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Taking the pulse of healthcare

A young female doctor looks closely at the patients chest x-ray

Healthcare systems around the world are under pressure as never before from ageing populations, chronic diseases and new technology. Pam Garside, Coach of the Cambridge MBA Health Strategy Concentration, makes her predictions for healthcare trends in 2019 and beyond.

What are the main stressors on the global healthcare industry now and in the next few years?

Pam Garside, MBA Coach
Pam Garside, MBA Coach

Healthcare systems across the globe are dealing with a perfect storm of pressures that are putting great strains on governments’ ability to offer their populations adequate and improving healthcare. People are living longer so many countries are dealing with ageing populations. So-called developed countries are facing not only an ageing population but one with associated growth in chronic diseases such as diabetes, cancer, pulmonary and vascular diseases – all of which place enormous strain on systems and budgets. Then there is the issue of excluded populations – defined by the UK Home Office as four overlapping groups – homeless people, individuals dealing with substance abuse, sex workers and imprisoned people. In other parts of the world, excluded populations may be refugees from war-torn countries or those which discriminate against, for example, LGBTQ+ people. In 2018, for the first time, the concept of ‘inclusion health’ became current within the healthcare establishment, defining how the medical profession must operate to tackle the high mortality rates among excluded groups. This is a great step forward but will also come at a monetary cost.

The shortage and unequal distribution of workforces in healthcare systems is a growing challenge. It is estimated that the global shortage of skilled medical professionals runs to around 4.5 million and this constraint holds true in both developing and developed nations, significantly hampering the pursuit of health-related millennium development goals. A lack of medical and nursing schools and ‘brain drain’ affects developing countries and, in developed regions, health workers are concentrated in urban areas and many leave the profession prematurely.

Treatments for cancer, personalised medicine and genomics are all rapidly developing fields which will all add to the cost burden of health systems and force ethical decisions for payers. This is challenging for governments, insurance companies and individuals.

Then there’s opioid abuse (anything from pain relief to heroin), which is at epidemic proportions across the developed world. In the US alone, the National Institute on Drug Abuse calls the misuse of and addiction to opioids ‘a serious national crisis’ and says the ‘total ‘economic burden’ of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement’. Healthcare systems are working hard to tackle this, putting strain on budgets and services. Life expectancy in the US has fallen for the last two years, opioid related deaths contributing to this alarming statistic.

How is the rapid advance of new technologies impacting the healthcare industry?

New technologies present both an exciting step-change in healthcare and a significant stressor. The exponentially increasing availability of data; the growing involvement of tech giants such as Amazon, Google and Apple in healthcare; the burgeoning of artificial intelligence (AI) and machine learning; the collision of the life sciences industry with healthcare in the area of data – all of these make for exciting but challenging times. Start-ups moving into the AI healthcare space reached a high in 2018. And the big players are already deep into the space with Google’s Deep Mind trialling the use of AI in diagnosing eye diseases and treating acute kidney injury in the UK’s National Health Service (NHS). Apple is working on software such as ResearchKit and CareKit, which will provide medical researchers with sophisticated data, and has a joint venture with Johnson & Johnson in heart monitoring. And Israeli company Beyond Verbal is developing voice enabled AI which diagnoses chronic diseases over the phone by studying voice patterns and vocal emotion. This trend of disruptive and innovative AI start-ups into the space is only set to grow, increasing customer expectations of what is possible with resulting pressures on health provision. On the positive side, there are massive developments in tech supported wellness where individuals and patients are encouraged to take care of themselves and their health.

What is the trend picture in the UK – home to the world’s largest publicly financed healthcare system, the NHS?

The UK faces issues around the availability of primary care, with acute shortages of GPs (General Practitioners), a shift of care away from hospitals and into the community (something advocated for by the profession for decades), the transformation of outpatient services, and the encouragement of self-care and preventive services to avoid disease, including behavioural change. The National Health Service (NHS) perennially faces challenges around shortages of key staff. There is some good news in that the NHS has been allocated more funding and mental health services, in particular, are set to receive more funds and more attention. All these changes will be underpinned by the continued rise in digital services and more open access for people to their own health records. This last move raises the issue of the security of this highly sensitive, personal data. Healthcare is the industry most targeted by cyber-attacks for the rich data it yields to cybercriminals. And yet the sector mainly lacks the cybersecurity standards which prevail in industries such as banking and retail. Healthcare organisations are expected to begin making big strides to close this gap from 2019 onwards but they are going up against increasingly sophisticated criminals.

What skills are needed in the UK sector going forward and where should recruitment occur to fill these, especially given the issues around Brexit and visas?

The health sector relies heavily on recruitment from the EU, so Brexit is expected to hit UK staffing hard with consequences for waiting times and quality of care. A recent report from the Cavendish Coalition, an alliance of 36 health and social care organisations, warned that over the planned three-year Brexit transition period to 2021, the UK exit could contribute to as many as 10,000 additional nursing vacancies on top of the 41,722 unfilled roles we currently have. One estimate predicts that the gap could widen to around 70,000 workers by 2025. The Independent Newspaper estimated last year that this would mean a shortage of the equivalent of 45 hospitals’ worth of nurses. Sector leaders are urging the UK Government to step up recruitment and training now to prepare for the loss of EU staff. We need all forms of staff, particularly in primary care, and nurses almost more than doctors. We need basic carers for hospitals care homes and people’s homes. The other main areas of need are researchers, scientists and software and data scientists specialising in the health sector. Brexit affects all of these and the Government will have to be creative about visas and implementing a simplified immigration process. We are already losing EU staff due to Brexit, so we also need the UK Home Office to guarantee that settled status for EU nationals will go ahead in the event of a no-deal Brexit.

What does the Healthcare Concentration offer MBA candidates interested in the sector?

Given all the seismic shifts outlined above, this sector is a very interesting one to study and offers a route to a wide range of professional roles. The Health Strategy Concentration for Cambridge MBA students is aimed at those with a background in the health sector who wish to continue their careers with a broadened or different emphasis, and those who are new to the sector and exploring it as a potential area of employment or interest.

The Concentration seeks to draw on the general and business management concepts that students are familiar with and apply them in the context of the health care industry, specifically focused on the particular challenges and opportunities offered by the sector. I bring in senior global faculty to teach the sessions and the student group and have arranged visits to the heart of the UK Government at 10 Downing Street, London and to Google Deep Mind.

Pam Garside began her professional life in management in the NHS and is now an advisor to the private sector, working with US and European companies, including life science companies who want to learn more about the UK health sector. She is an Angel Investor in health care start-ups and sits on company and charity boards. Pam teaches at CJBS and sits on the investment committee for Cambridge Enterprise, the technology transfer company for the University of Cambridge. She also co-chairs the Cambridge Health Network which brings together private and public sector leaders in the UK.