The thought of a top-down initiative to ‘transform’ the National Health Service (NHS) and its use of technology and data will likely fill many with dread. Those that lived through the experience of the disastrous National Programme for IT will rightly have pause for concern - we don’t need another multi-year programme that sees billions of pounds wasted on nothing.
However, Health Secretary Matt Hancock’s current pitch for ‘transformation’ of the NHS is worth a bit of optimism (as much as it pains me to say it), as he is pulling directly from the government-as-a-platform (GaaP) playbook. Whilst GaaP in central government has taken a backseat in recent years, the NHS is a prime target for this approach and there could be significant benefits gained.
What would NHS-as-a-Platform involve? Well, there are a few key components to the approach, which Hancock is already making use of. These include:
A central function that sets standards and controls spending
Re-using common components wherever possible (build once and reuse)
Making use of open-source to enable sharing of code
Using the Internet as a common platform
The key to this is that NHS-as-a-Platform doesn’t have to mean standardisation across the health service. Local delivery units can still develop services for local needs. However, this should be done by using common components wherever possible, then adding specialist requirements on top.
This is often referred to as a Lego approach in those that promote a GaaP delivery. In a speech last week, Hancock explained it as follows:
In both primary and secondary care our patient record management systems are often ‘full stack’ contracts. The hosting, the data and the application are all built together as a single system.
It means that if you want to change that system in any way, it’s like swapping a crucial block from a Jenga tower. You risk the whole thing crashing.
It also means that when better, faster, cheaper tech is developed, the NHS can’t always use it, because we’re locked in to something that was cutting-edge when I was at university. Sadly quite a while ago now.
To extend the metaphor of the Jenga tower, we need to move from a Jenga world ‒ where you can only build one way, very slowly and with great caution ‒ to a Lego world ‒ where you can build lots of ways, swapping new pieces in and out as often as you like, without breaking the underlying structure. You can tell I’ve got kids.
This is not some unimaginable tech utopia, by the way. It’s how the internet works.
To this end, Hancock has already made some progress in putting this into action. For example, he has established NHSX - the NHS’s central tech transformation unit, which will be responsible for setting standards and reviewing spend. The organisation hasn’t been up and running too long, but it’s ambitions sound promising. Hancock said:
The purpose of NHSX is twofold. First, it’s about cutting through the bureaucracy used to stand in the way of tech transformation. When I came in to this role, one of the first things I wanted to do was make emails and not letters the default mode of communication between patients and the NHS.
Not too controversial, I thought. Surely this was low hanging fruit? It took me 7 months to get that decision agreed by all parts of the system. Seven months. Just to get to the end of the 20th century, let alone 2019.
So NHSX has brought together our scattered tech leadership into one decision-making point, giving them powers, the policy tools and the clout to get things done.
The second goal of X is to bring the mindset and practices of the internet to the way we deliver tech in the NHS. That means nationally agreed standards, locally-led delivery.
Commission what you want, but it has to meet our standards on cyber security, data access and interoperability. Otherwise we won’t approve the spending.
Hancock has also said “open sourcing any code developed in the NHS” will be mandated. Equally, the NHS will be moving health and care away from private networks such as N3 and HSCN, so that all services will be run over the internet.
In addition, the Health Secretary announced the new GP IT Futures contract, which he states will make it as easy for a GP surgery to switch IT provider “as it is for a small business to switch bank accounts”. Under the new contract, providers will have to follow set standards on interoperability and data access; systems will need to be continuously upgrade able; patient data will need to be securely hosted in the cloud.
He added that if providers do not follow these rules, “they will not get contracts”.
As Hancocked noted during his speech: “the problem is organisational, not technological”. And as much as it pains me to say Mr. Hancock is right, he is spot on in this assessment. As we’ve seen with central government’s digital ambitions, particularly surrounding the work of GDS, structural, systemic change is hard. Behaviours are deeply embedded. That being said, the NHS is so critical to supporting our society, and is coming under so much strain, that those in charge need to do everything they can to force the necessary change. I’m impressed with what I’ve heard thus far, but as always, the key will be execution. Let’s hope that NHSX and Hancock can learn from mistakes elsewhere and work collaboratively with key stakeholders to ensure everyone comes along for the ride.