Health Secretary Matt Hancock is not wasting any time in delivering a new technology vision for the National Health Service (NHS), one that threatens vendors that are not willing to comply with an approach that centres around open standards, interoperability, user-led design and a cloud-first approach.
The new technology strategy for the NHS, announced today by the Department for Health and Social Care, states that “any system which does not meet these standards will be phased out and the government will look to end contracts with providers which do not understand these principles”.
Hancock took up his new position as Health Secretary over the summer following a Cabinet reshuffle and has since promised over £400 million towards ‘tech transformation’ within the NHS. He was previously Secretary of State at the Department for Digital, Culture, Media and Sport, where he spent much of his time talking up the benefits of digital and data within government.
The NHS has a chequered recent past when it comes to technology projects, with the National Project for IT proving to be a multi-billion pound disaster, and care.data failing within a matter of months.
However, the technology strategy announced today appears to opt for a GDS-style approach of setting standards and controls centrally, whilst allowing NHS organisations to adopt compliant technology that suits local needs. This is a far better approach, as the mandated top-down strategies of the past have failed to take into account the nuance of local healthcare delivery.
Health and Social Care Secretary Matt Hancock said:
“The tech revolution is coming to the NHS. These robust standards will ensure that every part of the NHS can use the best technology to improve patient safety, reduce delays and speed up appointments.
“A modern technical architecture for the health and care service has huge potential to deliver better services and to unlock our innovations. We want this approach to empower the country’s best innovators — inside and outside the NHS — and we want to hear from staff, experts and suppliers to ensure our standards will deliver the most advanced health and care service in the world.”
The main points
The full strategy - or ‘tech vision’ as the Department of Health and Social Care is calling it - is a wide ranging document, but those familiar with the approach taken by the Government Digital Service (GDS) will recognise some common themes.
For example, it states that at the core of the strategy’s vision are four guiding principles - user need, privacy and security, interoperability and openness, and inclusion.
It consistently states throughout the document that every service must be designed around user needs, whether that be the needs of the public, clinicians, or other staff. This has been a core mantra of GDS since the early days of its creation.
However, it’s the architectural principles that I think are particularly strong, as it gives the NHS a strong guiding framework to work towards. These principles are:
- Put tools in modern browsers - allowing all users to choose any modern computers and operating systems that meet their needs, as well as moving to a mobile-first approach.
- Internet first - adopting internet standards and protocols for networks and digital services
Public cloud first - start with the assumption that all services should run in the public cloud with no more locally managed servers
- Build a data layer with registers and APIs - The NHS should store data once - usually where it is created - and make it available where appropriate. Building registers allows the NHS to make data accessible over APIs.
- Adopt the best cyber security standards
- Separate the layers of the NHS patient record stack into: hosting, data and digital services - this aims to create a modular ecosystem and break up large contracts.
With regards to the open standards that have been discussed, the NHS’ standards will be in line with the government’s Open Standards Principles. However, the departments notes that it is consulting with staff, technology experts and suppliers to make sure the standards are the best choices for NHS users.
Offering her support for the new strategy, Sarah Wilkinson, Chief Executive at NHS Digital, said:
“Greater standardisation of data, infrastructure, platforms and APIs will create a health and care system which is more joined-up, and as a result safer and more efficient. Connected systems ensure that clinicians have immediate access to all relevant and appropriate patient data from all care providers and settings, and ensure that data is communicated between systems with absolute fidelity, eliminating misinformation and misunderstandings. In addition, we will increasingly be able to provide citizens and patients with direct and immediate access to their medical records.
“We recognise that the implementation journey is complex. Through consultation we will seek to understand in detail what the challenges are for different parties and throughout implementation we will focus on providing clear specifications, detailed guidance and extensive support. Our goal is to ensure successful implementation through engagement and facilitation, ensuring that changes that are mandated are reasonable and achievable.
“This work matters too much for any of us to shy away from the challenge.”
I’ll be honest and say that I didn’t have much care for the work Hancock did throughout his time at DCMS - it appeared to be more showboating and PR, rather than anything tangible. However, this strategy announced today is pretty strong. It’s got the core elements of a modern digital strategy - and a mandate - that the NHS can work towards. NHS organisations now know what they are aiming to achieve. However, the Department for Health and Social Care needs to learn from GDS’ mistakes. Forcing change from the centre is tough. Whilst some hard lines are excellent and will drive the necessary change, the Department needs to continue to work collaboratively to ensure it brings the NHS - which is an incredibly diverse organisation - along with it.
Also, as one of my contacts noted, this is a very technology-led strategy, which is the “easy bit”. There’s very little in there about cultural change, resourcing, recruitment, governance or a procurement strategy. This may just be the start with more to come, but those elements are also crucial.