Oli Hudson, content director at Wilmington Healthcare, explores the rapid and startling changes to the NHS customer landscape – and how it will affect medtech.

Two months ago, the NHS had a customer environment that was often challenging, sometimes frustrating, but largely predictable.

Change appeared at a stately pace and in line with the NHS Long Term Plan, which set out to foster gentle collaboration rather than competition.

So integrated care systems were emerging, but yet to contract officially with integrated providers; some hospitals within trusts were being divided into ‘hot’ (emergency or specialist) and ‘cold’ (elective) sites; limited partnership between trusts and joint purchasing strategies were being developed, but slowly; and pilot programmes for pathway change, specialisation, and digital adoption seemed the norm, rather than the wholesale transformation desired.

Some elements of the plan, such as a move away from long-term hospital bed use towards care in social, community, primary and home settings, were well intentioned but happening sporadically in areas where all the players within an ICS could agree.

Smart medtech companies were watching, with a view that organisational relationships between their customers, and between their customers and them could change, albeit slowly; perhaps the most crucial thing was the change in the national procurement model.

Two months later, the Coronavirus outbreak has made all these assumptions null and void.

Integration

The crisis has forced the pace with integration – with all the players within integrated care systems including acute, primary, community, specialist, ambulance and social care, as well as representation of local housing, transport, education and police, having to come together to make decisions on resource and capacity. Meanwhile, the Long Term Plan’s drive to create more coherent governance models in the shape of CCG mergers is ahead with increased fervour. This lays a baseline for a more integrated stakeholder map, with some ICS representatives saying they have achieved more in seven day timelines than had previously happened in 18 months. The learning? ICSs will be the standard operating unit of the NHS after the outbreak, and their decisions will affect which hospitals do which procedures and how pathways that involve medtech are managed.

Acute care

Within acute care, we are seeing changes to the purpose of hospitals– with whole units given over to COVID-19. Operating theatres have been turned into ICUs, and staff not previously specialising in respiratory or critical care requisitioned for this emergency. Departmental structures that previously existed within large hospitals have been shaken up beyond recognition, with clinicians working well beyond their normal disciplines. In places like London, a reconfiguration is underway between hospitals dealing with COVID-19 patients, and ones which are specialising in other areas, with Royal Brompton and Harefield forming a ‘hub’ model for heart disease, the Royal Marsden for cancer, and St Bartholomew’s for emergency elective treatment. The NHS has even enlisted the entire private sector to increase its critical care capacity. As a landscape, it is unrecognisable.

There is also developing a backlog of long-term conditions treatment, outpatients and elective care. The medtech products used to treat them will be needed at some point, but when? Acute care will be a confusing and challenging customer environment for medtech during the outbreak – and industry may have to change its approach, determining the route to engagement – for example, via digital and remote channels.

It is unlikely that hospitals will revert to the pre-COVID working-in-a-vacuum strategy. There will be trade-offs and resource sharing. This is likely to foster closer collaboration in procurement in the future.

Long-term conditions

The emphasis on COVID-19 has detracted from other groups of patients – vulnerable groups such as respiratory, diabetes, cancer, heart and autoimmune conditions. How are these patients now being catered for and will the outbreak mean changes to care pathways? Cancer surgery has been affected, with patients being risk-stratified into four groups. Some groups will not receive treatment, depending on the likely outcome, whether it has a clinically meaningful aim, whether the patient is likely to gain significant extra life, and whether operating will expose the patient to a COVID-19 risk that is greater than not operating. Such measures have been outlined across most therapy areas by NICE in its series of rapid response guides, and will affect operations performed that use medtech for some time.

Industry impact

Hardly anything industry does with the NHS will be unaffected by this pandemic. It is important that industry stays well informed, prepares to be agile, offers solutions that deliver value and address issues of rapid, reliable and consistent supply and distribution – and act as a partner to the local and national NHS during this crisis.