As the year opened, Theresa May was prime minister, Matt Hancock was health and social care secretary, NHS England and NHS Improvement were separate organisations. As the year closed, Brexit had forced a change of government and a general election, and the NHS was in the throes of an under the radar re-organisation to try and support the NHS Long Term Plan.
Over the course of the year, there were also changes to health tech leadership, with the departure from NHS England of Matthew Swindells, the leader of the global digital exemplar and local health and care record exemplar programmes, and the arrival of Matthew Gould at NHSX, which has still to launch any substantive projects. There were also stories about major US companies being given access to NHS data that turned out to be significant when this became an election issue; and a potential focus for IT coverage in 2020.
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The country went back to work with the health service waiting for the NHS Long Term Plan; the strategy setting out how it should spend the additional £20.5 billion a year by 2023-4 that prime minister Theresa May had found to mark NHS70 the previous summer [HCRU 4 January 2019].
The plan was published on 7 January, with ambitions for the service to return to financial balance, deliver on targets and productivity improvements, move to an integrated care services model, tackle health inequalities, and improve mental health, cancer and primary care [11 January].
Then, wholesale changes to the NHS and health tech leadership started when chief digital officer Juliet Bauer quit NHS England to work for video consultation provider Livi. And rumours surfaced that health and social care secretary Matthew Hancock wanted to set up his own IT unit within the Department of Health and Social Care [18 January].
As May’s government struggled to secure a ‘meaningful vote’ on its EU withdrawal agreement, the NHS started to make plans for a no deal Brexit, setting up a logistics operation in Belgium. A trust in Kent warned that gridlock on port roads could force staff to sleep at work [8 February].
Hancock said he wanted the NHS to use email instead of sending letters [15 February] and then confirmed the creation of NHSX, although not within the DHSC. A press release said the new unit would report to both Hancock and the chief executives of NHS England and Improvement and take on “strategic responsibility for setting national direction on technology” [22 February].
The government also issued a code of conduct for data-driven health and care technology, laying out ten principles for the developers of NHS IT, apps and analysis products to abide by. Then Hancock decided to “ban” pagers [28 February].
May finally admitted the UK would not be leaving the EU on 29 March. The UK was granted a short extension, to 12 April. It was announced that NHS England chief executive Simon Stevens was going to lead NHS Improvement, and that the regulator’s chief executive, Ian Dalton, was going to step down.
The move raised a question mark over the future of Stevens’ deputy, Matthew Swindells, the former Cerner executive responsible for the global digital exemplar and local health and care record exemplar programmes. NHSE/I also published legislative proposals to undo elements of Andrew Lansley’s Health and Social Care Act 2012 and support the NHS Long Term Plan’s integration agenda [8 March].
At Digital Health Rewired, government advisor Ben Goldacre called for the open publication and analysis of NHS data and Hancock advisor Hadley Beeman said NHSX would drive the use of open standards and create a regulatory sandbox to support innovation [29 March].
April 12 came and went, and the UK was given another Brexit extension to 31 October. NHS England and NHS Improvement formalised their near-merger by saying they would work together “as a single organisation”. The National Audit Office suggested this would have its work cut out to deliver the NHS Long Term Plan, as there were “signs that the NHS’ financial health is getting worse”. [18 April].
US tech giant Microsoft announced that it was going to close the HealthVault personal health record platform that it launched 2010. NHS Digital published its initial evaluation of the NHS App, which said beta users wanted less cumbersome security and more transactional services [12 April].
In one of the few, big electronic patient record developments of the year, University College London Hospitals NHS Foundation Trust went live with Epic. While on the LHCRE front, the Great North Care Record chose to work with Cerner.
Two of the most high-profile figures in NHS technology moved on as NHS England finally confirmed that Matthew Swindells was going to work for Accenture and Richard Corbridge, the chief information officer at Leeds Teaching Hospitals NHS Trust, went to Boots.
Corbridge warned the NHS could face a “brain drain” of “frustrated” digital leaders, saying IT needed more money and fewer distracting initiatives like “purge the pager” [10 May]. Matthew Gould, the former ambassador appointed to lead NHSX, published his first blog and effectively killed the NHS App by announcing it was going to become a “platform” rather than an “all singing, all dancing” product.
NHS Digital published the GP IT Futures contract developed to replace the GP Systems of Choice or GPSoC framework. Gloucestershire Hospitals NHS Foundation Trust announced that it was gong to deploy Allscripts’ Sunrise electronic patient record as a ‘clinical wrap’ around its patient administration system [24 May].
May resigned as Conservative Party leader on 7 June, triggering a leadership election that was briefly entered by Hancock, before foreign secretary Boris Johnson and former health secretary Jeremy Hunt emerged as the run-off contenders.
As the contest got underway, the NHS Confederation held its annual conference in Manchester, and warned that the £20.5 billion “birthday present” would be nothing like enough. Simon Stevens assured his audience that he knew there was “more work to do” on capital, training and social care funding [21 June] with a new administration.
Confed also heard that local areas would create implementation plans for the NHS Long Term Plan by November. Matthew Gould axed more NHS IT programmes. The GDEs and LHCREs survived, but with hints they would be refocused on “the parts of the NHS that need most help” [28 June]. North Tees and Hartlepool NHS Foundation Trust signed a five-year regional pathology deal with Sectra.
As a heatwave hit England, hospitals warned they were seeing winter-like levels of demand. The Local Government Association and the Association of Directors of Adult Social Services held their annual conferences and tried to get social care on the national agenda [5 July].
Johnson was selected as Conservative Party leader on 23 July and promised, as he entered Downing Street, to sort out social care “once and for all”. Hancock was kept on at health. The NHS said it had finished the financial year at “break even”, with an £830 million overspend in the provider sector balanced by a £920 million underspend in commissioning. Think-tanks estimated the underlying deficit could be £5 billion [26 July].
South West London Pathology announced that it would be moving to CliniSys’ next generation LIMS, WinPath Enterprise. And the DHSC announced that it had struck a deal with Amazon to make NHS website information available via Alexa voice-search, raising data fears.
The DHSC found £2.1 billion for no-deal Brexit preparations, with £434 million earmarked for stockpiling and bringing in medicines. Already in election mode, Johnson announced 20 hospital building projects worth £850 million over five years, and £1 billion for maintenance. Think-tanks quickly established the latter was not new money.
Hancock announced that a £250 million AI lab would be created at NHSX. Eight EPR suppliers were included on the final lot of the Health Systems Support Framework drawn up to make it easier for trusts and integrated care services to buy new IT [9 August].
NHS Forth Valley went live with the InterSystems TrakCare electronic patient record, making it the twelfth of Scotland’s 14 health boards to do so. But shadow cabinet office minister Jo Platt established that the NHS had one million computers using Windows 7 – six months before Microsoft was due to start an “end of life” phase for the operating system.
The summer holidays ended, and Johnson announced that his government was scrapping the three-year, comprehensive spending review. Instead, a mini-budget was held on 4 September; a major disappointment for think-tanks, the NHS, building and tech companies, who had been hoping for a capital settlement [6 September].
The board of NHSE/I approved proposals for an NHS Integrated Care Bill, but Labour indicated that it would block the plans and push for a repeal of Andrew Lansley’s unloved Health and Care Act 2012 [27 September]. NHS trusts working with analytics company DeepMind were criticised for signing contracts with its parent company, Google Health, because of its record on patient privacy [19 September].
Boots announced a video consultation service with LIVI. One of the longest running and most mature integrated care records in the country, the Hampshire Care and Health Information Exchange, announced that it was moving from Graphnet to Orion Health.
At the start of the month, the Conservatives held their party conference. Johnson announced it would build 40 new hospitals. Publications quickly established this meant six projects had been given the green-light; another 34 projects were getting “seed funding” [4 October]. A week later, the King’s Fund calculated that the cost of NHS backlog maintenance had reached £6.4 billion.
Figures confirmed the NHS has been “exceptionally busy” over the summer, leading to warnings that it was in poor shape going into the winter. Audit Scotland warned that north of the border the NHS was “running hot” and needed to focus on integration and reform to become sustainable [25 October].
In good news, University Hospital Southampton NHS Foundation Trust won the #HealthTechToShoutAbout category in the Health Tech Newspaper’s awards for its work on My Medical Record. Then, after weeks of fraught political and legal manoeuvres, the UK failed to leave the EU on 31 October.
With Brexit off until January 2020, Johnson called a general election [1 November]. NHS Providers chief executive Chris Hopson pleaded with politicians not to use the NHS as a weapon by “over-dramatising its difficulties” or making “disingenuous” claims. This fell on deaf ears [8 November].
The Conservatives promised an extra £34 billion for the NHS; which turned out to be the “birthday present” plus the refurb cash, in cash terms. Labour and the Lib Dems both promised to spend more; although not much more [15 November]. The Conservatives also repeated their hospital building claims and said they would deliver an additional 50,000 nurses.
Everybody quickly established that 18,500 of these were already working in the service; but would be the focus of “better retention” measures [29 November]. Later in the campaign, privatisation and the use of patient data by US companies also became campaign issues, fuelled by the visit of US president Donald Trump for a NATO meeting.
December arrived, and with it the first signs that the NHS could be facing a “perfect storm” of high demand and low capacity, funding and staff. Manchester University NHS Foundation Trust announced the outcome of its £400 million electronic patient record tender; it selected Epic as its preferred bidder. The company now has five English customers [6 December].
The final days of the general election campaign were dominated by the treatment of Jack Williment-Barr at Leeds General Infirmary, and by a warning from NHS Providers that none of the main parties had levelled with the public on the health service.
But, in the end, it was Brexit that delivered a major realignment of the political parties on the evening of Thursday, 12 December [13 December]. As the year closed, Boris Johnson was prime minister and contemplating a cabinet reshuffle. The NHS, like the rest of the country, was waiting to see what came next.