Twenty-five years after the publication of the Information for Health strategy, suppliers and tech leaders met at ExCeL London. There was plenty of optimism and innovation at Healthcare Efficiency Through Technology; but also growing concern about deteriorating infrastructure, stalling national programmes, and a debilitating lack of funding. Lyn Whitfield reports.
Nobody mentioned it, but this year’s Healthcare Efficiency Through Technology conference took place almost 25 years to the day that the NHS published its first, significant IT strategy: Information for Health.
The “national strategy for local implementation” wanted to create “lifelong electronic health records for every person in the country” that professionals would be able to access “round the clock” to deliver “seamless care” including “on-line information services and telemedicine” while enabling “more effective use of NHS resources” by giving managers “the information they need.”
As a key milestone, it envisaged that a third of hospitals would have a ‘level 3’ or basic electronic patient record by 2002 and that every hospital would have one by 2005. At HETT 2023, Vin Diwakar, Tim Ferris’ replacement as national director of transformation, said 88% of trusts have an EPR today and 90% will have one by the end of the year.
Promoting the NHS App, fobbing off concerns about the FDP
These figures are a bit of a puzzle, unless NHS England is going to count procuring a system as having an EPR. Because, while trusts involved in the frontline digitisation programme have certainly been naming suppliers over the past couple of years, they have been pencilling in go-lives for 2024 or 2025.
However, EPRs were not the focus of Diwakar’s presentation. Instead, he said NHS England is working on the current iteration of “patient information and telemedicine” services by building out the NHS App, which is going to have a “critical role in this year’s Covid and flu campaigns.”
A quarter of a century after the British Medical Journal reported that “booking an NHS outpatient appointment in the future should be as easy as booking a package holiday in the sun if the new information strategy is successful,” he also revealed that 48 trusts have also signed up to let patients “see and change appointments” through patient experience portals that integrate with the app.
And 11 will be using PEPs to send patients questionnaires. NHS England has also been active on the management data front, by running a tender for a Federated Data Platform. This looks set to be won by controversial US giant Palantir, but Diwakar was anxious to dispel concern about a project dubbed ‘care.data on steroids’ (after a previous, disastrous, plan to collect and use patient data with minimal public involvement).
The FDP, he said, is just software that will “sit across trusts and integrated care systems, who will retain control of their information. But it will do great things – like generate data to analyse waiting lists or feed new, patient facing applications. “We will be engaging with the public to make sure the public have confidence in it,” he added.
“So, my big message on the FDP is: ‘Let’s not make it something it isn’t, and let’s focus on what it can do for the service and patients’.” Other central priorities include secure data environments for research and the development and deployment of AI.
Meanwhile, NHS infrastructure is deteriorating
However, Diwakar noted, “before we can achieve these lofty aims, we have to get the basics right” and there are signs that the NHS is not just struggling with the basics but to maintain some of the IT that it has managed to implement over the years.
As many speakers noted, the health service performed well during the Covid-19 pandemic but is now struggling with a huge backlog of elective care, chronic staff shortages, endemic strikes, and a looming financial crisis. Think-tanks worry that the NHS could be looking at a deficit of £7 billion this year, and IT is often seen as a good place to make “back office” savings; even though a persistent lack of investment is one reason that IfH and subsequent strategies have not been delivered.
In a fireside chat, new NHS chief information officer John Quinn said he was particularly worried about infrastructure. “We have a lot of legacy technology, systems that are out of support, [and that increases the] risk of cyber-attack and costs a lot of money,” he said.
Indeed, he startled session chair Tristi Tanaka by saying there will be “disasters” before the situation improves, although he argued trusts could and should “prepare and mitigate” for them. “If you are still building or adding to a data centre, you are in the wrong place,” he argued, urging trusts to make use of cloud or – better – software as a service.
And the SCR programme may be stalling
In a similar vein, a round-table discussion on shared care records suggested that what should be a flagship programme is stalling. NHS England set and hit a target for every integrated care system to have one in place by September 2021.
The centre is now encouraging ICSs to expand their functionality, starting with care planning, and to engage with a national project to join them all up – creating, finally, something like those “lifelong electronic health records for every person in the country.”
However, Joss Palmer, who worked on one of England’s earliest shared care records in Bristol and is now programme director for One London, said many areas were “struggling in the current financial environment.” “We see people saying: ‘Shall we keep the lights on and not push on’,” she said. “That is the practical reality around what we can actually do.”
Participants argued healthcare communities should be looking to build their SCRs around Professional Record Standards Body standards, so their data can not only be viewed by professionals working in different organisations but used to feed new care pathways and patient-facing services.
Laura Godtschalk, programme manager for the Leicestershire, Leicester and Rutland SCR, also argued for a more consistent approach to funding. She said ICSs should see their SCRs as “strategic infrastructure” and they’d actually “stop wasting money” if they built out from them, instead of constantly buying “new things” like PEPs that operate in isolation from each other.
Time to retrench and go again?
This theme, of encouraging a strategic approach to save money in the long run, came up several times at the show. In lunchtime session on workforce and how to do more with less, Paul Rice, chief digital and information officer at NHS Bradford Teaching Hospitals NHS Foundation Trust said his organisation invested in an EPR seven-years ago, has optimised it, and has no problem selling the potential of newer technology to staff.
Yet there are still challenges. “People are pulling tech off me hand over fist, but we need to get the most out of what is there already,” he said. “There are various reasons that doesn’t happen, including money. I have to make everything look like a shiny, new revenue programme, even if we’re looking to get the most out of what we have.”
Back in his fireside chat, John Quinn said some of his priorities include developing health tech as a profession and equipping CIOs with the skills to help their organisations to make better decisions. He acknowledged that the protracted merger of NHS England, Health Education England, and NHS IT bodies NHSX and NHS Digital has been painful and distracting.
But he argued that it will, in the end, make it easier to do this and to get the finances aligned. “I think coming into a single organisation helps us to understand how to get best leverage out of [the capital budget that is available] and, if we are moving to a revenue model, to understand the implications,” he said. “We also need to get suppliers to engage and show payback. I think the onus is on us to make the case and show that digital technology, done well, equals better working conditions and outcomes.”
Looking to the fourth industrial revolution…
Out on the HETT 2023 show floor, there were lots of companies with ideas for doing that; many of them aligned with the ‘six plus one’ priorities that NHS England outlined in the summer, plus the ongoing roll-out of virtual wards and digital outpatient platforms.
Vin Diwakar also promised his audience that “fourth industrial revolution” technologies, that make use of data, insights, and AI tools, will “transform” the NHS by “helping people to say healthy, treat disease, and create more personalised care” – and said he felt “optimistic about the future” despite the challenges.
Even so, there was a nagging sense that the NHS has fallen behind other sectors that were just starting their own digitisation journeys when IfH was published. In session on new ways of thinking about digital maturity, that go beyond the old ‘level 3’ or HIMSS 5 models for EPRs, chair Ronke Adejolu asked why banking now seems to be so far ahead.
Jaz Dhaliwal, lead partner – digital health at KPMG said one reason is that challenger banks, like Atom or Monzo, aren’t encumbered by a lot of legacy infrastructure and are instead able to start from “net new.” Plus, of course, they work in a very different competition environment, “and it would be remiss not to talk about funding” – or the lack of it.
It’s not, she said, that the NHS doesn’t want to use technology to respond to the many challenges it faces, but “the circumstances are very different.” And just at the moment, it has to be said, really very difficult outside the tramlines of frontline digitisation and tech tied to recovery or winter pressures initiatives.