NHS IT - will there be a digital cure this time around?

Profile picture for user gflood By Gary Flood October 2, 2016
"If we don’t do this, we won’t achieve the Five Year Forward View." A grim warning from the top of the NHS about the prospects for a digital healthcare service.

Take the medicine

Here's a tale of multiple programmes of technology-driven change for the National Health Service (NHS) in the UK - but will this one have a happier ending than previous ones?

One program is that of the NHS itself, in the shape of the Five Year Forward View, which sets out a set of ‘must-haves’ in terms of extra funding and organisational restructuring that, in the words of NHS Chief Executive Simon Stevens, “secure the future that we know is possible”, but only via a process where “the NHS needs to change substantially” and which “needs the support of future governments and other partners to do so.”

Another is that of the current government, which in the shape of the politician in formal charge of the NHS, Secretary of State for Health Jeremy Hunt, has been pushing for a ‘paperless NHS by 2020,’ which has earmarked £4.2 billion of extra funding for more use of IT between now and the end of the 2020-21 financial year, and who earlier this month outlined a raft of specific proposals about how that money should be disbursed.

Hunt’s plans are in turn a response to yet a third vision of how tech can help the struggling service, the Wachter Review.

But Stevens published his report in October 2014, which seems to suggest we only have 3.5 years left to meet his goals, most of which haven’t been anywhere near achieved.

And of the 20,000-plus health and social care organizations that collectively make up the National Health Service, a mere 12, all ‘Acute Trusts’ (hospitals that treat sick and injured people), have been singled out as being of potential world-class status when it comes to using digital technology.

The problem – or one of the many problems? – that bedevils the NHS from a technology point of view is its antediluvian dependence on paper. The system can’t get enough of it, as one of the key individuals tasked with doing something concrete with that £4.2 billion, Andy Williams, Chief Executive of NHS Digital, the newly-rebranded former Health and Social Care Information Centre (HSCIC), told the 4,000 delegates at the HETT (Health Efficiency Through Technology conference in London last week.

Flashing up a picture of NHS staff pushing supermarket-size trolleys full to overflow with binders and folders bulging with the stuff, Williams allowed himself a gag that drew wry chuckles from his audience:

The Information Superhighway of the hospital I was in for a recent minor procedure.

The problem

Funny, but for much of those listening, so much of this story – and the suggested solution, more computerisation – is deeply familiar. There seems to be some kind of systemic issue at the heart of the NHS’s approach to computers, fuelled by resistance by at least some clinicians in those 20,000 organizations (who seem unwilling or unable to take on the level of business process redesign and move off that paper) and resentment and suspicion about privacy of information at the public level (viz last year’s abandonment of the highly-controversial care.data data harvesting scheme).

Meanwhile, patients suffer – or at least, get levels of inconvenience from this industry that seem decades behind what they get when they digitally shop, bank, or travel.

Williams had three very telling examples of just how this works.

  1. An elderly patient with dementia who had two more blood tests than necessary, because the ward had no way to record they’d been performed.
  2. A patient with diabetes and Addison’s disease who shuttles between eight departments in five hospitals across three separate Trusts, who regularly wastes whole days because someone broke the chain or reporting and data’s bee lost.
  3. A blind patient who is totting up the number of ‘blind miles’ (which is different from the miles able-sighted people walk, due to the hassle of navigating a complex built environment with support aids) he racks up going for face-to-face appointments with his GP that could be much easier be done over Skype.

For Williams and other NHS IT fans, the solution is obvious:

We have got to get much better as a system when it comes to using the information that we have available to us.

As is the wrong way to do it – the much-trumpeted National Programme for IT, or NPfIT in NHS collective memory, the effort to do all this with much more than £4.2 billion at the start of the century (“We’ve tried top-down, centralised, and it kind of didn’t work”).

So, we try again, with the propaganda this time round of “a locally-driven, flexible approach,” ‘exemplars’ (those 12 super-IT hospitals) to show the way, and an attempt to raise the status and power of tech-oriented NHS managers via a new NHS ‘Digital Academy’.

My Take

Williams concluded his speech by warning,

If we don’t do this, we won’t achieve the Five Year Forward View.

There does seem to be genuine willingness to push the digital agenda in the NHS this time round, and the benefits of digital convenience in the rest of patients’ (and doctors’) lives is a big difference to the days of NPfIT.

But how realistic is the aim of ending the need for all those binder trolleys? Given disappointing past experience, I have to say not that great.