The NHS can’t meet tomorrow’s demand with yesterday’s model

Without a more proactive approach to care, demand will continue to outstrip capacity, writes Markus Bolton, executive director at Graphnet Health

Across the health service, there is growing recognition that the current model is no longer sustainable.

Hospitals and GP practices are under sustained pressure, while workforce and infrastructure struggle to keep pace with rising demand.

The NHS was built around a reactive model. That approach cannot meet the scale and complexity of modern healthcare needs.

As people live longer, often with multiple long-term conditions, demand continues to rise across general practice, emergency care and hospital services. Even modest increases now translate into significant system pressure.

The opportunity is clear: intervene earlier, manage conditions more effectively in the community and prevent deterioration wherever possible.

Digital technology is central to enabling this shift, but it is only part of the solution.

What is required is a fundamental change in how the NHS identifies risk, coordinates care and manages populations, built on three foundations: data, scale and integration.

Why pilots are not enough

Over the past decade, the NHS has delivered many successful digital pilots. Yet relatively few have translated into system-wide transformation.

The key issue is scale.

Small pilots can demonstrate positive outcomes, but they rarely produce the level of evidence needed to drive widespread adoption. When programmes operate across only a few hundred patients, their impact remains open to interpretation.

By contrast, when initiatives scale to thousands or millions, reductions in emergency admissions and A&E attendances become measurable, and the operational and financial benefits harder to ignore.

When initiatives scale to thousands or millions, reductions in emergency admissions and A&E attendances become measurable

This is the difference between innovation and transformation.

The NHS has seen this before with shared care records, which demonstrated local value long before becoming embedded nationally.

The same now applies to predictive analytics, remote monitoring and population health management. To transform care delivery, these approaches must move beyond pilots and become part of routine clinical practice.

Predicting risk before crisis

One of the most significant advances in modern healthcare is the ability to predict deterioration before it happens.

The NHS holds vast amounts of data across primary care, hospitals, community services, ambulance services and social care. Bringing this together creates a more complete picture of risk.

When analysed effectively, it allows services to identify individuals at highest risk of deterioration or hospitalisation and intervene earlier.

In Cheshire East, predictive modelling identified more than 3,500 high-risk residents. Multidisciplinary teams coordinated proactive support.

Emergency admissions fell by 26%, while A&E attendances dropped by 14.6%, with some areas seeing reductions of up to 48%. Importantly, 74% of patients maintained or improved their complexity score.

Instead of responding to crisis, services intervene earlier, reducing escalation and improving outcomes.

Looking beyond the virtual ward

Much of the NHS focus on ‘hospital to home’ care has centred on virtual wards. This is a valuable model, but the greatest opportunity for remote monitoring lies in long-term condition management.

In virtual wards, monitoring is typically short-term. By contrast, patients with long-term conditions can be supported over months or years, with monitoring embedded into everyday care.

The greatest opportunity for remote monitoring lies in long-term condition management

This allows clinicians to detect early signs of deterioration and intervene before conditions worsen.

In East Kent, emergency hospital visits have fallen by nearly 70% among patients supported through proactive monitoring. In Frimley, reductions in A&E attendances have approached 40%.

These outcomes demonstrate that remote monitoring is most effective when deployed as part of long-term, population-level care.

A connected view of the patient

For proactive care to succeed, it must operate within a connected system.

Patients move between GP practices, community teams, emergency departments and hospitals, with no single organisation holding the full picture.

Shared care records enable this coordination by giving clinicians access to a single, up-to-date view of the patient.

When data flows across the system, patients can move between levels of support, from self-management to remote monitoring and, when necessary, escalation to specialist care.

This step-up, step-down model is fundamental to delivering sustainable healthcare.

Looking beyond clinical data

Predictive analytics also enables services to look beyond clinical data alone.

Many drivers of poor health, such as housing quality, financial hardship or fuel poverty, sit outside traditional healthcare settings. By combining clinical and socioeconomic data, systems can identify at-risk populations earlier and target support more effectively.

In St Helens, this approach has been used to identify families experiencing fuel poverty where children were at increased risk of respiratory illness. Targeted intervention helped address these risks before serious deterioration occurred.

From pilots to system change

Across the NHS, there is increasing evidence of what can be achieved when proactive care models operate at scale.

Population health platforms support insights across millions of patients, enabling more targeted intervention. With scale, systems can stabilise demand, reduce avoidable hospital activity and improve outcomes simultaneously.

In the coming years, success will not mean eliminating demand, but managing it more effectively.

More patients will manage their health at home with digital support. Remote monitoring will detect deterioration earlier, population health analytics will guide intervention, and clinicians will share a unified view of patient information.

Hospitals will remain essential for acute and complex care, but will no longer be the default destination for every health crisis.

Technology enables this transformation, but the real impact comes from how services collaborate, integrate and operate at scale.

The evidence exists. The challenge now is to act.