The last few weeks have seen a welter of major policy developments relating to data and digital in the NHS. Following on from the Goldacre Review on health data for research and the updated Data saves lives policy paper, Health Secretary Sajid Javid this week also launched new digital health and social care plan in a Policy Exchange speech.
Why reform is (still) needed
The health minister once again underlined the imperative for change, noting that health spending is set to account for a massive 44% of public service spending by 2024. It doesn’t take a genius to see that this is unsustainable. Health is and will remain vitally important, but a system focused on acute care (and beset by a host of additional systemic strains, including but certainly not limited to the impact of the pandemic) is not working.
The most obvious need is for a shift to better prediction, prevention and earlier and more effective diagnosis and treatment of disease. Various policy changes are attempting to address this shift – albeit with perhaps disproportionate focus on the technological opportunities than the larger scale, harder to solve holistic prevention agenda.
However, technologies are undoubtedly part of the solution, and amongst these, digital and data solutions are critical. The NHS App seems to hold particular appeal for health ministers; and indeed it may become in time a very useful interface for coordinating, booking and delivery of some forms of appointments. How useful it will be for prevention in ‘helping people to find healthy choices’ and features such as the tool to estimate personal ‘heart age’ remains to be seen. What is unquestionable is that wider digital transformation of health and care that creates a robust, inter-operable and efficient system of electronic patient records is absolutely critical.
Closing the digital divide in health and care
At present – and despite years of announcements about and investment in digitisation of the NHS – over 10% of NHS Trusts still lack any form of the digital record systems, as do over 50% of social care providers. This is something that really has to change, and political action to close that gap is heartily welcome.
Perhaps one of the most telling observations in the new Plan comes from Dr Timothy Ferris, who as National Director of Transformation has the challenge of implementing meaningful change. He noted that ‘much of the important work the NHS does in this space won’t ever be noticed by people and their families – especially if it’s working well’. This is very true, and much like the rest of the health service – efficiencies and integration are not immediately obvious, but spiralling costs are only too clear to those in charge, whilst fragmented and ineffective care immediately affect both patient experience and outcomes. So how will these plans make a difference? Their aims are to:
- Prevent health and social care needs from escalating
- Personalise health and social care and reduce health disparities
- Improve the experience and impact of people providing services
- Transform performance
Driving digital transformation
The single most important elements in the new plan – which is less a plan than a statement of intent for the production of future plans – are those designed to drive digital maturity in the 42 new Integrated Care Systems (ICSs). These are the new regional partnerships between NHS and other local organisations involved in health and social care, launched today (1 July 2022).
Measures to embed digital transformation targets in ICS governance and regulatory requirements in partnership with NHS England (NHSE) and the Care Quality Commission (CQC) are outlined in the new plan, notably identifying ‘essential, non-negotiable standards of digital capability’ and enforcing them. The aim is also to provide targeted support to enable all ICSs to have core digital capabilities including electronic health records in place by March 2025, and all citizens to have a joined up life-long health and social care record by the same point. Recognising that social care is further behind, and in need of additional support with respect to high-speed connectivity, digital skills and cyber resilience, the stated aim is for 80% of Care Quality Commission registered social care providers to have digital records by March 2024.
In addition to these ambitious but critical targets, the plan also alludes to the need for new digitally-supported diagnostics and therapeutics, and for faster adoption of useful technologies in the NHS via clear standards for clinical safety and utility, interoperability, usability, cyber security and sustainability. Plus, of course, expanding the functionality of the NHS App and website ‘with features to help people stay well, get well and manage their health’ including digital health self-help products.
Making it work
These latest announcements are in line with the details of the Data saves lives policy, which included a big focus on ensuring that information is readily available to frontline health and care professionals, and to local and national decision-makers. They are also ambitious – whilst there has been progress on digital transformation in recent years, there is an awful long way to go. For example, whilst most NHS Trusts have some sort of electronic patient record systems in place, they are not necessarily effective ones, nor do different health and care providers within the new ICS groupings necessarily have the same or even compatible systems in place.
There are two key solutions to these mighty challenges. One is to get the right infrastructure, systems and standards in place. Key policy commitments that will help deliver these ambitions include:
- Making it easier to collect and share health and social care information, including simplifying information governance
- Developing effective technical infrastructure, including a focus on interoperability, standards and guidance, data architecture, storage and analytics
- Building analytical and data science, management and engineering capability
In order to achieve this, the other solution is to put in place leaders with the knowledge and skills to make it happen – which is why the stated intentions to embed digital skills, leadership and culture at every level of the system are perhaps more important than specific commitments. Whether the NHS is able create and empower this new workforce – which is radically different, and will require a whole host of new incentives, training schemes and support structures as well as integration with existing health and care professionals – is open to question. It may prove an even greater mountain to climb than the significant infrastructural, governance and technical hurdles.
In this context, it is interesting to note the Health Secretary’s assertion that it was his decision to combine NHSX and NHS Digital and bring them both into NHSE ‘putting all of the NHS’s digital bodies into the heart of a single organisation, exactly where it belongs, so ownership would sit right at the top of the NHS’. Whilst to most people this change was barely noticeable, could it kick start the cultural changes needed to deliver true digital transformation in the NHS?
The recent House of Commons Health and Social Care Committee inquiry into digital transformation in the NHS (to which the PHG Foundation contributed some specific insights) may also uncover important additional areas where scrutiny and action is needed.