Just last week we heard about how the NHS is facing a slew of new cuts to services across the country -with NHS England needing to find £22 billion in efficiency savings by 2020-21. Upon hearing the news, I asked the question: ‘Will the potential of digital health ever be realised?’.
Part of ensuring that the NHS fully takes advantage of its digital opportunity is understanding the role that data plays. Without organised, clean, well understood and accessible data, the NHS will really struggle to provide digital services that complement the necessary public facing healthcare.
Data should form the basis of everything that the NHS wants to do digitally. Inaccessible and siloed data will result in poorly delivered services that could have a real impact on patient health.
If you take a look the government’s platform strategy, for example, central to this is the ability to create new data registers that provide sources of ‘truth’ for what they relate to. These data sources can then be tapped into, with the approval of citizens, to provide a digital service.
The NHS’s data strategy will be critical. And MPs on the House of Commons Health Committee this week have released a report that warns about both the cuts facing public health, but also the inability for public health teams to get access to the data they need.
The report reads:
Local authorities face a number of challenges and have had to cope rapidly with major system change. In addition they face real terms cuts to public health budgets, including last year’s in-year cut of £200 million. As a result, they are trying to deliver more with less.
Whilst we have seen examples of innovative practice, local authorities are now at the limit of the savings they can achieve without a detrimental impact on services and outcomes. There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS 5 Year Forward View.
Cuts to public health and the services they deliver are a false economy as they not only add to the future costs of health and social care but risk widening health inequalities.
Quite. Which is why I’ve argued that cuts need to be balanced with a coherent strategy around how end-to-end digital services can complement existing physical NHS services. This is obviously very challenging to do, given the complexity and diversity of the NHS as an organisation, but it’s of critical importance.
As noted previously, NHS Digital, a relatively new organisation that is doing some interesting work and creating some interesting prototypes, is making some good progress.
However, the MPs noted that data is a problem. The report states:
We were told of significant problems with public health teams not being able to access the right level of information they need to do their jobs effectively. In some cases these problems may not have been a direct result of the move of public health teams to local authorities, but nonetheless they need to be addressed with urgency.
We recommend that the Department of Health review the barriers which exist to greater information-sharing, and that Public Health England and NHS Digital (the Health and Social Care Information Centre) address the specific issues which have been drawn to our attention.
The data conundrum
The NHS’s attempts at data organisation and sharing in recent years have largely been unsuccessful. The most significant proposal came in the form of care.data - a project that was aimed at linking data and mapping the delivery of services.
However, due to poor planning and terrible communication with the public, it was deemed a privacy risk and campaigners successfully got the programme scrapped.The project had promise, and what it was trying to achieve was admirable, but NHS England underestimated how sensitive the public are to their data being used in new ways. There is some comfort in the disorganisation of the NHS, in that silos create barriers.
Equally, the target of creating a paperless NHS by 2020 has been called into question, with the head of a government review into NHS IT systems declaring that the target was “not possible”.
In evidence to the House of Commons Health Committee, Public Health England, the primary regulator responsible for improving the NHS and the nation’s health, acknowledged that there are problems with data. Professor John Newton, chief knowledge officer for Public Health England, said:
I completely agree that at the moment directors of public health do not have good enough access to the data that they need to do their jobs. It is variable across the country. Again, it is one of the things that varies, but nevertheless there is a problem. It is in two categories. The first is getting access to data on healthcare activity for their population. The second is in getting access to operational data about the public health services that they commission – things like vaccination and screening services.
The report notes that in some cases data is “beginning to flow”, but that public health professionals claim that it has taken nearly three years of campaigning to get it. But even when data does come through, there is often a significant time lag, and an inability to link to other data sets.
The House of Commons Health Committee recommended:
Public health teams need to be able to access data in patients’ interests. We were told by PHE’s chief knowledge officer that a change in policy was needed to remove the current restriction that all linkage of health and social care data can only take place centrally, within NHS Digital (HSCIC). We recommend that the Department of Health review these barriers
Some areas have managed to access the data they need, and others have not. Some areas also lack the capacity to analyse their data. A co-ordinated national support programme is needed to ensure that until data is easily available to local authorities, all areas at least understand what data they are able to access, and how they can do so.
As noted above, getting this right is critical to the future success of the NHS. Whilst data use is always going to be sensitive when it relates to people’s health, if we want to provide a health service that is free at the point of delivery and keeps up with digital trends in the private sector, we need to consider how we can use data effectively to support digital services.
And once that strategy has been decided, the benefits need to be communicated properly and thoroughly to the public. Any hint that the public’s data isn’t being used and managed effectively, and there will be a backlash. The public need to be made stakeholders in these plans, to the benefit of everyone.