by Karen Taylor, Director, Centre for Health Solutions
This week I attended the launch of a new report, “Powerful Patients, Paperless Systems: How new technology can renew the NHS”.1 The report, authored by Alan Mak MP, Member of Parliament for Havant, and founder of the All Party-Parliamentary Group (APPG) on the Fourth Industrial Revolution (4IR), was published by the Centre for Policy Studies, and proposes ambitious reforms to the NHS. These include shedding paper, pagers and fax machines to create a fully digital NHS that will help patients take control of their treatment. Much of the content resonates with our own thinking, highlighted in our recent reports, – “Time to care: Securing a future for the hospital workforce in the UK” (February 2018) and “The future awakens: Healthcare and Life Sciences Predictions 2022” (November 2017). This week’s blog therefore shares some of the content from the Powerful Patients Paperless Systems (PPPS) report and discusses how this aligns with our own findings and, more importantly, could help health radically improve patient care.
Key findings from the PPPS report
The PPPS report acknowledges that the 4IR presents a ‘unique opportunity to strengthen and renew our most cherished public service’ – the NHS – but that there are obstacles to overcome. The foreword to the report, written by the Secretary of State for Health and Social Care (SoS), the Rt Hon Jeremy Hunt MP, echoes a key tenet of our Predictions 2022 report: that the rise of the connected patient is transforming the traditional paternalistic relationship between clinicians and patients. A transformation hat is driven by the availability of smart ‘finger-tip’ technologies that enable people to have a better understanding of their own health and become co-producers of their own treatments. Furthermore, that technologies such as automation and Artificial Intelligence (AI) have the power to liberate staff from labour-intensive, low-value tasks and also improve their understanding of a patient’s condition and treatment options, a message we articulate in our Time to Care report.
The SoS, speaking at the launch, highlighted plans to improve patient choice and access through technology including a new NHS app – which will enable patients to book appointments, contact the online 111 service, order repeat prescriptions, access and add to their GP record, and control how their personal data is used. He mentioned plans to invest in new apps and messaging services to allow doctors and nurses to communicate easier (highlighting the medCrowd app), and up-skilling NHS staff to use new technologies such as automation, virtual reality (VR) and personalised medicines. He also articulated his hope that the NHS should become a global leader in Big Data, AI, automation and connectivity. He pointed out that the Government’s Life Sciences Industrial Strategy and Personalised Health and Care 2020 policy provide an impetus to help achieve this vision, but noted that there are still challenges to overcome, not least the rate and scale of adoption.
Indeed, the reality, as illustrated in the PPPS report, is that pagers, fax machines and paper records remain ubiquitous across the NHS (with the NHS accounting for over 10 per cent of all pagers in circulation and the largest consumer of fax machines worldwide). Moreover, if the NHS is to achieve the vision of becoming ‘digital and paperless’, all NHS providers will need to implement a significant change management programme.
Related findings from our Time to Care report
Our Time to Care report provides evidence of some of the challenges to achieving the vision of the PPPS report, namely that currently few, if any, hospitals in the UK have developed a hospital-wide IT system to manage the entire continuum of care and workforce management. While our interviewees reported an increasing engagement with digital strategies, most struggled to use existing technologies, such as electronic health records and e-rostering to their full potential. Reasons given include difficulties engaging with and training their diverse workforce. In addition, our crowdsourced survey of doctors and nurses working across Europe, which explored, among other issues, their current use of technologies, found that:
- only 57 per cent of UK participants felt they were adequately trained in the use of technology;
- 52 per cent of UK doctors and 47 per cent of nurses consider their organisation well prepared for new technology; and
- doctors show greater satisfaction than nurses with the training and support they receive from their employer.
While doctors were generally more receptive to new and emerging technologies than nurses, robotics, virtual reality and AI were not seen as technologies that staff expected would improve the efficiency of patient care. Although this may simply reflect the low level of exposure to these technologies in the UK (see Figure 1). Our interviewees confirmed that while the technology to implement the future hospital vision is available, its implementation to date has mostly been in back office and administrative functions with only a few examples of successful use by frontline staff in their daily work.
Figure 1. Hospital doctors and nurses views on technologies that can improve the efficiency of patient care
Learning from the overall findings from both the Time to Care and PPPS reports
Both the Time to Care and the PPPS reports include a number of evidence based case studies of how breakthroughs are already transforming many aspects of healthcare, while also emphasising that as of yet, adoption remains quite localised. For me, one of the most compelling aspects of the PPPS report is the further evidence on the need to scale up adoption of proven technologies. The report highlights a King’s Fund article commissioned by the six Academic Health Science Networks AHSNs responsible for spreading health innovation. The reserach found that while only £1.2 billion is currently spent by the NHS on R&D, less than one per cent, just £50 million, is spent on the spread of new technologies.2
The PPPS report does not propose a single top-down project, but suggests that the Department of Health and Social Care should work with suppliers and NHS partners to drive a fundamental shift in behaviour through a series of linked changes. The report sets out three key targets to be achieved by 2028:
- move the NHS from paper-first to digital-first, with 100 per cent of interactions within the health service digitally driven by 2028 (an extension of the current target of 2023);
- build a flourishing ecosystem of apps and innovation, to better serve patients and put them in control, and ensure that savings from automation and innovation are ploughed back into frontline services; and
- ensure that budgets for R&D and technology training for staff rise in line with overall NHS spending.
The report also presents 10 key recommendations to drive forward these goals. While the report concludes this is not about more funding, clearly some seed-corn funding is needed, including investment in the spread of evidence based innovations that will improve care and the efficiency of care delivery. Additionally, given the vast amount of money still spent on outdated paper-based systems and processes that hold back improvements in both patient care and the public finances, some transfer of funding seems entirely possible.
In conclusion, two specific things need to change if the shared ambition for the NHS is to be realised. Firstly, clinicians need to be equipped to embrace the healthcare revolution through training on how to effectively use new technologies such as VR, AR and AI in order to deliver more effective patient care. This training could be funded via the savings provided from automation. Secondly, patients need to be at the heart of any new models of care, alongside wider accountability and transparency – which the adoption of new 4IR technologies should enable. New technology in the NHS can and should mean less time spent on administration, better diagnostics, fewer missed appointments, and ultimately more engaged patients empowered a by digitally enabled and paperless NHS.