Looking ahead: 2021 – what will happen to the NHS?
Oli Hudson, content director at Wilmington Healthcare, looks forward to the next year in the NHS, and what it means for the medtech industry.
Post-COVID service reorganisation
The expedient changes made to the healthcare system owing to the pandemic – COVID secure wards, keeping vulnerable patients out of hospital, the movement of staff from other disciplines to ICUs, for example – will likely retreat as the vaccination programme kicks in, infection rates go down, and capacity is released for hospitals and other providers to return to pre-2020 patterns of activity.
Many commentators, and increasingly decision makers on the inside, are realising that some of the changes forced upon the system this year are here to stay. But as other services, hampered or curtailed during 2020, are brought back online, expect some grand rationalisations within systems and places.
Strategies adopted in different regions will include choices: whether to continue unchanged, replace, transfer, triage, rationalise, centralise, cancel or suspend, or reduce. This will vary widely from place to place – so one job medtech has next year is to map out the shape and size of services in territories – what will be done by whom and for which patient group – expect a lot of change in this area.
The backlog
Much of this activity will concern the ‘backlog’ – not just the build-up of elective care interventions undone this year, but a growing demand from unscreened and undiagnosed patients who have not entered NHS pathways this year, and whose healthcare burden will be carried over. In surgical, orthopaedic, and ophthalmic ‘hi-flow’ pathways there will be opportunities for medtech companies who can assist the customer with managing this backlog, and care should be taken to include its overall effect in business cases.
The single pot
A little-discussed but incredibly helpful and revealing document was published in early December, Integrating care: Next steps to building strong and effective integrated care systems across England. It tells us much of what we need to know next year about the NHS landscape – who will be working with whom, how it will work, what the KPIs will be, and how it will be financed.
On that last note, the document says there will be a ‘single pot… which brings together current CCG commissioning budgets, primary care budgets, the majority of specialised commissioning spend, the budgets for certain other directly commissioned services, central support or sustainability funding and nationally-held transformation funding that is allocated to systems.’
This pot will be held at integrated care system (ICS) level. It means that the financial assumptions worked on by medtech for many years – that industry exists in a transactional relationship with individual hospital trusts – is not really the truth anymore, and hospital budgets will exist in a wider health economic ecosystem where money is distributed according to population health need.
This could spell the end of the hospital as ‘revenue-generator.’
That said, the document also makes clear that it should be the ‘duty’ of systems to delegate budgets down to ‘place level’ – that is to the level of trusts and provider collaboratives, and that they should design pathways and decide how to fund them – with heavy clinical input.
There may be opportunities for industry here to influence the establishment of new services – and influencing existing and growing clinical networks will be absolutely key.
Provider collaboratives
Much of the document talks of the need to speed up and streamline the process of integration. This will happen both vertically – with trusts integrating with community, ambulance and primary care providers to assume the trappings of one organisation – but also horizontally, with hospital Trusts in particular taking ‘collaboration’ further to link with one another.
One eye-catching phrase is ‘provider collaboratives’ and expect to hear much more about these in the new year.
The integrated care document says a blended payment model for secondary care services will be used – that is, block contracts, plus variable elements for some types of services paid by activity. This will ensure that provider collaboratives have greater certainty about the resources available to them to run certain services that might, in the old system, have not made economic sense, and will be able to invest where the patient need is. There will almost certainly be an effect on joint procurement here too.
At the most advanced end of provider collaboration expect to see some ‘hospital groups’ emerging. Long trailed by the NHS five year forward view and the Long Term Plan, these will see previously autonomous Trusts come together under one banner.
A recent example has been in the Midlands, where Trusts in Walsall and Wolverhampton took on a joint chair prior to a touted Hospital Group formation with two other Trusts in Birmingham and Dudley. (In actual fact NHS England has more or less dictated that they must become a hospital group).
Once this goes through this will be one of the largest hospital organisations in the country, with some big purchasing clout. Medtech should expect more such hospital groups to emerge as the full effect of integration kicks in in 2021, prior to the new statutory landscape that must, according to NHSE, be in place by April 2022.
Specialised care
If your product is used in specialised care – such as genomic testing, CAR-T therapy, mechanical thrombectomy, Proton Beam Therapy and CFTR modulator therapies for patients with cystic fibrosis – expect changes in how these therapies are funded.
Some of the specialised commissioning budget is due to be delegated from NHS England to systems – in large part at least. What NHS England actually says is: “Strategic commissioning, decision making and accountability for specialised services will be led and integrated at the appropriate population level: ICS, multi-ICS or national. For certain specialised services, it will make sense to plan, organise and commission these at ICS level. For others, ICSs will need to come together across a larger geographic footprint to jointly plan and take joint commissioning decisions.”
However, some services, such as those in the highly specialised services portfolio, will continue to be planned and commissioned on a national footprint.
In conclusion…
So, what with all this, plus the possibility of mergers between organisations, a statutory duty of data sharing which will allow both providers and industry to ascertain which pathways are delivering the best outcomes for spend, the ongoing march of digital transformation in the NHS, with not only remote consultations becoming normal but AI involved in stratifying patients and decision making – there is a lot to look out for in 2021. It’s worth the time to research and absorb these changes – for companies that understand where the service is going and what it will need to achieve in the future – a huge challenge – will stand to benefit from enhanced relationships with the customer – and the possibility of mutually beneficial future partnership.