MPs hear how digital can support sustainability of NHS, but barriers remain

Profile picture for user ddpreez By Derek du Preez January 19, 2017
Written evidence to the Health Committee outlines the important role digital could play in reducing pressures on the NHS.

Health NHS
The NHS this winter has been under an extreme amount of pressure. The amount of people passing through the system, combined with the lack of space and staff to support them, has led to the Red Cross declaring a “humanitarian crisis” in England’s hospitals.

The NHS disputed this claim and the Prime Minister said that she ‘didn’t accept this description’, but said that the pressures were down to the UK’s ageing population.

And whilst Prime Minister May isn’t wrong about an again population across the UK, it’s also true that the most recent OECD figures show that as a percentage of GDP, the UK spends less on healthcare than almost all of the original 15 EU countries, as well as its peers in the G20.

Combine an ageing population, a rise in multi-morbidity, an increase in patient expectations, population growth and a lack of investment in the system - it’s unsurprising that hospitals, doctors and nurses are struggling to cope.

Given this winter’s pressures, it was with interest that I saw that the parliamentary Health Committee this week published a very large document with written responses from doctors, the private sector, hospitals and the health industry, regarding the long-term sustainability of the NHS.

Throughout the 1,200 page document there are 218 mentions for digital and over 900 mentions of tech. In short, there was a lot of evidence submitted regarding the impact that modern technologies could have on easing NHS pressures.

In fact, there was too much evidence submitted to highlight in full here. However, I thought it may be interesting to pull out and present some of the key messages submitted by some of the more notable organisations that took part.

The AHSN Network

The AHSN Network brings together the 15 Academic Health Science Networks across England and aims to spread innovation “at pace and scale”.

The AHSN Network highlighted how the NHS is yet to fully respond to the potential of digital, and that barriers remain regarding the NHS’s ability to experiment and introduce innovation. It’s submission said:

The past two decades have seen a level of technological innovation that can shift the NHS from analogue to a digital care model, putting the patient at the centre as a co-producer of their health and healthcare. Such innovation has the potential to democratise the existing medical model in a way never seen before. However, unlike other industries, the NHS has still not sufficiently integrated these technologies at pace and scale to turn potential into reality. The reasons for this are complex and there are no silver bullets.

Most organisations in the NHS are required to plan on an annual basis and, more importantly, commissioners have to balance the books in-year. While there is some flexibility, this is a commonly cited barrier to long-term commitment to invest-to-save programmes. Short-term accounting rules militate against long-term investment and require finding alternative routes locally, such as social impact bonds or new contracts with industry.

A lack of contestability of most existing services, most notably in primary care, provides incumbent providers with very little impetus to change radically, unlike in other industries. The most radical improvements have often come from outside the NHS, for example from SMEs or wider industry.

We therefore would like to see more options to non-NHS providers to provide services under the NHS branding and in accordance with NHS values, as is the case with self-employed GPs. This would offer providers currently outside the NHS – e.g. from the voluntary sector – with the mechanisms to provide their services and contest the market, proving the extent to which it is open to new ways of delivering services.

There is currently an expectation that all nationally driven change programmes will be successful, such as the recently launched Vanguards programme. True innovation and transformation requires experimentation, failure and learning from these failures. Such an approach also requires reviewing the scale of and political investment in pilot programmes and moving towards smaller, quicker and cheaper methods of experimenting which are more akin industry standards in other sectors, such as engineering.

Association of British Pharmaceutical industry

NHS Health
The ACBI represents research-based biopharmaceutical companies leading biosciences in the UK. It represents companies that supply more than 80 percent of all branded medicines used by the NHS.

The ACBI took its response as an opportunity to highlight the opportunity that better use of data could provide to the health system in the UK. It’s worth noting that NHS England has attempted to improve its data infrastructure in the past and run ‘big data’ projects - but due to poor communication, failed to convince the public of its benefits and faced a backlash.

The ACBI said:

The NHS should capitalise on its potential to act as a ‘single healthcare system’ to make it a global leader in using real world data. Better use of real world evidence would allow for more innovative patient pathways to be created, facilitate the creation of more complicated reimbursement models and improve patient outcomes by increasing our understanding of treatments.

Progress is already being made with data registries, like the Cancer Registry for the Cancer Drugs Fund, which can help to improve early access and accelerated access to new medicines. There are already examples where the pharmaceutical industry is working with the NHS to invest in the technological infrastructure needed to realise improvements in patient outcomes.

One way to improve NHS sustainability is to reduce the cost burden on the NHS through this kind of innovative collaboration. NHS England could use a competitive advantage in data, to encourage increased company investment in the UK health sector.

Better data makes the UK a more attractive environment for investment, clinical trials and this will lead to innovative treatments being available faster in the UK.

Dell EMC

As one can imagine, Dell EMC (well, mostly Dell) has a long history in providing technology to the National Health Service and working with the government on IT programmes aimed at improving frontline service. The failed National Programme for IT, being one it probably wishes to forget.

However, as Dell EMC was one of the few technology providers to respond to the Health Committee, I thought it worth highlighting its response here:

Better use of data and technology in the NHS can bring huge efficiency savings and fundamentally transform how care is delivered. A recent report by the economic consultancy Volterra Partners examined the productivity and financial implications for the NHS of making more widespread use of current best practice with regard to the use of information and analytics technology across the NHS. This report found that doing this would improve efficiency in the healthcare sector by between 15% and 60%, resulting in savings to the NHS of between £16.5 billion and £66 billion per year.

There is an opportunity to respond to the challenges posed by an ageing population and rise of long term conditions by using data more effectively to move to a more proactive, preventative, and personalised system – the Wellness Model.

This can be achieved by focussing on: Interoperability of patient records, enabling them to be accessed and updated at any point in the healthcare system; Greater use of data analytics, to enable risk stratification and prevention, and improved treatment outcomes; Using mobile technology to enable health professionals to work more efficiently and make patients more engaged in their care through use of e.g. apps and health monitors.

Local Government Association

The LGA works with local authorities, regional employers and other bodies - effectively as the voice of local government.

Whilst the LGA recognises the potential of technology improvements across the NHS, its response also did well in highlighting the significant barriers that remain in driving effective change throughout the system. Its response said:

Despite innovations in this area there remain barriers and challenges to support local delivery. These are as follows:

• A national lack of funding which specifically supports innovation in social care: There is a national commitment to support the development of information and technology across health and care through the National Information Board (one of the Five Year Forward View Boards). The Secretary of State for Health has committed £4.2 billion to a programme of work over the next five years. The LGA is calling for a significant emphasis on those programmes to focus on enabling local delivery and to support the move towards health and care integration (including for care providers), rather than solely funding digital adoption in the acute sector.

• Challenges to information sharing: There are positive local examples of where information sharing is taking place locally and where there has been strong engagement with citizens. However, more should be done to address the challenges to information sharing and support the effective delivery and commissioning of local health and care services.

• Broadband coverage: The LGA has called for better broadband speeds and phone coverage in rural areas. Access to faster and reliable broadband is a key way of enabling residents who are housebound to live independently, which can help to reduce social isolation particular in rural areas. Greater broadband coverage has significant benefits for community healthcare and telehealth, for example ensuring GPs have access to patient medical records or they can check the availability of medicines when necessary. Good digital connectivity is a vital element of everyday life for residents and can help them cut household bills, shop online for cheaper goods, stay in touch with distant relatives and access their bank accounts. As central and local government services increasingly become ‘digital by default,' it will become increasingly important for more people to have faster and more reliable speeds.

• Leadership and cultural change: With significant progress being made in the digital and technology sector, there is an opportunity to transform health and social care and most importantly, to achieve greater integration between services. To build on this progress, we are calling for whole system leadership to create greater awareness of the benefits of technology for health services. The LGA has been working with councils to highlight areas of best practice and we have called for system leaders within the health and social care system to build on this momentum. We want to see a culture change in health and social care whereby technology is used to enable innovative and transformative programmes, to improve the service for patients and the wider community,

Public Health England

Public Health England is an executive agency of the Department of Health, and exists to “protect and

improve the nation’s health and wellbeing, and reduce health inequalities”.

The organisation took the opportunity to highlight the potential of technology to change behaviour, but also noted that the benefits may be skewed towards higher income earners. It said:

There is substantial potential for technology to provide new and improved preventative approaches and better public health, although in many cases the evidence to support the use of these new approaches is still emerging.

There are new digital health interventions that have the potential to provide behaviour change support at large scale and at low cost – for eg apps on mobile phones to help diet or lose weight, or ‘wearables’ – such as step counters. The number of medical, health and fitness apps is increasing with more than 40,000 on the market. The potential for this is increased by high levels of smartphone ownership in the UK (71% of adults have one).

In addition, as with most new technologies, uptake can be skewed towards those who are wealthier, or with higher socioeconomic status – so caution has to be taken to ensure that technological solutions do not act to create or reinforce existing inequalities in access or health status.

Also challenges exist around data ownership and privacy for new digital prevention approaches, as well as interoperability of these approaches with NHS data systems.

In the future, there may be opportunities for new technologies, including artificial intelligence and machine learning, to learn to spot disease patterns or provide advice that is highly tailored to the individual or population. For example, Google Deepmind is currently using artificial intelligence techniques to see if it can identify signs of eye disease earlier from eye scans and UCL is developing techniques to use artificial intelligence to rapidly pull together the best evidence on behaviour change. Much of this work is exciting, but still a work in progress.

My take

If you’d like to take a look at all of the submissions, the document of evidence can be found here. The NHS is a huge and massively complex organisation. The top down approach to technology implementation hasn’t seemed to work in the past, due to local needs and requirements not willing to change for a standardised approach.

Apart from the obvious cultural change priorities, the NHS’ biggest challenge in my mind is data. So much could be done if data was organised and being used properly. But again, given the sensitivities in this area, it’s not an easy hurdle to overcome.

I am aware that NHS Digital is doing some good work in these areas. However, this also needs to be matched with funding from the government if we want to maintain free healthcare at the point of service.