On 7th February the Health Secretary, Jeremy Hunt’s announced that the NHS would receive a £4.2 billion package of investment in health technology over the next five years, to move it towards a digital, ‘paper-free’ future.i This announcement not only throws up a number of challenges for the NHS it has also rekindled memories of past attempts at modernising the NHS IT infrastructure. In this week’s blog, Rebecca George, Head of our Public Sector Health team, shares her reaction to this strategically important announcement.
In fairness, the NHS gets less credit than it should for its progress to date with technology. All GP surgeries are computerised, the NHS has excellent technology for transferring data around the country, including digital imaging and online referrals, and the largest secure email service in the world.
But, with the National Programme for IT still casting a long shadow, many processes are stuck in the 1950s. Letters are sent between hospitals, GPs and social services. Many doctors still hand-write test requests, staff in hospitals move paper records from ward, to clinic, to operating theatre. Patients wait for doctors in beds and in clinics. NHS and social care organisations work in silos and, whilst some have improved processes and IT, they don’t communicate electronically with each other. Imagining the future when you are stuck in the past is difficult and the NHS will need support to embrace the opportunities health technology can bring.
Meanwhile, patients are becoming more digitally active and want to interact with health services in the same way as other areas of their lives. In 2015, 76 per cent of UK adults owned a smartphone, with ownership among people over 55 increasing by 40-50 per cent between 2013 and 2014. Seventy-five per cent of the population now go online for health information and there are over 165,000 health apps – though few are linked to NHS IT systems.ii
There are good examples of technology in the NHS. Community nurses equipped with tablets running a mobile working solution can cut paperwork by 60 per cent, giving them 29 per cent more patient time. Airedale NHS Trust found two way secure video consultations with care homes led to 35 per cent fewer hospital admissions, 53 per cent reduction in use of A&E and 59 per cent fewer hospital bed days.iii But the NHS has struggled to repeat such successes across different organisations.
More digital interaction with patients and other organisations has huge scope for improvement and savings. But, for technology to work well, lessons should be learnt and the right people must be involved.
Clinicians must own and lead the process. Digitising care is difficult because medicine is complex and full of judgement and exploration. Clinicians must know what’s on offer, what works for their environment, help develop their organisation’s vision and work with colleagues and management to agree clinical processes. Technology can, and should, enable this vision and professionals need, and often want, to be at the forefront.
We mustn’t underestimate the need to invest. You can’t design new ways of working from a desk. Experience suggests that every £1 spent on technology requires £5 to be spent on system transformation to ensure a safe and effective transition.
One size won’t fit all. A system right for one hospital, or to link several, won’t be right for another. It depends on the clinical vision. A large teaching hospital, with academic links, specialist treatments and looking at collaborating or merging with other hospitals, community health or other organisations will require a comprehensive transformation programme assessing and improving patient pathways and care plans, taking two or three years. But smaller organisations, offering a narrower range of services, won’t need such complicated solutions.
It’s no accident that some IT applications, like SAP and Oracle, are world leaders used by thousands of organisations. They are standard, ubiquitous and touch everything from finance, customers and inventories to staffing, performance analytics and communication. Installing new software can be complicated and everyone in the organisation needs to be involved before it arrives, knowing what to expect and how the ways they work will change.
As with all IT projects, things can change or go wrong. All sectors and all countries know IT projects are risky and complicated, particularly in the medical world. IT changes the way people work, people will want to change the project and external factors evolve over time. So it’s vital there are people involved who have done it before, can keep patients safe as clinicians learn the new systems, know what to expect and can fix things when they go wrong.
As our Connected Health report illustrates, done correctly, digital services can ensure the NHS continues providing world-leading universal care, overcoming financial challenges, supporting advances in research and improving patient outcomes.
There are inevitably risks, and 2020 is not far away, but the reward is a cost-effective, 21st century healthcare service.