Technology-based tensions and the 10 Year Health Plan

At around 170 pages and 90,000 words, the 10 Year Health Plan for England is a sizable document. But the front cover provides an accessible summary. A double helix glows out, and – from that moment on – technology and innovation are never far away.

Innovation is life-saving and life-enhancing. Many of us wouldn’t be here if not for medical breakthroughs. And we are on the cusp of technological advances, from genomics to AI, that promise to transform health systems and society.  

So innovation was always going to be central to a long-term vision for health and care. Even so, the plan’s framing is strikingly optimistic: ‘…the size of the prize for NHS financial sustainability, for economic growth and for our ambition to enable healthier lives for all has never been bigger.’ 

Innovation as a route to health, wealth and sustainability. Could this be true? Is it possible to achieve these aims together? Or, as Sally Gainsbury and others have noted, are there trade-offs between them?  

In this blog, we sketch out three tensions: areas where success in innovation could hinder progress on other objectives. We also ask how these tensions might be navigated.  

Tension one: innovation and the shift from hospital to community

Reviewing two decades of data, Strategy Unit analysis for the Health Foundation found that innovation and new treatment possibilities fuelled growth in hospital-based care at a far greater rate than for primary care and community services. And forthcoming analysis suggests that new procedures accounted for around half of the growth in elective admissions, and 67% of outpatient visits in England (2006–2019).   

Hospitals are magnets for research infrastructure, data, equipment, scientific and clinical expertise. If encouraged but left unchecked, innovation in technology and life sciences could further contribute to acute services taking an ever-greater share of the NHS pie.  

How might this be addressed?  

The King’s Fund is exploring this, including through ongoing work to identify steps to strengthen research and innovation in community settings, dedicated sessions at recent and upcoming events, and through a forthcoming long-term programme of work focused on leveraging innovation to support the shift from hospital to community.  

And the Strategy Unit is encouraging ambition in shifting care from hospitals to communities, backed by analysis showing the scale of the shift needed. 

Tension two: innovation and the shift from treatment to prevention

Evidence suggests that ‘an ounce of prevention is worth a pound of cure’. Yet not investing enough in prevention is a recurring theme in health policy. And despite improvements, investment in research still skews in favour of treatment.  

The 10 Year Health Plan includes commitments to support the highly-innovative and research-intensive life sciences sector. Might this focus – and consequent gains in diagnosis, treatment and economic growth – sit uneasily with the aims of preventing ill health in the first place?   

There is subtlety here. Some treatments, including statins or newer drugs such as GLP-1 medications, are a form of prevention. And the plan sees genomics playing a central role in prevention and population health (albeit via thorny ethical questions).  

Nonetheless, a balanced approach is needed to ensure preventive medicine does not crowd out non-pharmacological approaches. A focus on novel treatments, genomic risk scoring and targeted early prevention shouldn’t come at the expense of support for lifestyle changes or action on wider determinants, which is where the greatest population health gains are.  

And so, greater cross-government action is needed to deliver the wider ’prevention revolution’ that has been promised.

Tension three: innovation and cost 

Technology is seen as a way of containing NHS costs. For example, in outlining the five ‘Big Bets’ for innovation, the plan says that these bets: ‘…have been chosen both on their potential to accelerate health care reform but also to secure the financial sustainability of the NHS.’ 

This is understandable. In most areas of economic life, innovation can reduce cost. And yet, as the OECD and Office for Budget Responsibility note, the opposite tends to be true in health care. Individual innovations may be cost saving, but the overall effect is both large and inflationary.  

Many mechanisms explain this. The most obvious is where a breakthrough creates treatment for a previously untreatable condition. Another is where a new treatment is more effective – but more expensive – than current treatments. This is explored in a paper in the Lancet, which shows how recent treatments have grown significantly in cost, while becoming more marginal in effectiveness.  

Which innovations to fund, for who and when? These are some of the most challenging questions health systems must face. The current pace of innovation, together with constrained public finances, mean that answers look set to become ever more complex. There is unlikely to be an easy win-win. Innovation must be guided if financial sustainability is the aim.   

Healthy realism   

The economist Thomas Sowell wrote that: ‘There are no solutions. There are only trade-offs.’  

This insight is essential, particularly when it comes to innovation, since every technology brings both upsides and downsides. Optimism can inspire and get things going; realism is needed to spot and navigate tensions.  

And so, as the 10 Year Health Plan moves from development to implementation, making the most of its emphasis on innovation will demand clear-eyed choices, careful stewardship, and a willingness to confront trade-offs head-on. The tensions between innovation and other goals are not reasons to retreat from technological progress – they are reasons to engage with it more deliberately.