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Dr Thishi Surendranathan, manager Health Advisory, KPMG LLP, explores how patients and their caregivers will increasingly play a key role in the uptake of new technologies

The next great transformation in healthcare will be driven by health service users wielding their power and influence to drive change


Dr Thishi Surendranathan, manager Health Advisory, KPMG LLP, explores how patients and their caregivers will increasingly play a key role in the uptake of new technologies

We are moving into an exciting new world of smart healthcare, but how soon can we expect to see game-changing new models of care? Historically the health sector has been slow to embrace technological change. The next great transformation in healthcare will be driven not through coherent policy making, nor even well executed strategies from payers and traditional providers, but rather health service users wielding their power and influence that will drive change, challenging the health system to adapt to meet their needs.


Last October, we saw the publication of the Accelerated Access review, an independent report commissioned by the UK Government to recommend ways to improve access for patients to new medicines and technologies, including digitally based products. However, the report placed little emphasis on the role of service users in making decisions on the adoption of new health technologies versus simply “being involved” in their development. We need to better consider how patients and their caregivers will increasingly play a key role in the uptake of new technologies.


In recent history we have seen how pressure and influence from public or patient opinion has had a direct effect on the decision-making of payers. In 2014, Ashya King’s parents took their son abroad for state-of-the-art high-energy proton beam therapy (PBT) against the advice of their doctors – sparking a public manhunt in the process! We now see the first NHS-funded PBT centres due to commence treatment in 2018. Even more starkly, we have seen the parents of Charlie Gard wage a court battle essentially rejecting the opinions of medical experts and several judges in favour to the United States for an experimental treatment. The repercussions (nationally and internationally) of this episode are yet to play out but an interesting question is, would we have seen this kind of public reaction even 10 years ago?


The changing attitude of service users towards healthcare professionals show the determination of individuals and their caregivers/guardians to exercise free choice. We think key causes of this trend are:


1) Advances in choice and convenience in other sectors: we can plan our travel, and purchase goods and services through our smart devices, so why can’t we do the same with our healthcare?


2) Expanding access to specialist knowledge. Patients now often come into healthcare consultations having done extensive research online on what is wrong with them and what management / treatment they need. Similarly, patients with chronic diseases often become “expert patients” with knowledge of their illness that begins to challenge that of their specialist. Conversely, medical practice is also adapting - with greater emphasis on using clinical judgement versus having an encyclopaedic knowledge of every manifestation and cause recorded in the medical literature.


3) Greater awareness of health outcomes and their measurement. Service users and health professionals can increasingly look up the outcomes achieved by their healthcare services and use this information to make decisions on the care provided. This is an area that will need more development and standardisation in order to be meaningful but already we are seeing good progress through the work of the International Consortium of Health Outcomes Measurement (ICHOM) and other innovative organisations such as Outcomes Based Healthcare (OBH).


4) Increasing ownership of service users over their medical records. Patients are increasingly taking control of their medical records with the effect they are more empowered to navigate a complex healthcare system.


So what does this mean for smart healthcare agenda? Increasingly we will see new treatments and services provided directly to the patient, bypassing healthcare providers and payers, who are each led by healthcare professionals and managers.


In the short term we will see service users paying to meet immediate needs. For example, there are millions of unmet requests for a GP appointment each year, causing a gap in the market for primary care services that has resulted in the rise in popularity of online GP service and booking platforms such as Babylon and Doctor Care Anywhere.


In the medium term, we will see service users being increasingly savvy in their “consumption” of health services, by accessing more on the basis of performance against outcome and other quality measures. As a result, we will likely see technology providers provide products making this process as easy as possible for the service user.


In the longer term, we will see a truly integrated system with the user of the system at the centre: healthcare, social care, housing, utilities and other services will all be connected to meet the demands of service users seeking the greatest convenience possible in their lives. Most fascinating will be which of the various sectors can lead the convergence with other sectors – to develop services that are truly centred around each individual’s needs.




Dr Thishi Surendranathan manager Health Advisory, KPMG LLP, is a qualified doctor with experience working in a variety of health care settings including acute care, general medicine, surgery, general practice and rehabilitation. He joined the Health Advisory team at KPMG in the UK in 2012 and has completed a number of engagements across strategy, finance, contracting and operational improvement. Thishi has a specific interest in value-based healthcare approaches and the influence of technology on the practice and organisation of healthcare.



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