Understanding NHS digital strategy

Following the recent submission of the Wachter report, Martin Cooper AMBCS looks at digital health’s past, present and future.

In a 36-hour period, the NHS provides care to one million people. In a year it delivers 700,000 babies and handles 22 million accident and emergency visits.

Care remains easy to access and, across many metrics, has improved over the last 15 to 20 years. To survive however, the NHS needs to digitise.

Let’s start at the beginning: What’s the problem we’re trying to fix?
Founded in 1948, the NHS has, at its heart, three core principles:

  • To meet the needs of everyone
  • To be free at the point of delivery
  • The availability of care should be based on clinical need, not on ability to pay

It has remained largely true to these principles for 68 years but the NHS is finding it increasingly difficult to remain so.

As people live longer their care needs tend to become more complex and expensive to support. The NHS cannot continue on its current path.

Haven’t successive governments tried to fix the NHS for years?
Over the past twenty years the NHS has attempted cost-cutting, reorganisations and changes in incentives and targets.

Despite these, the system is under serious and unprecedented stress. To continue to meet its founding principles, the NHS needs to change.

What’s the answer?
Healthcare is mostly about information. The problem is, the NHS currently stores lots of its information on paper - Trusts spend millions on buying, storing and transporting the stuff.

So, for the NHS to continue meeting the needs of everybody - at an affordable cost to the tax payer - the NHS needs to digitise and to use appropriate digital technology at every level.

Computers have been around for decades. Why digitise now?
The English GP sector began digitising in the 1980s and, by mid-2000s, achieved a near complete transition. It’s a tremendous success story.

The National Programme for Information Technology (NPfIT) targeted digitising secondary care and was launched in 2002. The programme was shut down in 2011 after having mostly failed to achieve its goals.

What went wrong?
NPfIT was criticised for being too centralised, for not engaging with trusts and their healthcare professionals, and for trying to accomplish too much too quickly.

A consensus has since emerged that the time has come to move forward. The Five Year Forward View, released in 2014, outlines an ambitious set of goals for the NHS, including improvements in quality and service and £22 billion in financial efficiencies.

Who is responsible for making digitisation happen?
In late 2015, the National Advisory Group on Health Information Technology in England was formed to advise the Department of Health and NHS England on its efforts to digitise the secondary care system.

It has recently released a substantial report: ‘Making IT Work - Harnessing the Power of Health Information Technology to Improve Care in England.’ The report is called the Wachter Report for short.

Who is Bob Wachter?

Robert M. Wachter MD is a world authority in the field of digital healthcare management. He is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco.

Dr Wachter is also an expert and leader in the fields of patient safety and healthcare quality and has been honoured for his contributions.

His book ‘The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age’ is a best seller in the US.

So, what’s the state of play with US digital healthcare?
The US came to the challenge of digitising health after NPfIT and, to some degree, learned from that project’s mistakes. The current US healthcare system isn’t however perfect.

The Electronic Health Record (ERH), for example, is well established but is not universally loved by carers. Some reports state that, because of ERH, doctors spend twice as much time on deskwork than they do with their patients.

According to Dr Wachter, one of the main reasons why America’s health digitisation programme has failed to deliver on its initial promise is the lack of user-centric design.

How committed is the UK government to seeing digitisation through?
Very. In early 2016, the Treasury allocated £4.2 billion to support the digitisation of the NHS. Jeremy Hunt, the Health Secretary, is reported to be a strong supporter of digitising the NHS too.

In a nutshell, what is the Wachter Review?
The Wachter Review was commissioned to inform the English health and care system’s approach to the continuing implementation of IT in healthcare. The review looked closely at the use of digital records and other electronics systems, in the acute care sector.

And the Wachter Report. What is it?

The Wachter Report was published in September 2016 and it makes many suggestions, including:

  • Digitisation should be done for the right reasons. This means meeting healthcare’s triple aim - better health, better healthcare, and lower cost. These align with the NHS’s Five Year Forward View and also the desire to achieve £22b of efficiencies across the health sector.
  • Trying to meet Five Year Forward without digitisation would be a costly and painful mistake.
  • We should avoid rushing into digitisation. The report emphasises the importance of getting digitisation right over getting it done quickly.
  • We must learn lessons about centralisation from NPfIT.
  • User-centric design and the importance of interoperability and effective data sharing are paramount.

Can you sum it up?
The NHS cannot afford to remain largely non-digital. Against this backdrop the report is broadly positive and finds that the NHS is poised to launch a successful strategy which will, ultimately, lead to a digital and interoperable healthcare system.

Critically the report warns: digitising effectively is not simply about the technology, it is mostly about the people.

Wachter himself is clear about the risks and pain of introducing technology, yet he is still a purveyor of hope. It will be difficult, but it is too important to avoid.

At the Chartered Institute for IT, our purpose is making IT good for society. In order to so this we have identified four challenges. One of which is health and care.

We are committed to leading debate and posing the difficult questions. IT Impact debates are events where you can contribute.

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