“Worrying lack of a credible strategy” for digital in NHS, says Lords report

SUMMARY:

The Select Committee on the Long-Term Sustainability of the NHS warned against short-termism thinking, a lack of leadership and poor incentives.

NHS HealthThe House of Lords Select Committee on the Long-Term Sustainability of the NHS has warned that there is a “worrying lack of a credible strategy” to encourage uptake of technology and innovation across the health service.

In a report out this week it cited short-term thinking from the government, a lack of funding, poor incentives, as well as change management and leadership challenges.

The NHS has a very chequered past when it comes to the implementation of new technology – with the most notable disaster being the National Programme for IT, which was intended to transform the way the health service uses information, but ended up being a complete failure and costing the taxpayer billions.

Currently the digitisation of the NHS is incredibly fragmented, and there have been numerous commitments to speed up progress. The latest being an ambition to make the NHS paperless at point of care by 2020 – which has been allocated £4.2 billion, but has already been dubbed as “likely to fail”.

However, change is necessary. The NHS is facing huge pressure from a lack of funding and an ageing population. Technology is likely to be key to its future sustainability – as a mechanism to cut costs and create new models of service delivery – but the strategy for how this is achieved remains unclear.

Part of the work is being done by NHS Digital, an organisation charged with improving the use of information and technology across the health system, but its still in its early days and the extend of its remit isn’t entirely clear.

Lord Patel, Crossbench Peer and eminent obstetrician, commented on the report out this week and said:

The Department of Health at both the political and official level is failing to think beyond the next few years. There is a shocking lack of long-term strategic planning in the NHS. This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.

To solve this we need a new body that is independent of government and is able to identify clearly the healthcare needs of a changing and ageing population and the staffing and funding the NHS will require to meet those needs. This new Office for Health and Care Sustainability should be a trusted, independent voice as the Office for Budget Responsibility has become on economic forecasting and on public finance matters. It will need to look ahead and plan for 15-20 years into the future.

The report states that a “culture of short-termism” seems to prevail in the NHS, with the short sightedness of successive government reflected in the Department of Health, which doesn’t’ think beyond the next few years. The report says:

A new political consensus on the future of the health and care system is desperately needed and this should emerge as a result of Government-initiated cross-party talks and a robust national conversation.

The Lords Committee argues that an increase in funding or a change in government focus will be needed to protect the NHS’ future. It continues:

We are clear that a tax-funded, free-at-the-point-of-use NHS should remain in place as the most appropriate model for the delivery of sustainable health services. In coming years this will require a shift in government priorities or increases in taxation. We are also clear that health spending beyond 2020 needs to increase at least in line with growth in GDP in real-terms.

Slow progress

The Committee report states that leaders in the NHS seem “incapable” of driving the much needed change in levels of productivity, uptake in innovation, effective use of data and the adoption of new technologies.

It says that too much management and clinical attention is focus on the day-to-day work and there are few incentives to get the NHS to look ahead at the longer term.

To add to this, the report states that it not clear who is ultimately responsible for driving innovation and ensuring consistency across adoption. The Committee wants to see harsher consequences for NHS organisations that don’t comply with any set digital agenda. It states:

It should also identify the bodies and areas within the NHS which are falling behind in the innovation and technology agenda and make it clear that there will be funding and service delivery consequences for those who repeatedly fail to engage.

However, the opportunities are there and technology could change the type of care that is provided. Andy Williams, Chief Executive of NHS Digital, gave evidence to the Committee and outlined some of the ways in which new technologies would support NHS sustainability. He said:

In the future, as patients start to have access to their health records and so-called ‘artificial intelligence’ can be used to understand what is wrong with them and to compare their health record to the health records of the broader population, they can come up with smart diagnoses to help the patient understand what they should do next, and it could be to go to A&E or it might not be.

The second is that we can use technology better to create more efficiencies in the way the system works, through interchange and passing information around … Within hospitals, technology systems can not only improve quality but can increase efficiency and effectiveness.

The third area is a much better use of data generally … data can be used in all sorts of ways in the future: to understand how effective the system is; to develop new treatments and new drug treatments more effectively; and linking genomics data to phenomics data.

Better incentives

Dr Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, told the Committee that healthcare professions “love technology”, but there are problems around getting standardised, joined up systems that can be used across the board. These sound like the sort of problems that GDS in central government is attempting to provide solutions for, which suggests that there may be a role for NHS Digital to play here.

Professor Sir John Bell, from the Academy of Medical Sciences, told the Committee that the government needs to directly link financial incentives to innovation – otherwise change will be slow and fragmented. He said:

It is worth remembering that the Americans did this in a really short timeframe. They, essentially, digitised their entire healthcare system, which, as you know, is chaotic at best, and they did it by incentivising the hospitals and making sure that reimbursement was directly related to the ability to digitise.

If the NHS tomorrow said, ‘Do it at whatever pace you like, but you will not get paid if it is not digital data’, I can tell you that, by Christmas, you would find a lot of stuff had happened. Hospital trusts have a lot of stuff on their plate, so why would they do it when they are doing everything else?

Better leadership

However, opportunities and technical challenges aside, it is unsurprising that the Committee heard plenty of evidence that the problem largely rests with the people in the organisation. Changing culture and approaches is never easy and the report state that “the evidence was almost always accompanied, however, with a call for stronger leadership and more effective management”.

It adds:

Technologies do not implement themselves and innovative ways of working will only be adopted where there is a culture which embraces change.

Andy Williams, Chief Executive of NHS Digital, said:

… this is not a technology challenge; the technology largely exists and will continue to exist. Like everything, it is a people challenge, so the one thing I would point to is to get the leadership at all levels across the system to understand the benefits generally and the benefits in particular to their organisation of these sorts of technologies.

My take

Incentives, leadership, centralised standards, top-level driven change – all these things are needed. It amazes me that with all the talk of the NHS being under pressure that not more focus is given to the opportunities technology gives for changing the models of service delivery. This should be the number one priority.

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