The NHS as an Engine of Economic Growth

The principal priority of the new Government is kickstarting economic growth, with the Health Secretary asking the DHSC recently to expand its focus on boosting economic prosperity. In this blog post, we spoke with Shane DeGaris, Group CEO of Barts Health NHS Trust, about the opportunities and implications this brings for one of the largest Trusts in London and the diverse community it serves.

Note the views expressed herein are those solely of the author.

Tell me about Barts Health NHS Trust

Barts Health is one of the largest Trusts in the UK, serving one of the most diverse communities. We operate across five hospitals, including a national centre of excellence for heart and cancer care at St Bartholomew’s, a major trauma centre at the Royal London, with district general hospitals at Newham and Whipps Cross and a community hospital at Mile End. To give an indication of our scale, we have the most births in London and are the busiest Emergency Department across the capital. We have a turnover of approximately £2.4bn and employ about 21,000 staff. Whipps Cross hospital is on the new hospital programme, and we are really excited to see that progress.

We operate a group model, setting a clear strategic direction for hospitals to manage and implement at a local level by hospital leadership teams. This helps us to learn from each other and have a consistent standard of care in all our hospitals.

What are your priorities for the Trust over the next few years?

Ultimately our aim is to provide excellent and equitable healthcare for our local communities. We know that in North-East London health inequalities are greater than other parts of London and the UK. We want to address that and ensure everyone has access to the best treatment.

Like the rest of the NHS, we’ve been under pressure for some time, and this has impacted patients. In the short term, we want to reduce elective backlogs and ensure patients can be treated quickly in A&E.

But we also need to look to the future, taking advantage of new technologies that will help us to reduce demand for acute services. This will be crucial given our local population will rise significantly. I’m pleased the recent Darzi review has emphasised priority themes of digital, community and prevention.

What is Government suggesting the NHS’s role should be in supporting economic growth?

It’s long been recognised that the NHS is a major catalyst for economic growth for two reasons. The first is the sheer scale of the organisation employing over 1.5 million people, which through consumption locally and nationally adds significantly to the economy. The second is boosting numbers of those in active employment or able to work by reducing sickness due to ill-health and raising productivity. Some reports suggest that every £1 spent on the NHS results in £4 of economic benefit. Never-the-less, the country has suffered from tepid economic and productivity growth since 2008, with the Government suggesting the NHS focus on three main areas:

The first is reducing elective waiting lists to enhance the health of the working population. Waiting lists in England stand at approximately 6.4 million individuals, with elective waits across Barts Health at ~110,000 people. There are also reportedly over 2.8 million “economically inactive” individuals nationally due to long-term sickness. Resolving this backlog and returning healthy people back into the workforce is a primary ambition. Together with proactive care – that is stopping people becoming unwell in the first instance while maintaining their good health for longer – the size of the economically active, productive workforce should increase.

The second area is encouraging the NHS to work even more closely with industry and academia to enable the accelerated deployment of new treatments, devices and digital tools, which will lead to improved health outcomes for patients. In parallel, this should also enable growth of industry collaborators, who can then employ more people. Raising the number of people in high quality employment, especially those from areas of economic hardship, is an important ingredient in reducing health inequalities. The Government are suggesting the NHS act as the end-market, sending demand signals to suppliers, and playing a central role in enabling the UK to become a Life Sciences and Medical Technology Powerhouse. I believe that the Government ambition here for greater partnership between NHS-industry-academia is already an established and growing macro trend.

The third area is using the “local anchor institution” status of the NHS, where Trusts such as Barts Health can be one of the major employers in the locality, and therefore can provide both training and job opportunities for the local population. Of course, this endeavour encompasses people of all ages, from school children up.

Given the Government focus, what are the opportunities regarding waiting lists?

Across North-East London, there are approximately 220,000 people on a waiting list, mainly for initial outpatient appointments, of which approximately half are from Barts Health NHS Trust. Thanks to a collaboration with two other acute providers in the region (Homerton Healthcare NHS Trust and Barking, Havering and Redbridge NHS Trust), we are collaborating to schedule extra elective operations. People facing long waits for planned procedures will be offered the choice of appointments with a shorter waiting time. The plan maximises collective clinical capacity in specialities like oral surgery, ENT procedures, urology, ophthalmology and neurology. It means patients needing planned treatment could be offered a slot at any one of eight acute hospitals based on clinical priority and waiting times. The arrangement will help each Trust meet the national ambition to have no-one waiting more than 65 weeks for planned care.

The capacity plan is one example of how the NHS organisations in North-East London are increasingly supporting each other to become more resilient in providing both elective and emergency care, creating an “Acute Provider Collaborative.”

Further, within Barts Health, we have already seen the productivity benefits of specialised HVLC facilities. For example, surgical hubs like the Orthopaedic Centre at Newham exclusively perform planned operations and play a key part in plans nationally to increase elective capacity by bringing staff with specific skills and expertise together under one roof to streamline and increase the number of operations carried out. They are separated from urgent emergency services, so beds are kept free for patients waiting for routine procedures, reducing the risk of short-notice cancellation.

And what about the Government focus for the NHS enabling the UK to be a Life Sciences and Medical Technology Powerhouse?

This has been a long-held strategic priority for us and we are now in the position where, through various collaborations, we are planning to create one of the largest, most concentrated Life Sciences areas in the UK, with one Cluster in Whitechapel, based adjacent to the Royal London Hospital and Queen Mary University of London, and another in Canary Wharf.

While North-East London is home to two anchor institutions – Barts Health and Queen Mary University of London, what we have lacked, and are now creating with partners, is first-class, health-focussed, innovation space at scale for industry. The new real estate will enable us to deepen industry and academic partnerships and accelerate innovation into every-day healthcare practice, ensuring the people of North-East London, who have typically been under-represented in research, get the best possible treatment first. For industry, they will have access to our talented staff and compelling assets, such as our Secure Data Environment of anonymised patient records, and our new, larger phase I-III Clinical Research Facility in the Royal London.

In addition to being one of the largest Trusts in London and working closely with one of the most cited universities globally for medical research, a key USP is the scale and diversity of our local population, with over 2.5 million people representing backgrounds covering 97 countries. Having the world’s gene pool on our doorstep provides a “research window on the world” meaning research and innovation that works in North-East London can be scaled globally.

Barts Health is already working with a range of private sector and academic partners. This is going to scale exponentially as the new real estate at Whitechapel and separately in Canary Wharf comes on stream. Realising one of the largest, most concentrated Life Science Clusters in the country will create thousands of high-quality jobs which should make a meaningful impact on economic prosperity, and therefore improving health, in the local region. It is essential though that as many of our local community as possible can capture the employment opportunities on offer. We will be drawing on established endeavours, such as our Healthcare Horizons School Outreach, which works with 37 local schools, or our Barts Health Futures initiative, where we partner with local FE Colleges to provide the skills and training required for modern healthcare careers. Barts Health Futures has trained over 1000 Londoners, and we are tripling the training locations available over the next 12 months.

Creating a Life Sciences and Medical Technology Powerhouse is already well underway in North-East London. Never-the-less, in the long run we will be judged by whether we have made a transformative difference to the lives of the people who live here – improving health outcomes, reducing health inequalities and raising economic prosperity.

Our endeavours support the national imperative, but they also support London with its own developing Growth Plan. From a Life Sciences perspective, London has some enviable assets such as world-renowned healthcare providers, globally-leading universities, house-hold name innovative industries, not to mention the huge diversity of our population. Never-the-less Life Sciences currently faces skills shortages, a lack of high-quality real estate, challenges with investment capital, as well as ever-increasing global competitiveness. Our Trust will continue to work in partnership with those across London, such as MedCity, to help deliver the health and shared prosperity for all Londoners.

What are the challenges you foresee in delivering the Government’s ambition and how might these be overcome?

NHS capital investment will be a real challenge. We already have a significant capital shortfall at Barts Health and what we do have is prioritised on essential equipment and maintenance. To really transform healthcare, we will need up-front investment – which will undoubtedly deliver a return on investment in future years.

The NHS workforce shortage also constrains our capacity to accelerate change. For example, given the scarcity of some specialty roles, we find ourselves competing with other NHS Trusts – and the private sector – for these people. We know that there is a longer-term workforce plan, but it will take time to train these individuals. As another example, a greater number of staff will be required to boost our ability to trial and operationalise new innovations safely and at scale.

Meeting future demand is also a challenge. North-East London is the fastest growing area in the Country, with our population scheduled to grow 15% in the next 15 years, adding extra demand on our front-line services. The demographic change means we will simultaneously experience an increase in younger people as well as older patients, meaning increased demand for example for both children services as well as services supporting long-term conditions.

We will also need to find a balance between, on the one-hand, keeping a focus on shorter-term priorities such as waiting lists, urgent and emergency care, and financial sustainability, versus on the other-hand, delivering strategic, longer-term transformations that are discussed earlier.

Finally, to truly transform healthcare we need to have a whole system approach, centred around the patient, to provide the right care in the right setting. All of us need to be pulling in the same direction otherwise we will create further fragmentation in provision, which will have a detrimental effect on patients.

About the author

Shane was a physiotherapist in his native Australia, working clinically and managerially in public hospitals and private practice in Adelaide. He came to the UK in 1996 where he obtained a MSc in improvement methodology. He was part of the NHS London Next Generation Chief Executive programme and held several executive director posts at Board level, including at Epsom and St Helier University Hospitals NHS Trust and Barnet and Chase Farm Hospitals NHS Trust.

Shane was CEO of Hillingdon Hospitals NHS Foundation Trust and was deputy CEO at Barts Health for four years, leading on the operational performance of the five-strong hospital group. Shane took up the Group CEO role on 1 August 2022, becoming the accountable officer for both Barts Health and Barking Havering and Redbridge Hospital Trusts.