The paperless NHS by 2018 challenge was announced by the Health Secretary back in 2013. Somewhere along the line this got pushed back to paperless by 2020. However, following a review by Professor Bob Wachter of the University of California, which stated that the 2020 target was also “likely to fail”, it is now thought we are looking at at least 2023 before the ambition is realised.
Speaking to the Committee, Hunt said:
I have made big, bold statements about it. I perhaps rather bravely said I wanted the NHS to be paperless by 2018 in my first few months as Health Secretary, and I am quite relieved that most people seem to have forgotten that I made that promise.
I think we are making good progress. There is definitely lots to do. We are weak at the moment on hospital IT systems. Professor Bob Wachter of the University of California, San Francisco, came over and looked at the state of hospital IT systems, and has given us some very good advice.
He does not think 2018 will be possible, it will not surprise you to hear, but he has given us some very good advice about how we can get our hospitals to world-class levels over the course of the next five years.
NPfIT failure a good thing?
The government’s track record on technology transformation in the NHS is poor, to say the least. One of the largest ever Whitehall IT projects was the National Programme for IT, which was aimed at standardising health systems across the country, and failed spectacularly.
MPs dubbed the programme “one of the worst and most expensive contracting fiascos in the history of the public sector”, with the government wasting over £13 billion of taxpayers’ money - and has very little to show for it.
Given the poor performance in recent years, it’s unsurprising that citizens and stakeholders are cautious about the Department of Health’s future plans for technology across the NHS. That being said, it seems that things are changing for the better.
We recently wrote about how NHS Digital, the team charged with delivering the paperless NHS promise, recognises that technology implementations in days gone by have been “too ivory tower” and about how it is trying to involve clinicians in the transformation programmes.
Equally, NHS Digital is working on how technology can better help patients to manage their own health, which will be essential to the sustainability of the health system, given the pressures faced by reducing resources and an ageing population.
Hunt told the Sustainability Committee that the failure of the National Programme for IT could actually benefit the NHS’s digital plans going forward, as he believes that it now provides the opportunity for the UK to “leapfrog” the rest of the world on healthcare technology. He explained:
This is an area in which we have been behind but we are hoping to leapfrog the rest of the world due to a very remarkable thing that our GPs did about 10 years ago. They decided to ignore the Government’s plans for a national IT programme in the NHS and exercise their right to go their own way.
The government programme collapsed, but they set up fantastic electronic health records, some of the best primary health records anywhere in the world, where the software is done by two British suppliers.
Amazingly, without anyone murmuring about this, without any request for funding from the government, they have digitised people’s lifetime records, going right back to the pre-internet era, and we have complete medical histories we are now able to use.
What we do not do at the moment, but it is starting to happen, is allow those records to flow around the NHS, but we have complete histories of people, which is a fantastic asset.
When asked by the Committee if it was fair to suggest that if the NHS failed to adopt innovative technologies and get digital right, would the sustainability of the NHS be jeopardised? Hunt responded:
Absolutely. I think this is a completely necessary condition to get this right.
Hunt said that GP records now flow freely around the GP system, and they are also reaching two-thirds of A&E departments, but that they are not yet flowing inside the rest of the hospital. The outcome that Hunt is hoping for is that patients will be able to go online, identify themselves and then get access to their own records - even on their mobile phones.
The right structuresHunt raised two other points regarding how the NHS should be promoting digital transformation across its very diverse estate. Firstly, Hunt suggested that health organisations need to make better use of data to make purchasing decisions, and that better incentives need to be put in place to make those decisions. He explained:
More broadly, we do not have financial structures that incentivise smart decisions. One of the things that the CCGs (Clinical Commissioning Groups) are in the process of doing, and through them the STPs (Sustainability and Transformation Plans), is for the first time tracking the total cost of each of their patients.
That is really important, because if you have a piece of disruptive technology that can help a diabetic improve adherence to their regime, you would be able to say to a CCG, “If you spend £100 on this little machine, you will reduce the annual cost of your diabetics from £5,400 to £4,200”, and it is a no-brainer for them to buy one of these devices for every single diabetic.
Because they do not have that data at the moment, which we are in the process of sorting that out, they look at that device and say, “That is £100. That is going to cost me money. I do not want to spend money on that because I am already overspent.” That is what we need to change.
Equally, Hunt doesn’t want to see the Department of Health mandating too many technology requirements or decisions, as what happened with the NPfIT, as this doesn’t allow CCGs to be innovative and experiment. Equally, the top-down approach has typically faced resistance from clinicians. Hunt said:
There is a lot of thinking going on about this, but the conclusion we have come to, or at least that I personally have come to, is that, when it comes to disruptive technology, the old model which says you have a single payer, who is the Health Secretary, and he or she decides the best technology for people with dementia living at home, and then we adopt it and roll it out across the whole system, is too slow and clunky. This is a very big system, and we need to free up the CCGs to purchase innovatively and to experiment.
I think that would be a quicker way to get new technologies adapted than if we rely on national bodies to do all these processes. National bodies can assess for safety and value for money, but I think we need to free people locally to experiment more.
It’s not like a politician to make a promise that can’t be delivered in the timeframes...oh wait…
Seriously though, I’m not adverse to those in charge changing their mind if what they had hoped is unachievable. That’s certainly better than forcing a system in a rushed timeframe, which is then poorly implemented.
Whilst Hunt has a track record of failing to deliver on what he promises, when it comes to the technology decisions currently being made (based off what he said during this session) it seems he’s taking some sound advice at least.