Balancing the need for a digital-first healthcare system with an increasingly ageing and dependent population

Tim Morris, vice president, clinical solutions, Elsevier Health has a look at the pros and cons of digitised healthcare

The UK healthcare system is currently under huge strain. Nearly 20,000 people a day are waiting at least four hours in A&E, while 7.1 million people in England are waiting for elective hospital treatment, up from 4.4 million before the Covid-19 pandemic. The target time patients should wait for cancer therapy in the UK is 62 days, however, the total number of people waiting longer than this period has exceeded 69,000 in England, Northern Ireland and Scotland, and doubled since 2017-2018.
The frontline is facing unprecedented pressure to reduce the number of patients waiting for services whilst significantly understaffed. Recent analysis of NHS figures shows 4.8 million patients waited more than six weeks for a test or scan from Sept 2021 to Aug 2022, which is a 12-fold increase on figures before the pandemic. This is coupled with the reality that there are more than 130,000 vacancies to fill across the NHS, and the effects of this shortfall are exacerbated by the current cost-of-living crisis.

A poll of more than 2000 adults by the UK Council for Psychotherapy and YouGov found that almost one in two feel the cost-of-living crisis is affecting their mental health. NHS therapy services won’t be able to manage the increased demand driven by the crisis as they are already thousands of therapists short. Moreover, the significant lack of available social care also means many patients who are fit for discharge are unable to leave hospital as they have nowhere else to go. As many as one in three hospital beds in parts of England are occupied by patients who are medically fit to leave, but appropriate care services either in patients’ homes, placements in care homes, or NHS-funded aftercare, are lacking.

Increasingly dependent population in the UK
In the UK, we are already facing an ageing population with a growing number of people living with long-term chronic conditions. The number of Brits over the age of 85 is predicted to double to 2.6 million in the next 25 years, and as such, the population that is dependent on continuous care will also significantly grow.
There is also a growing number of younger patients presenting with comorbidities and obesity-related diseases, while it is now estimated that a third of middle-aged adults in the UK have at least two chronic health issues. These groups will continue to contribute to the healthcare burden as they age, presenting challenges when planning health and care services.
The 2022 Elsevier Health Clinician of the Future report explored global trends and changes that are expected to impact the future of healthcare through a global survey of nearly 3,000 clinicians from 111 countries. The report revealed that clinicians believe the increasingly dependent population is driving change across the global healthcare landscape, with 94 per cent believing the rise of chronic health issues will be a key driver of change in healthcare over the next 10 years. Data also showed that 71 per cent of clinicians agree the increase in comorbidities in younger patients will also play a pivotal role in the changing healthcare landscape.
The report suggests a shift to preventive care could potentially reduce the burden of chronic illness and, in the longer term, result in people visiting healthcare facilities less often. However, findings show that 79 per cent of clinicians believe there is currently not enough being done on preventive care, and 84 per cent agreed that patients with age-associated diseases will make up the majority of the patient population in 10 years’ time.

Digital transformation driving the future of sustainable healthcare
The use of digital technology is ever-increasing, as clinicians continue to use innovative tools to support interactions and communication with patients. The movement towards more digital appointments, especially in primary care, was accelerated by the pandemic. The Clinician of the Future report highlighted that doctors and nurses believe there is great potential in a digital-first future. Of those surveyed, 70 per cent of clinicians believe the widespread use of digital health technologies will enable the positive transformation of healthcare, in fact, 63 per cent expect most consultations in 10 years’ time will be remote rather than face-to-face.
If digital health technologies are designed with clinicians and patients in mind, well-integrated, and supported by sufficient training, they have the potential to provide many benefits. Digital technology could save clinicians time spent on administration, enabling them to spend more time with patients, either remotely or face-to-face. Furthermore, using technology to improve processes around patient records and transitions throughout the care pathway could also free up the frontline from maintaining electronic medical records (EMRs).

Considerations for digital-first care
A shift to remote may have the potential to empower patients to take on a more active role and become equal partners in the management of their long-term care, however, we must also acknowledge that the evolution to a digital-first will not come without its own challenges. This is also recognised by clinicians themselves. The Clinician of the Future report showed that 69 per cent of clinicians agreed digital health technologies will be a challenging burden, and a further 64 per cent agreed the impact of health inequalities will be exacerbated by digital tech.
With primary care activities being pushed to online support and teleconsultation, we risk excluding vulnerable and older adults without digital skills from accessing important health information. According to NHS Digital, it is predicted that by 2030, 4.5m people in the UK, totalling around 8 per cent of the population, will remain digitally disengaged.
The reality of the shift to digital-first health services has a huge impact on the well-being of vulnerable patients and places challenges on access to care, I’ve had to manage the consequences of this with my own parents. Both my mother and father have physical and social health needs, my mother specifically has respiratory health issues and lives with cataracts and macular degeneration. Though there was adequate online support for respiratory breathing exercises, the ability to assess her condition was significantly more complex when she was unable to travel to the place of care. Further to this, having to book appointments online with impaired vision poses significant challenges.

Digital solutions as the future enabler of clinical care priorities
As clinicians continue to face an increasingly dependent patient population, digital transformation has the potential to empower patients to take an active role in their care. This can help reduce the time clinicians spend on administration so they can prioritise those patients that have more complex and continuous needs. It is vital that we ensure digital health technologies should be co-developed with clinicians and patients, to ensure they are fit for purpose.
With a shift to digital-first care, healthcare organisations must support clinicians with sufficient training on new technology and processes so that they are implemented and used to full effect. As a company committed to improving patient outcomes, Elsevier Health will continue to listen to and partner with clinicians, so that we can better understand the challenges they are facing and help to address their evolving needs to best support the dependent population.