United Kingdom

Although the 'available audience' argument is valid, the REAL issue is vested in the fact that, contrary to what Jones eulogises, one cannot compare the health of the nation with its telephone bills. To suggest that both of these can be accessed, processed, managed and understood in a similar way is an absolute nonsense. Choice is all very well and good, but the majority of humans lack anything like the knowledge and expertise required to make truly informed decisions about their own health care and this is not likely to change. Get real and accept that change for the sake of it is as pointless as it sounds.


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Added: Tuesday, 22 April 2008 08:17 BST
stewart mcmenemin, Glasgow, United Kingdom

Call me old-fashioned but this is hardly going to transform health care. It's another attempt to put a glossy package on Health Care. Who will it actually benefit? The 20% of our practice currently aged over 80 years? I think not.
In 1997, the UK was third bottom of the EU spending league on Health (just above Albania and Turkey,) and we had 40% less doctors per head of the population than the OECD average-a truly disgraceful statistic. We still have fewer doctors and spend less than the OECD averages although it is better. As a GP whose working day is 7.15am - 6.30pm I really wonder if the people that write such articles care about everyone or just the most vocal minority.


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Added: Monday, 21 April 2008 14:01 BST
Al Thompson, Atherton, United Kingdom

I wonder how many people will accept central health information storage like they do with Facebook information. i Idoubt people with real health need would do this.
I am also concerned that the people with the real health need are not sufficiently organised to take advantage of the suggestions in this article. It is the people who are the QOF exceptions that have the real need not those up to date with QOF assessments.

I wonder if it is more outrageous in concept to move back to personalised health care rather than the Asda/Tesco solution of "modernised" or perhaps "silo" health care. The challenge is to reach all not the Facebook generation. Al Thompson.


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