Lord Darzi's review of the NHS heralds a new era of innovation in healthcare, and with it the tools and opportunities to reach out to patients who are disengaged from health services.
Although the reasons for this disengagement are legion and include many factors outside the control of the NHS, they are magnified by the problems those in deprived communities encounter in accessing healthcare services.
Lord Darzi's welcome focus on innovation, however, offers an opportunity to realise one of the founding aspirations of the NHS: to give those in equal need equal access to health services.
Innovation is a constant theme in the Darzi review, both in the ways it proposes to entrench new technologies in the NHS and in the opportunities it creates for their greater use.
Technology's role in improving access to healthcare services can be significant. It can combat inappropriate use of certain healthcare facilities and bring the NHS closer to people, be it face-to-face, over the telephone, via the web or even digital TV.
Reaching deprived communities
Lord Darzi rightly recognises the importance of improving access to primary care services in deprived communities. Although the press has tended to focus on his most contentious proposal - establishing a new polyclinic in each PCT - it is in the review's detail where the true opportunity for improving access lies.
Creating one new polyclinic in areas covering more than 1 million people can deliver only limited improvements in access. However, allowing community NHS staff to deliver services in the community has the potential to go much further: staff working in deprived communities have known for years where the gaps in primary care services lie. With the new freedoms, they will have the opportunity to fill them with new, innovative services.
However, many will be disappointed that the proposed single number for non-emergency urgent care services has been put on the back burner. The more diverse community health settings become, the simpler access to them must be. A one-stop, urgent care phone number would have helped to direct members of the public (and particularly the less health-literate in the population) to the most effective point of care. The Darzi review says the government needs to do more work in this area. If some of the benefits of Darzi's community reforms are not to be lost, this work needs to be done quickly.
Preventing inappropriate use
The new polyclinics, GP surgeries and other models of community health provision will all be able to showcase the new technologies for triaging patients that are already being used in the latest generation of walk-in centres. These new systems offer drop-in access to historically disenfranchised patients, helping to manage them quickly and cost-effectively and referring them onwards to more intensive care settings only when clinically necessary.
The most savvy health economies have already been using such systems on a micro scale for years - for example, by co-locating walk-in centres and accident and emergency departments - but opportunities exist to broaden and deepen their use and reinvest the savings made back into patient care.
Managing long-term conditions
Lord Darzi rightly prioritises the care of those with long-term conditions, acknowledging that this patient cohort consumes a disproportionate amount of healthcare resources and that long-term conditions impose a disproportionate burden on deprived areas.
The review proposes that patients with long-term conditions should each have their own personalised care plan. Those with stable, predictable conditions are to hold their own part of the health service budget to commission services directly.
Although challenging to design, the potential benefits of the policy are huge. A patient with long-term needs for whom the NHS has commissioned a district nursing package, for example, may consider this package too intensive. They may instead choose to commission care from a service offering a telephone outreach package, where a nurse rings the patient at home or work to assess them and only calls in a district nurse if necessary, improving care in a cost- and clinically effective way.
Looking to the future
One of six challenges in Lord Darzi's review was how the NHS can meet the demands of the population in an age of information and connectivity. Patients, he noted correctly, are now more able than ever to share their information with others, seek out new treatments, and highlight their experiences of care.
However, in my view this is not a challenge but an opportunity. A connected patient population, after all, is one that can fully harness the benefits of telecare, telehealth and e-health services. Bringing healthcare closer to people is key to overcoming the barriers to access that entrench and deepen health inequalities.