Next Steps – what it means for the NHS and its IT 

NHS England has published an update on the Five Year Forward View, outlining what it describes as “a series of practical and realistic steps for the NHS”. In this Q&A, Lyn Whitfield, Highland Marketing’s new content and strategy director, explains why the Next Steps document matters, and what it has to say about healthcare IT.

Remind me about the background?
NHS England’s chief executive, Simon Stevens, published the Five Year Forward View in October 2014. It laid out recommendations to closes a growing gap between NHS funding, demand and cost that is otherwise projected to reach £30bn by 2020-21.

Broadly, it argued that if the government found an additional £8bn for the health service in England, then it would be able to find the remaining £22bn through a combination of efficiency savings, new ways of working, and a renewed focus on public health to tackle demand.

How has that been going?
Since the Forward View was published, England has been divided into 44 sustainability and transformation plan areas, to develop plans to implement it at a local level. Last week’s Next Steps document updates on their progress and – as its name implies – says what should happen next.

So, what is the document’s assessment of progress?
Think-tanks and MPs on the health and public accounts committees have become increasingly concerned about NHS finances and performance. Much of the extra money that the government has found for the health service has been swallowed up by a crisis in the acute sector, while performance on key waiting times has slipped.

The Next Steps document notes that “the budget is growing – albeit slowly” but accepts that while “waiting times are still low by historic standards” there will need to be a “trade off” between maintaining existing targets and tackling financial and service pressures [more from Public Finance].

It sets out a new, NHS 10 Point Efficiency Plan to try and make the money go further, and a “stretching but realistic agenda” to create a “more joined up and responsive NHS” with quality improvements in key areas, such as mental health.

Anything about IT in there?
The original Forward View had a section on IT, and led to the Personalised Health and Care 2020 IT strategy. Next Steps says again that “the NHS needs to leverage the potential of technology and innovation” so that staff have new tools to do their jobs and “patients can take a more active role in their own health and care”.

Chapter ten, Harnessing technology and innovation sets out four areas for action: helping people manage their own health, digitising hospitals, technology to support NHS priorities, innovation for future care improvement.

Helping people manage their own health: Next Steps praises the ongoing success of NHS Choices, but says it will be ‘upgraded’ to nhs.uk this September. It also promises the relaunch of the NHS Digital Apps Library this spring, the London roll-out of the eRedbook baby and child record from this April, and further investment in free wi-fi for GP surgeries “subject to HM Treasury approval”.

Digitising hospitals: As so many documents have done before it, Next Steps notes that “while the NHS leads the world in the use of IT in primary care” there is a lot to be done in hospitals. Its plan is to expand and global digital exemplars programme, first launched in September 2016, and to partner exemplar trusts with “fast followers”.

Next Steps announces four new exemplar trusts, and seven mental health exemplars. It also says a new NHS Digital Academy will be launched by September, to “train a new generation of chief information officers and chief clinical information officers” and increase the chance of deployments being successful.

Technology to support NHS priorities: More of a mixed bag, loosely focused on improving first port of call digital services. Next Steps says NHS 111 will be redesigned to provide better triage, that all A&E departments and urgent treatment centres will get access to the NHS Summary Care Record or local shared care record service, and that STPs will be expected to improve online booking and prescription services.

Innovation for future care improvement: NHS England wants the health service to retain its position as a cutting-edge research environment, and outlines several steps to this end. These include further rounds of NHS Innovation Accelerator funding, which might do to IT, and more ‘test beds’ to drive take-up of proven ideas.

What was the reaction to Next Steps? The organisations warning the NHS is heading for meltdown were not convinced that the Forward View update would stop this. NHS Providers, which represents trusts, said the health service faced “mission impossible” and more money would have to be found.

The King’s Fund welcomed the report’s clarity on “what can and cannot be done” for the money that is available, but said the NHS “will have to work exceptionally hard to deliver all the promises in the plan” while taking forward its bigger ambition to integrate health and social care. The Nuffield Trust took a similar line, welcoming the report’s ambitions while outlining some major “stumbling blocks” to reaching them that include both cash and workforce challenges.

And on the IT front?
Next Steps received a relatively muted reception, since it reiterates existing policy. Digitalhealth.net noted that the funding for the first round of global digital exemplars has yet to come through, and there were no indications of when the mental health exemplars would get their cash. It also noted that there is still relatively little information on what the fast follower programme will look like.

Computer Weekly focused on the challenges that the NHS faces with apps, having been forced to close an earlier iteration of its apps library because of security concerns and a lack of clinical evidence for the apps included. The new version will be supported by a three-stage verification process.

What should healthcare IT suppliers take from all this?
The Next Steps document matters because it sets out the big picture against which the NHS will be working for the next few years. Despite the concerns of think-tanks and MPs, it does not ask for more money for the health service, or accept that more money will be needed.

Instead, it attempts to clarify what can be delivered and, importantly, reiterates that as far as NHS England is concerned the STP process is the only game in town. NHS administrative areas will shift as the STP ‘footprints’ mature and, in some cases, become ‘accountable care organisations’ delivering preventative, treatment and social care services for a defined population [more from the Health Service Journal (HSJ – subscription required)].

Suppliers will need to understand which organisations are covered by the STPs, and what their ambitions are. However, the STP process should create opportunities for the suppliers of data and shared record solutions to the NHS.

On the hospital front, Next Steps strengthens support for the global digital exemplar and fast follower concepts, by including mental health for the first time, and suppliers are likely to find the market shifting as trusts form up around digital leaders. On the digital front, it outlines some practical steps to try and make it easier for innovators and SMEs to use NHS data and to encourage organisations and staff to take up their ideas.

Useful resources:

• The Five Year Forward View
• Next Steps on the NHS Five Year Forward View
• HSJ round-up of Next Steps coverage