The case for NHS Online
Research Manager and Head of Health
Imagine recovering from major surgery without ever setting foot in a hospital, tracked in real time by doctors, in the comfort of your own home. This is not a pilot or a thought experiment, but the reality for patients in the near future. Too often in political rhetoric, politicians reach for buzzwords like modernisation or innovation, but for the NHS, the prime minister just made this real.
The NHS itself was a world first. A publicly funded, universal health system, leading the rest of the world in how to deliver critical care equitably. But it’s also true that a health system designed in 1945 is not a health system for 2025. As the NHS faces an overwhelming generational challenge, the reformist energy that once characterised the NHS – transforming the delivery of health care for decades to come – needs to be channelled again.
The first entirely virtual hospital is a welcome step in that direction.
There is a clear rationale underpinning the need to fundamentally reconfigure the NHS. It remains one of the most enduring frustrations in government – even with spending increases that make other departments wince – the NHS inexplicably remains stuck in a state of perpetual parsimony.
But aside from its plain lack of fiscal sustainability, the hospital model itself has not adapted from 1945, even though today’s clinical demand is unrecognisable from that era. If you lifted our hospitals and put them back into the post war world, the only thing that would look different would be the sophistication of the medicine, surgery, and technology. The underlying model remains the same.
People are getting older, and with more resource intensive medical problems. Waiting lists are the largest they have ever been in the history of the NHS. The cost of care is increasing, and inflation presents a significant financial pressure on the NHS’s disproportionately large workforce. Overall, demand on the system is increasing both in volume and complexity.
Pouring more money into the same old system is no longer an option. Modernisation isn’t a luxury, it’s a necessity. Technology is transforming every part of our lives and healthcare is no exception. As virtual wards and hospital at home becomes the norm, it’s evident the future of the hospital is in the living room as much as it is the waiting room.
While many may be hesitant about an entirely virtual hospital, evidence of other initiatives clearly illustrates that it offers a unique benefit to patients, the system, and the taxpayer that the traditional analogue model simply cannot provide. Radically expanding capacity may mean more care is delivered virtually, but that’s a small compromise for faster, more efficient treatment.
Crucially, it subverts numerous problems that haunt the introduction of any extra capacity in health care. It can be developed and scaled extremely quickly, with minimal overhead costs in comparison to a physical hospital. The construction of a hospital alone takes 3.5 to 7 years, and from inception to delivery it can take as long as 11. Contrast this to Moorfields virtual A&E: 32 different virtual waiting areas, with two of their large services seeing 40 to 50 patients a day, all set up within a month. Drop in video consultations were launched less than 48 hours after the UK lockdown was announced.
Since it would provide less services than a traditional bricks and mortar hospital, could move through appointments faster and have lower fixed costs, it could serve a much larger group with lower overall expense. It would not be bound by physical capacity or local geography. Staff can work from home at times convenient to them.
Traditional hospitals need more space and equipment as they scale – a remote hospital just needs more bandwidth and digital infrastructure. Services can reach unprecedented volumes of people almost instantaneously.
But it’s not just about cost effectiveness: the same referral process we’ve always had doesn’t process elective demand any quicker. Seeing a specialist can be an intensely anxious experience, and for many patients a quick answer is what matters most – regardless of the medium.
If it’s a choice between going to the virtual hospital – where I don’t have to travel to an appointment unless a physical examination is essential and I can get my issue resolved within a month – or going to a traditional hospital, where I might wait six months for an appointment and another two for an answer, I’ll choose virtual every time. And I suspect many other patients will too.
The brutal truth is this: if we were designing the NHS from scratch today, it would look nothing like it does now. NHS Online is the first step towards transforming the health service to meet the demands of the modern world, not the post-war world. As the Secretary of State has said, the NHS must “reform or die.” I choose reform.