e-Health Week 2017

With civil servants in purdah for the general election on 8 June, e-Health Week 2017 might have been quiet. However, the keynote speakers still found plenty to say, not least about the next steps for the NHS global digital exemplar programme. Lyn Whitfield reports.

With a general election called for 8 June, the UK’s civil servants are in purdah. Matthew Swindells, NHS England’s national director for commissioning, operations and information, told the first session at e-Health Week that this had led to “some interesting conversations with the communications team.”

He joked that the outcome was that he was “not allowed to say anything interesting and not allowed to take questions.” So instead of making announcements, Swindells and other keynote speakers reminded visitors to Olympia of the big picture against which healthcare IT needs to deliver.

Swindells: NHS IT must deliver change, not systems
That big picture emerges from the financial crisis faced by the NHS, which is facing a gap between funding and demand that could reach £30 billion by 2020-21. A plan to tackle this gap, the Five Year Forward View, was published in October 2014, and an update, Next Steps, was issued just before the election was called.

Swindells told e-Health Week Next Steps “set out a clear set of priorities for the next couple of years” and the role of technology is to deliver it and with it what has become known as “the triple aim” – “better health, better care, better value.”

In other words, he stressed, the intention is not to “introduce technology for its own sake” or even “to make the NHS more fun for the iPhone generation.” It is to “redesign pathways” and deliver the more integrated, patient centred care the Forward View hopes will deliver a big uptick in efficiency.

“The NHS is in financial trouble,” Swindells said, adding that the traditional solution, to expand capacity, was not going to work. “We have tried creating a bigger NHS, and we found it filled up and looked like the smaller NHS.”

Instead, he said: “We have to redesign pathways” and “we need IT people to focus on that; not [on] delivering stuff, [but on] impacting on care and doing things better.” Just to underline the point, he challenged his audience to “have the bottle to step up” and not “just sit in your office, delivering one more maternity system.”

NHS IT leaders need to step up
Other speakers took a softer line, but partnership and leadership were still themes of the two-day event. NHS Digital signed a strategic partnership with techUK to “transform” the way in which suppliers work with the organisation.

On the professional front, there was a lot of support for a pledge campaign led by Fed-IP, a registration body set up to drive professionalism in health informatics.

Will Smart, NHS England chief information officer, was on board. “Informatics has been a lonely journey for all of us,” he said. “We often live in the basement or in the office furthest from the chief executive. Fed-IP provides great recognition for the work informaticians do every day around the health service.”

However, he stressed that “leadership is a team sport”, while his NHS chief clinical information officer counterpart, Keith McNeil, talked about the need to make sure that everyone working in the “complex, chaotic system” of the NHS was supported to make it work. 

NHS Digital is focusing on customers
The Forward View was followed by an IT framework, Personalised Health and Care 2020. It stressed that the technology cannot be left to the ‘let a thousand flowers bloom’ approach that preceded the National Programme for IT; but nor can it be delivered by NPfIT’s ‘ruthless standardisation.’

In line with this, speakers at e-Health week stressed the need for action at both a national and a local level. Beverley Bryant, director of digital transformation at NHS Digital, said she had used purdah to “reflect” on where it had got to in delivering on its part; national infrastructure, national services, standards, cyber security advice and data services that are “both useful and used.”

Among her highlights, she said NHS Digital had re-platformed the NHS Spine, which links trusts and gives them access to the personal demographics service; and was now able to make changes on a weekly basis, when previously they had taken 12 months to deliver.

She said it had delivered some useful services like the Child Protection Information Service (CP-IS), which links healthcare staff in emergency services with social care works, and flags up child protection issues, and is now keen to see them used.

It is working on embedding “building block” standards like SNOMED CT into IT systems, starting with primary care in 2018. It is speeded up the production of the NHS’ Hospital Episode Statistics and is working on a new data service, SUS+.

Bryant: healthcare digitisation is happening
Juliet Bauer, NHS England’s new director of digital experience, added that ‘the centre’ is also working on new services for patients. These start with a revamp of NHS Choices into nhs.uk, continue with the roll-out of the eRedbook for newborns, and include the extension of wi-fi to the whole NHS estate.

Overall, Bryant was feeling positive that healthcare IT could step up. “Yes, there could be more money, and yes, we could get it out faster, and yes there are some controversial policies,” she said.

“But we are doing this, and I am confident that after the general election this cannot be slowed and cannot be halted. We will drive this through and then we will have the modern health and care system our patients and citizens deserve.”

The GDE programme will be blueprinted and evaluated
The development of IT at a trust level is now focused on one of those controversial programmes; the global digital exemplars that were announced after the publication of US ‘digital doctor’ Robert Wachter’s report on NHS IT last year.

So far, 16 acute and seven mental health exemplars have been unveiled; although they’ve yet to get Treasury approval for the £10m and £5m of national funding they’ve each been promised, respectively.

Criticism of the exemplars programme has focused on how it rewards just a handful of large organisations running mainly US electronic patient record systems. However, Paul Rice, head of technology strategy at NHS England, told a lunchtime ‘meet and greet’ session that what had “distinguished” the acute exemplars was their vision.

“IT runs through the DNA of these organisations,” he said, “and [that set them apart] from those bids where you could see that something would be created but it was not clear clinicians were on board or that it would be used.”

He added that the exemplars were already in the process of identifying ‘fast follower’ organisations to work with and that they would be working on ‘blueprints’ for digitisation at further trusts.

“The blueprints are not a technical spec,” he said. “What will be necessary but not sufficient, because what people want to know is how to engage the board, or get clinicians engaged, or realise the benefits. We want to get those human factors into the blueprints.”

Exemplars are aligned with local digital roadmaps
All of the global digital exemplars were at e-Health Week, and they were also keen to stress that the programme was not just about acute – or large mental health – trusts. Instead, they told visitors that they would be working across their local health communities.

James Reed, the chief clinical information officer at Birmingham and Solihull Mental Health NHS Foundation Trust, told a panel session on the first day, that he had led the local digital roadmap drawn up to say how his area would take forward Personalised Health and Care 2020, and that this had “underpinned” its exemplar bid.

David Walliker, the chief information officer at Liverpool Women’s and Royal Liverpool and Broadgreen NHS trusts, said that on a practical level it simply couldn’t work in isolation from other health and social care services.

Royal Liverpool and Broadgreen is moving to a new campus with fewer beds and no paper records space next year, and Walliker argued that: “If we ignore social care we will fail. One of the things we are looking at is a bed management system for social care. They cannot afford it, but we need stop down to free up beds, so if we can get that working it will help all of us.”

Place based care could be the next big policy idea
That wasn’t enough for some visitors, however. A near-final session discussed place-based care; the idea, developed by a King’s Fund report, that health and social care should come together and use their common resources to deliver care in a specific place and the people living in it.

Justin Whatling, vice president, population health at Cerner, pointed to the Nuka Care experiment in Canada, in which the local population rebuilt services around open-plan primary care centres with digital access to hospitals and specialist advice.

“It was a huge change to get there, but it’s the sort of thing the Five Year Forward View is talking about with clinician hubs serving 30,000-50,000 people,” he argued. “To manage that, we need systems that bring information together. It will not work if all these services are still using different systems.”

Michael Dixon, a Devon GP who already runs a practice with a vegetable garden, and who writes “social prescriptions” for everything from housing support to yoga, said his challenge to technology was to make this work better for patients. He said he wanted IT that could: “Take on transactional services where possible and support personal services where they are needed”.

There are rumours that one of the announcements stopped by the election was for another set of exemplars, focusing on placed based care. Something to watch out for when purdah lifts on 9 June.