At Unboxed, we’ve been following the Health Secretary’s comments carefully as the Department for Health and Social Care gathers evidence through ‘Change NHS’, their consultation on the next NHS 10 year plan. We’ve been working with partners in healthcare for decades. We’ve seen first hand the challenges of making change in one of the most complex public health systems in the world.
Anyone who has interacted with the NHS in recent years, whether as a patient, a member of staff, a person caring for someone else or as a supplier, will be aware of many of the issues that Lord Darzi raised in his 2024 investigation. Through the consultation so far, the big issues include:
making it easier for people to get an appointment with a GP or in hospital
more investment in recruiting, supporting and retaining staff
reducing waste and inefficiency, like unnecessary appointments, manual admin and paper-based communication
coordinating health and care services around patients, rather than putting the burden on patients to navigate their way between different providers
As a digital agency, we believe that technology has a big part to play in solving these problems. We know AI is already being used effectively in certain areas of healthcare, like diagnostics and back office systems. But Lord Darzi acknowledged that ‘the NHS is in the foothills of digital transformation’ and is way behind other sectors in its use of technology to improve everything from patient outcomes to the day to day tasks of NHS staff.
Why is the NHS so slow to catch up?
Lots of reasons - highly complex procurement that favours purchase of ‘big’ systems that can do everything, rather than more agile services that can develop as needs change. Legacy tech that is too costly to replace. Locked up data that is held in different parts of the system. Staff that have no time or energy to get involved in innovation and see tech as something that is thrust upon them, rather than something that they can help to shape and design. Intense pressure on fixing the problems that are right in front of you (freeing up beds that day, for example) that reduces capacity for long term thinking.
We know that technology is never the solution, only an enabler of the solution. Digital, and AI in particular, needs to be developed with the people that use it and benefit from it. It also needs to be flexible enough to adapt to changing needs - our expectations of how we interact with public (or any) services are completely different to what they were 10 or 15 years ago. And the government is finally talking about a ‘test and learn’ culture , moving away from procuring One Big Product That Does Everything (we hope).
Here, we’ve summarised our thoughts on a few key recommendations from the Darzi report, based on our experience of working with NHS Trusts, community healthcare organisations and Integrated Care Boards (ICBs). Quotes are all taken from the Darzi report.
Moving care out of hospitals and into communities
“ Instead of putting their time and talents into achieving better outcomes, clinicians’ efforts are wasted on solving process problems, such as ringing around wards desperately trying to find available beds. Too many people end up in hospital, because too little is spent in the community.”
Shifting care away from hospitals and into more accessible settings requires new models of delivering that care. Primary care is already at breaking point. We’ve seen how community-based models like Lambeth Health and Wellbeing Partnership’s (LHWP) Household Model can make it easier for people to access care. By working collaboratively at a local level, understanding the needs of that community and then working at the household level (for example, with a family), LHWP is supporting the overall wellbeing of that household and their capacity to manage their health, reducing the need for acute care.
“People living in poverty are getting sicker and accessing services later…Fewer children are getting the immunisations they need to protect their health and fewer adults are participating in some of the key screening programmes”
Reduced participation in screening programmes and NHS health checks can lead to late or missed diagnoses. People putting off getting checked means they may only enter a service when their condition is more developed, which usually means higher costs and patients not getting the early support and treatment that could prevent deterioration.
This is where user-centred design can really make a difference. In our work with SH:24, a digital sexual health service, we found that high risk groups put off getting tested for a whole range of reasons - fear, shame, worrying about been seen at a sexual health clinic, embarrassment about talking about their sexual health, cultural issues and stigma, as well as logistical barriers like having to take time off work to wait in a queue at the clinic for several hours.
That service, created in the early days of digital health provision, has completely transformed the landscape for sexual and reproductive health in the UK, stimulating a highly competitive and innovative market. Through agile, iterative development, they have the flexibility to respond to medical developments like PrEP, or cultural changes in how people view HIV as it becomes highly treatable.
Better use of data and AI
“The extraordinary richness of NHS datasets is largely untapped either in clinical care, service planning, or research…”
We love data-driven services. But one of the big challenges in the NHS is not a lack of data - it’s a lack of access to data at the right moment by the right people. In 2024 we worked with the cardiomyopathy team at University Hospital Birmingham to rethink their screening services. A huge frustration for clinicians was that they simply couldn’t get hold of the data they needed to fully understand a patient’s risk level. This means that many patients come in for repeated follow up appointments when they don’t really need to be seen.
Clinicians also want access to population data - trends in results, treatments and symptoms that help to understand what works, what doesn’t and where to target resources. Making this kind of data accessible to both teams providing specialist, direct care and to researchers who are informing best practice could transform the effectiveness of care and resource allocation.
That means looking at where and how we capture data, and how we can use the once-only principle and reduce the burden on patients who are often asked repeatedly for the same information, and automate data gathering so we’re not relying on doctors, nurses and secretaries to manually copy information from one system (or document) to another. It means working with IT and digital teams to understand how we can share the minimum data needed at the exact point that it’s useful. And it means taking a holistic approach to pathway redesign, looking at how data is used across a whole patient journey and across multiple services or providers, and where there is scope for automation or AI-assisted interfaces.
Bringing primary and secondary care together
“The best way to work as a team is to work in a team: we need to embrace new multidisciplinary models of care that bring together primary, community and mental health services.”
We’ve found that services are often built around operational structures, rather than around the needs of the patient, or, indeed, the people providing care. Integrated Care Boards (ICBs) have been set up to bring together different providers but that doesn’t make it easy. Even if willing, people have very little time and headspace to think about different approaches - the Darzi report also highlighted the challenge of staff disengagement.
Sometimes, the hard part is just getting people into a room together. We spend a lot of time building relationships and building trust with healthcare professionals, then using carefully designed questions to help them think differently. Care and attention is one of our core values at Unboxed, and it’s especially important in healthcare. We can’t expect service transformation if we don’t give a voice to the people who deliver those services. We want to make their experience better too.
In our work with South East London ICB we spent time with stakeholders from primary and secondary care to find common ground, shape a shared vision and set out a framework for action. We’ve found that ‘visioning’ or setting out a proposed model for the future is a great way to get healthcare stakeholders thinking beyond the challenges they’re stuck in now. By prototyping different parts of the model, we can not only get people excited about what’s possible but also dig into blockers and enablers to change.
A lot to do
We’re a long way from a ‘digital NHS’.
Wes Streeting has a huge task on his hands, whatever comes out of the consultation. But we think that, done right, digital can change the NHS. By ‘right’, we mean - designing and developing services around the needs of users; testing and piloting solutions in specific contexts but always with a view to scale; understanding the people and culture that will support adoption and implementation; and building in the flexibility to change.
