The Evolution of Specialist Healthcare

What does perfect healthcare look like?

Dr Richard Daniels

Healthcare in the UK is at a crossroads. After a tumultuous year of lockdowns and restrictions, the pandemic has highlighted the glaring gaps at the foundation of our healthcare system. This is a system under severe strain with healthcare professionals across the country needing immediate support. With patients either having to wait weeks for specialist healthcare appointments or being unable to afford private consultations, how can digital healthcare ease the burden?

Dr Richard Daniels, Clinical Lead at Pando, discusses how specialist healthcare is evolving and what perfect healthcare could look like.

What are the limitations of our healthcare system?

Resource, mindset and communication.


Central government funding has not kept pace for 10+ years with where it needs to be. This had led to capital issues: crumbling buildings, equipment outliving its lifespan and other false economies (ie removing staff spaces to create an extra bed space). This is a human resource issue – the well documented deficit in healthcare professionals of all stripes across the whole NHS. As the work burden increases, we find problems with recruitment and retention which then exacerbates the issues. There’s been a lack of investment in tech: EPRs that are clunky, sufficient IT equipment and a slow roll out of alternative healthcare options to patients. It’s taken a pandemic to force a reassessment of the paradigm and focus has therefore been on the sharp-end. Our acute care can be world class, but at the expense of non-critical care & mental health standards which have really fallen in recent years.


The NHS is an institution to be proud of, but it also creates its own culture, locally and nationally. This manifests a feeling that this is “how it’s done” and an unwillingness to challenge itself / be challenged. Even when change is agreed, the organisational inertia is huge and change can be slow. There’s a mistrust of new energy, which my cynicism suspects, comes down to serial governments announcing new miraculous plans to transform the service, which amounts to nothing but Political PR.


At some stage, we switched from a society that takes responsibility for our own health to expecting others to do stuff for us. This increases the demand which can’t be matched by the increase in supply of resources. How do we fix this? Improving the messaging on what the options are and what’s the right healthcare setting for each complaint? You wouldn’t take your car to a mechanic if you just needed some petrol. There needs to be a reeducation of what we expect from healthcare on a practical and digital level.

What are the biggest changes in healthcare today?

1. Staff are recognising their importance and, just as critically, are being recognised. Organisations are starting to put people at the centre of their planning and not numbers. It’s early days yet, but recognising this is the start of arresting the slide.

2. Digital innovations are changing the landscape. Although it can seem slow moving, with each year, the workforce becomes more digitally savvy with life in a way that was previously uncomfortable. There seems to be an acceptance between healthcare providers and patients that this is a good thing if done appropriately. Not a panacea, but another tool in the box.

Why is specialist healthcare important?

It is impossible to know everything – lord knows I’ve tried.

As a clinician, you have 2 options: breadth or depth. There are benefits to both depending on the situation, but everything is a trade off on those two axis. Specialist healthcare is all about depth. Having that depth of knowledge is critical at getting to the root of complex problems, or teasing out the shades of grey in non-textbook situations to ensure high-quality care can still be provided.

For a patient to receive quick, appropriate advice and reassurance, removes inefficiencies of care (i.e. waiting for referrals). Immediate access to specialist healthcare gives time to do a deeper dive into certain common conditions.

For our healthcare system, it helps redirect burdens from areas of high demand and ensures that only appropriate attendances to each area are made. In short, nothing is more important than access to the right healthcare.

What experience has shown the benefits of direct access to specialist care?

I’ve been in a privileged position over the last year to have worked directly on Juno, created by Pando Access, and seen how often we’ve improved the patient experience. By enabling them to avoid unnecessary care and alleviating anxiety quickly or by ensuring that a potentially significant clinical situation is dealt with before it becomes emergent – has been a truly innovating experience.

One particular example is the case of a small child who presented with non-specific symptoms, but the responding clinician felt something wasn’t quite right and referred the child onwards. The child ended up needing emergency surgery the following day, but in a stable fashion. This situation could have been a lot more extreme if left to develop without early specialist involvement.

Any predictions for the future of digital healthcare?

It’s here to stay and that’s a good thing. Technology has the capacity to shake up and level out huge parts of the old health paradigm that have baked in flaws.

Healthcare should now be more convenient, more integral to people’s lives. We have two choices as healthcare professionals: to fight it and lose, or to embrace it and mould the tool of technology to work towards ‘perfect healthcare’. It needs to be part of medical education and planning from here on out.

What does perfect healthcare look like to you?


For me, it starts with education and health literacy. What is normal? What is good? And what is bad? Nutrition, exercise, sleep, screen time, inequity and acceptance of mental health being as important as physical health.

Once we’ve cracked that simple first step…

Healthcare needs to be accessible: financially, geographically and communicatively (that’s a word, deal with it). You want to have speedy access to the right person, who can give high quality, patient centred care based on evidence and experience.

It should be a clean, simple and an ‘enjoyable’ process, where you feel part of the system and not carried away within it. It should be personal and recognised that health is more than cells and chemicals.

Healthcare should be honest about limitations and be willing to accept a patient’s needs above a clinicians. It should be truly multidisciplinary and it should be with a smile.

Don Berwick (a personal hero) talks about the Joy of Work in Healthcare. How it’s not enough to just be satisfied with your job, but that we should recognise the immense privilege we have to be part of people’s lives at their best and worst. That humility and recognising your part in the journey, despite all the training and the certificates on the wall, is absolutely critical to getting healthcare right.