There’s something that could radically transform the NHS in 2015 and beyond. But don’t expect to hear about it in the general election coverage. It’s not about funding, or patient demand or staff numbers…It’s far from new either. If you’re a fan of Hippocrates you’ll know he was rather partial to the idea of prognosis. It’s a concept so familiar in our everyday lives that we tend to take it for granted. From text messages to sat nav, almost every aspect of life today is now driven by predictions that we validate and learn from. So why doesn’t ‘predict-and-review’ play a greater role in healthcare?
The predict-and-review mentality is so deeply embedded in the world of work that we forget how far we have come since the farmer only got his tools out to repair the plough after the total surprise of discovering it broken.
Your sat nav prognosticates with a running estimate of arrival time that allows you to ‘phone ahead’ if you run into traffic. Your phone predicts with every word you text as it guesses what gems you’ll write next. When stocks run low, the factory manager turns to what the projections were and what plans had been put in place, and when a pilot appears over the horizon, air traffic control consults the forecast before deciding on a landing slot.
So why isn’t ‘predict-and-review’ standard practice for managing our healthcare? What if patients leaving hospital were asked to predict lifestyle changes – in a month’s time, in six months, next year? What if there were a systematic way of reviewing those predictions? What if all GPs predicted every Thursday evening how many of their patients would pitch up in hospital over the next 10 days? What if there were a sat nav for A&E running a predictor of the patient loading four hours ahead?
These are not questions you’ll hear uttered by politicians. Why? They know the public wants them to make a visible show of their commitment to the NHS, and just like with an engagement ring, the more they spent the more it is valued.
The Cumberland Initiative has set out to support a profound change in mind-set from reactive to predictive care. At our recent Festival of Evidence, Dr Len Goldschmidt of the Department of Veterans Affairs in the US noted, ‘by the time somebody is admitted to the hospital, they didn’t just get there. That was predictable months before, weeks before and even days before.’ The question is why so little is done with this predictive capability.
So what difference would this make? It is the difference between being surprised and being prepared. A serious attempt to address this issue would transform healthcare. It would trigger a quest for means and measures that would eventually put the entire business of service provision on a new footing. It would transform the quality of care, the cost of care, the sustainability of care, and the dialogue with patients – and probably spawn a whole new sector of our economy.
Niels Bohr said, ‘Prediction is very difficult, especially if it’s about the future.’ So why do other sectors spend so much on embedding models in their information infrastructure, on simulations, expert opinion, on Bayesian algorithms and forecasting? It is because the rewards are so much greater than the cost. The impact of such a shift in mind-set for our healthcare system is too vast to describe in a blog post. The more immediate question for now is whether our political leaders, quick to weaponise the NHS, will ever be just as ready to ask the crucial ‘What if?’ when looking for answers to the current problems.