Health May 29, 2019
How do we fulfil our digital aspirations for the NHS?

By David Duffy - Accountable Care Journal

Digital technology now forms an intimate part of our everyday lives and there is a strong consensus that the NHS is decades behind other sectors in embracing it. There is now an inherent expectation of having an integrated and interoperable health service, but this expectation has conflicted with the readiness of the NHS to adapt to transformational digital technology.

An outdated model for digital 

The readiness of the NHS, or rather lack thereof, to embrace digital reform was not properly considered in previous attempts to implement technological transformations. The sums of money associated with the benefits of these projects have been consistently inflated. When people lose interest in these projects, contractual levers are mandated in a way as to penalise staff for not using certain technologies.

A reasonable example would be the electronic referral system (ERS). While it is used in all hospitals in England, it is most certainly not being used with 100 per cent enthusiasm. Staff have paper-based methods to work around the process, rendering the presence of an ERS meaningless and too often the NHS ends up with a waterfall delivery of a project, rather than implementing a more agile approach.

The absence of effective performance management for digital projects has had a considerably restraining effect upon transformational change. Time and time again, organisations that fail to return instantaneous success are decapitated via central decision making – the same decision makers go on to ask why these organisations are failing?

Joining the dots 

Clearly, this approach is never going to nurture an environment in which digital innovators can thrive. The expectation for interoperability and integration of our health service, along with the acknowledgement that our current system will not facilitate this, was the genesis for the formation of NHSX.

Interoperability is key; no longer can the standard components of the NHS define its digital transformation. Until now the NHS has considered outpatient booking through an electronic referral system separately to another project considering how to book GP appointments using digital front doors while separately looking to book appointments via 111 online services. It is hoped that the small yet agile working group of NHSX will dissolve these barriers and bring digital development into single, tier-based, approaches.

Changes that need to be made

Time will tell how successful NHSX will be in creating a tier-based approach. After a first sale into a part of the NHS followed by a successfully implemented project, an innovative entrepreneur would be forgiven for thinking that they could do the same for another part of the health service. But this is not the case, the standard verticles that define the NHS often result in the failure to recognise the scalability of digital success.

The interoperability that allows innovation to spread is simply not there. Innovative organisations, often with genius ideas, formed by brilliant clinical minds, are being bankrupted by the NHS’ inability to grant them the market share they deserve. This is not only unfair but wholly counterproductive to the objective of digitally transforming our health service.

The future of this model

Within the NHS, directors need to have a better concept of what the value of their IT space is. Across the health service we are seeing executives who understand the nuances and complicated details of serious clinical incidents. However, when asked about their IT strategy they take a nervous look at their CIO and pray that they are competent.

The NHS must move towards citizen-centric technology; the successful implementation of which will see our dependency on workforce massively reduced. Even today, the crowds of staff that you see swarmed around single hospital beds are reminiscent of hospital care 20 years ago.

The idea here is to dissolve boundaries based on bricks and mortar and enable technology to coordinate and connect the pathways of every single point of care. Anticipating the effect that technology, like artificial intelligence, will have on healthcare can be terribly exciting, but we must get the basics right first. If we can correctly formulate our structure, our tiers, then perhaps Mr Hancock’s lofty ambitions for the health service will prove to be well-founded.

#ACJInsight #ACJDigital