Our NHS could be doing so much better

Health cost inflation exceeds headline inflation. New drugs and procedures are expensive. An ageing population places increasing demands across the health and social care system. Funding gaps will always be a challenge, and significant workforce shortages require to be addressed.

There is much to be rightly concerned about, but also many opportunities to do better with what we have.

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For every advance in technology that drives increased costs there are opportunities to dramatically increase the "productivity" of health care provision. Robotic surgery provides a faster, safer process with more operations performed. Yet last year only around 1.5% of operations carried out by Scotland’s NHS made use of this technology. Digital dentistry, the use of oral scanners, is faster, more accurate and needs fewer appointments with hard-pressed dentists than traditional methods. And it provides very important population level data on tooth decay rates that helps inform public health interventions to prevent problems in the first place.

Use of sensor technology and artificial intelligence can monitor and predict falls, one of the biggest causes of hospitalisation amongst the elderly. Scotland has world-leading technology in sensors, AI and innovative construction methods thanks to our Innovation Centre network.

Throughput in radiography can be dramatically improved by the use of AI - able to learn from past data to rapidly assess scans, discount 90% of the image as having no concerns and pointing the trained medical practitioner to the small areas where a clinical decision needs to be made.

Scotland benefits from a vibrant life sciences sector, with new technology being developed by innovative Scottish start-ups and spin-out businesses from our world-leading university sector. Yet so much of that great Scottish technology finds itself being exported only rather than tackling waiting lists at home.

Scotland’s health care system has much opportunity for improvement in this area. Fourteen different health boards all potentially suffering from "not invented here" syndrome, needing to go through their own individual processes before adopting technology that has been already proven to work elsewhere. And there is  resistance to innovation at a more local level too, with little incentive to adopt latest technology or process improvements.

GPs have welcomed the input of community link workers (Image: Getty)

There is talk of "pilotitis": a never-ending series of often successful pilots of innovations carried out locally that never see roll-out across the whole NHS.

Some good work is happening. The Accelerated National Innovation Adoption pathway (ANIA) is tackling these challenges at the margins. It needs to be doing so at pace and scale to shift the dial on our health and social care challenges.

Yes, there are investment requirements, but this can pay itself back rapidly. Earlier treatment delivers significant cost savings to the system as a whole, and better outcomes for patients. "Prevention is better than cure" is truer in healthcare than almost anywhere else.

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And this applies to "process innovation" as much as it does to new technology. The recent stand-off over who pays for Community Link Workers is an example. An initiative that has been proven to work, and is hugely popular amongst patients and GPs, freeing up their time to use their medical skills while the link workers provided support for patients to access more appropriate, often non-medical services, elsewhere in the community. A simple intervention, saving far more to the whole health and social care system than it costs, yet stuck in a bureaucratic budgeting impasse between health boards, local authorities, health and social care partnerships, integrated joint boards and Government until the Health Secretary, to his credit, stepped in to find another £700k. There is money in the system, more of it needs to find its way to the most effective intervention.

There are of course no silver bullets here. But what is necessary is an unwavering commitment to the fundamental principles of our NHS, a recognition that more bureaucracy is almost never the answer, a prioritisation of spend on cost-effective prevention and front-line services, a willingness to innovate at scale and at pace to make the best use of Scotland’s technological and research excellence to benefit patients and a need to overcome inertia when it comes to getting different parts of the complex health and social care system to align and work together. This can be done, but might require us to think differently about how we do it.

The workforce across our NHS is full of ideas as to how to make things better. Let’s empower them, not bury them under bureaucracy.

Ivan McKee is an MSP and former Minister for Business, Trade, Tourism and Enterprise