Hamstrung by tight regulation, legacy technology and sluggish working processes, many public health systems lag the latest innovations emerging from the healthcare start-up community.
The UK’s National Health Service acknowledged this in 2015 when it aimed to foster and implement technology-driven tools through a start-up accelerator programme. Last year it launched a tech funding scheme.
According to Will Gibbs, a health expert at British venture capital firm Octopus Ventures, economic pressure within the US private market is a differentiator for technology innovation compared with the NHS. “In the US . . . you see greater take up of innovation [than in the UK] as each hospital group competes with each other,” he says.
But the distinction between innovation in the private healthcare sector and public systems is becoming blurred as health tech start-ups look to sell their services directly to consumers in private markets, while also rolling them out within publicly-funded systems.
Ideally, innovation spanning the public and private healthcare spheres would take the best of both worlds: risk management and safety protections from public sector innovation, while working to commercially-driven timeframes and targets.
In practice, some instances of NHS partnerships with tech start-ups have imported the disadvantages of private sector healthcare innovation into the public sector sphere, including loosely regulated direct-to-consumer marketing, lower standards of clinical evidence and unequal access to resources.
According to a report by the Nuffield Council on Bioethics, two tech trends are driving the shift towards a consumerist approach in healthcare: the rise of internet-based medical services; and increasingly personalised advice from algorithms and data from wearable technology and genetic testing.
Digital tools have changed how people engage with healthcare through services such as advice websites, health statistic monitoring apps, and NHS digital services for health records, symptom checking and appointment-booking.
However, with these advances come concerns about the reliability of new technologies and of personal information. The Nuffield report notes that private providers “are using all the technologies of modern marketing, not merely to respond to consumer demand, but also to reshape such demand to create and sustain a market”.
Start-ups and private providers are able to offer low-cost, personalised services online using innovations in cloud computing, big data, artificial intelligence and other emerging technologies. They have more direct access to consumers through marketing technology including Google keyword targeting and personal data from online records.
Technological advances — such as online genetic test results or recommendations from health monitoring apps — are putting pressure on public health systems. The report says that unreliable results from online services can cause anxiety and confusion among patients, undermine the authority of doctors and burden public health systems with unnecessary follow-up tests in-person, according to Nuffield’s research.
Philippa Hodgson, director of NHS services at online medical start-up Push Doctor, says these advances are changing patient expectations of what they should receive when using healthcare tools. She particularly worries about start-ups that are not bound by the NHS Quality Care Commission standards and can provide, for example, prescriptions for antibiotics more freely or recommend unnecessary tests.
Instead of fairly distributing healthcare resources, new technology tools might contribute to antibiotic resistance, heighten demand on resources and create unrealistic expectations when patients are using NHS services, Ms Hodgson says.
“There is a huge expectation that comes from consumers using a private platform; you have paid for an interaction so you expect to get something tangible from it, whether that is a prescription or a referral. It’s something we need to deal with as more people use a combination of private and public medical services,” she adds.
Sensyne Health, a publicly listed healthcare technology company, uses a “partnership model” to work with the NHS alongside pharmaceutical companies. It hopes to sell its healthcare management tools for diabetes, lung disease and heart failure to private US healthcare providers.
The approach, says Paul Drayson, chief executive, meets the challenges and tensions of new technology employed across private and public healthcare contexts. Patient data are strictly protected and held within the NHS, but insights derived from this data using AI are applied for innovation and drug discovery in the private sector.
Public sector patient data, such as NHS records, are more inclusive and representative of the whole population than data from, for example, private insurance companies or tech groups such as Google and Amazon, says Lord Drayson.
Sensyne advocates funnelling returns back into the NHS through its public listing and using profits to subsidise the provision of free tools to the NHS.
Lord Drayson says: “We need to ensure the returns of investment in healthcare technology are also delivered back to the public.”
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