By Karen Taylor, Director, Centre for Health Solutions
Last month I participated in a panel discussion at the Technology Services Association International Technology-Enabled Care Conference on the subject of Citizen Powered Technological Enablement.1 In anticipation of the panel discussion, I agreed to write a blog on our July 2019 research report Closing the digital gap: Shaping the future of UK healthcare.2 This week, I thought I’d repurpose this blog as a Centre blog, to highlight some the challenges currently being faced in delivering a digital first NHS. Next month we will return to this issue with a focus on primary care.
What needs to happen to deliver a digital first healthcare system
Innovation and new technologies are key enablers of digital transformation, yet as most commentators highlight, healthcare lags behind most other service industries in the adoption of technologies to improve performance and the service user experience. Our report, therefore, highlights the opportunities and potential of digital technologies to tackle some of healthcare’s most intractable challenges. While we acknowledge the numerous policy initiatives that are currently in train, aimed at establishing ‘a digital first NHS’, we also highlight a growing divide between policy ambition and the reality of the experience on the front-line.
Key barriers to digital transformation include the complex structures of health systems in the UK, the many internal and external stakeholders, including local and national governments, regulators, commissioners, providers, variable quality of the IT infrastructure, the variability of digital technology suppliers and a wide range of end users with differing needs. This can often lead to misaligned interests, especially when it comes to sharing data and allocating resources. There is also an acknowledged need for clinical autonomy and robust regulations to ensure appropriate and safe patient care. Moreover, responsibility for digital, data and technology has, historically been highly fragmented, with accountability split across multiple agencies, teams and organisations. Although the establishment of NHSX in June 2019 is intended to address this, the extent and scale of problems facing the NHS means there is little time to lose.
Among the many digital health policy initiatives launched over the past six years, we identified several that are key to driving adoption of digital technologies. Two in particular are:
- the 2016 Wachter report ‘Making IT Work’ which recommended among other things, that all NHS trusts should achieve a high degree of digitalisation by 2023 or be deemed by the Care Quality Commission to be non-compliant on quality and safety grounds
- the February 2019, NHS Long Term Plan (LTP), arguably the most powerful signal yet on the importance of digital transformation and the explicit expectation that digitally-enabled care should go mainstream across the NHS, and that all providers need to advance to a core level of digitalisation by 2024.
Even though there is now a clear consensus that a digital-first NHS is needed, our research suggests that without additional investment in the IT infrastructure across the NHS, it is difficult to see how many trusts, especially those reporting financial deficits in 2018-19, can achieve the LTP’s expected levels of digital maturity by 2024.
Key findings from our research
The research for our report comprised an extensive literature review, interviews with 65 senior stakeholders across the healthcare ecosystem, a survey of 1,500 front-line clinical staff across the UK and insights from Deloitte colleagues working on digital transformation projects in the UK and globally.
Our survey respondents stated that the top three words that best describe the state of digitalisation today are ‘slow’, ‘expensive’ and ‘inefficient’. In addition, they identified the five largest barriers to the adoption of digital solutions as the cost of the technology (55 per cent); finding the right digital solutions (11 per cent); complexity of the technology (10 per cent); bureaucracy (8 per cent); and training (6 per cent). Our interviewees confirmed the findings of both our survey results and our literature reviews, that effective digitalisation at scale continues to prove challenging. Indeed, the majority of interviewees believe that it will take over ten years to achieve a fully digital health system, with the three major challenges to achieving this being ‘funding’, ‘leadership’ and ‘interoperability’.
Our interviewees also rated the current state of the IT infrastructure across UK healthcare as 5 out of 10, highlighting concerns about:
- a wide variation in digital maturity
- the general lack of investment in interoperability of electronic health records (EHRs)
- concerns over data privacy and security
- the need to equip staff with the information and training needed to adopt the technologies effectively.
Importantly, our analysis of the 2016 and 2018 digital maturity self-assessments (DMA) of all NHS trusts in England found that while the overall digital maturity had improved slightly, there is a growing digital maturity gap with scores varying from a low of 19 to a high of 98 out 100, and a national average of 66 out 100. Moreover, since 2016 the NHS has directed much of the funding for digital transformation to the 25 per cent of trusts that they considered were more digitally mature (the criteria also included having a strong financial position and good Care Quality Commission rating). This meant many other trusts have struggled to access digital transformation funding. Likewise, the establishment of eight Local Health and Care Record Exemplars, while providing a much needed boost to accelerate integration, also risks increasing the digital maturity gap.
Our research identified five key steps that are needed to ‘close the gap’:
- Create a robust health IT infrastructure for data storage, access to health data, and information sharing.
- Implement accessible electronic health records and invest in the basic technologies needed for digital transformation.
- Address the challenge of interoperability, identified as the biggest challenge to transforming services.
- Establish a robust governance framework to support a culture of digital transformation.
- Develop digital leadership skills and improve the digital literacy of staff and patients.
We identified 13 good practice evidence-based case studies and numerous other examples of transformation and recognise that innovative technologies are used in pockets of the NHS. However, we believe these have the potential to be disruptive if adopted at scale. Our research identified the following SMART characteristics that can help encourage adoption (figure 1).
Figure 1. SMART solutions transforming healthcare today
Encouragingly, when we asked our survey respondents what three words they would hope to use to describe the state of health care digitalisation in five years’ time, and the top three were ‘efficient, effective, and safe’. Our interviewees were more cautiously optimistic about the near future but also determined to help drive the much-needed digital transformation.
Overall we concluded that currently digital transformation lags behind where it needs to be if the NHS is to remain sustainable and affordable and deliver the ambition in the NHS LTP. The variable state of the IT infrastructure and differences in rates of adoption of technologies requires a more concerted emphasis on change management to accelerate and improve the quality of information flow, and close the digital gap. At the same time the UK’s existing health and care providers need to adopt a digital first mind-set and embrace the transformation needed to deliver a modern and responsive health and care system, or face being left behind and replaced by new incumbents with a more agile, innovative and accessible approach to care delivery.