At NESTA we started the People Powered Health programme in response to doctors and patients
and others who said that for several decades we've talked about co-production, about a
model where the patient takes more responsibility for their own care, there's more mutual support
in the community.
But despite all the talk, there's not been much implementation of the new ideas and most
of the system essentially ignores them.
So we tried out new methods of patient empowerment.
They included things like group consultations for GPs, social prescribing, mobilising communities
to look after patients being discharged from a mental health incident and tried to show
how the whole system could change around them.
Everything from workforce development, the design of financial incentives to the use
of technology and we showed that if scaled up these methods could save the NHS very large
sums of money; conservatively £4billion a year but probably £10-20billion if really
scaled up, mainly because of how much they would save in terms of unnecessary admissions
to hospital and A&E, unnecessary visits to GPs.
I think what we're seeing is the beginnings of a very different model of health care where
the rhetoric of putting the patient at the heart of the NHS is actually taken seriously.
One of the amazing things about health is that most professionals have fairly common
view of where we could be in twenty or thirty years' time.
A vision of health care where the patient has access to far more feedback, far more
technologies to tell them what's happening to your blood sugar, to your blood pressure
or things like that where you are much more empowered by online advice and guidance, where
you have much more specialised and much more efficient places doing surgery or specialist
treatment where health care isn't just something that happens in the hospital but happens at
home or in the work place and you've got access to health guidance pretty much everywhere
and where health becomes something which is just part of our culture - the water we drink
or when we choose food, choose our lifestyle or when we take exercise, all the time we
are aware of the implications that has for our health rather than health just being something
that happens when you get sick.
That's a radically different picture of health care and many people would buy into it but
what's, in some ways, amazing is how hard it's been to realise most of that vision.
Perhaps the biggest problem for health systems at the moment is just how successful they've
been.
They've worked incredibly well at increasing life expectancy, cutting mortality and dealing
with diseases of all kinds and the mid-20th century hospital-based health system which
has spread across the world worked in many ways.
But as a poet once said, success repeats itself until it becomes failure.
What we now need is health systems much more rooted in the community, in the home and in
the workplace, but the hospital as really the place of last resort.
My sense is to get to the change on the scale we need probably we'll need to bring in newcomers;
new players, new ideas, new institutions.
It's going to be very hard.
It's going to be very hard for the existing incumbent institutions, whether hospitals
or GPs, really to see through the scale of change that's needed.
But that's going to be very hard.
We're on the brink of another series of revolutions, particularly in digital technology.
The internet of things, machine learning, sensors, the quantified self - these are all
being talked about which are the next revolutions in how information can be managed, data and
knowledge.
But I think the lesson of recent decades tells us don't become fixated on the technology.
Technologies on their own don't tend to work very well, don't tend to fix things often,
drive up costs.
Much more important is how you think about the whole care pathway, the whole health system
and how technology can support that - can support good learning, good decisions, good
responsibility for the patient.
But if you become fixated on the hardware, the stuff, as it were, which tends to be what
innovation funding does, and R&D agencies probably will be disappointed.