TechUK has published a ten-point plan for health tech, covering everything from digital access for the public, to social care, interoperability, and procurement. Lyn Whitfield asked its authors why they’re optimistic that some gnarly problems can be addressed as the NHS gets ready to reset after Covid-19.
The first wave of the Covid-19 pandemic saw a big increase in the adoption of some types of technology across health and social care. Trusts with mature electronic patient record solutions were able to reconfigure them to support staff dealing with the pandemic, there was widespread investment in imaging and pathology systems, and a big increase in remote working and virtual consultations.
While the changes have been widely commented on, their impact has not been felt consistently across the country and there is a sense that momentum has slowed. Indeed, there has been something of a backlash against virtual consultations from patients living in areas where health and care is not just fragmented but now reduced to a series of phone calls as well.
Meantime, many of the familiar barriers to digital adoption that were in place before the pandemic began are still there. TechUK, the country’s technology trade association, has just published a report that looks at ten of the knottiest issues and makes recommendations to try and untie them as the NHS starts to think about a reset that needs to embrace digital working.
Power to the people (and social care)
Leontina Postelnicu, one of the report’s two authors, says: “While the report does not focus on Covid-19, we often hear from members that we need to build on what was achieved during the first wave and what we learned from it. So that has definitely influenced our decision to do this work.”
Her co-author Tom Russell adds: “We talked to our health and social care council and then organised a number of round tables to discuss key issues. Broadly speaking, the message that we got was that most of what we need to do is quite straightforward from the perspective of the technology itself.
“The challenge is to make sure that we address the societal and cultural issues that stop change happening and systems being implemented.” As an example, the report starts with getting past virtual consultations and putting proper digital tools into the hands of the public.
It suggests doubling down on long-standing government ambitions to give patients access to their data, so they can make informed decisions about their own care, while also making more information available to the public about what is being done around the country and what is available to them.
The report also recognises that if health has its digital challenges, social care has even further to go. It calls for government departments and digital agencies to work with techUK and other industry bodies to conduct an audit of the social care landscape and then to draw up a ‘target architecture’ to identify gaps and the technology to fill them.
Russell says: “The social care chapter is a good example of our approach. In one of the round tables, we talked about whether the sector needed more money, or something like the global digital exemplar programme. But we ended up with a recommendation on target architecture because the consensus was that if you can work out who is responsible for what you can apply the relevant levers to help make progress.”
Looking for the person in charge
Similarly, he says, the report addresses the perennially vexed issue of interoperability by renewing calls to take a standards-based approach, while recommending that there should be more clarity about who can mandate and enforce standards and what those standards are going to be.
Because, he continues: “It’s ok saying there should be standards, but without saying which standards and who gets to decide that you are not going to get adoption.” Another lever for standards adoption is procurement.
NHSX, the digital agency set up by health and social care secretary Matt Hancock, has created framework contracts to encourage health and care organisations to buy standards-based systems, while cutting the cost of procurement and making sure they get proven functionality.
But organisations don’t always use them. Most obviously, in the past year, some high-profile trusts have bought an EPR that is not on the flagship Health System Support Framework. At the same time, the number of frameworks in use is proliferating as procurement and IT partnerships maintain their own and everybody tries to respond to the new needs thrown up by COVID-19.
This limits the scope of frameworks to enforce standards or to shape expected workflows and outcomes. It also creates considerable cost for companies who can spend time and resources getting onto a framework that fails to deliver business.
Unusually, the techUK Ten Point Plan for Health Tech devotes a whole chapter and two recommendations to procurement. It argues the proliferation of frameworks should stop and more attention should be paid to getting procurement staff to use those that exist.
On a slightly different tack, it also argues the government should get on with enshrining integrated care systems in law, so suppliers can work out who their customers are, and everybody knows what procurement rules they should be following.
Postelnicu says: “We did not have one discussion in which procurement did not come up. Even some of the round tables that we organised on other issues were taken over by concern about procurement. It was an issue that we could not ignore.”
A roadmap for progress
Russell adds that it’s also an issue on which techUK can bring experience to bear. “As techUK, we have lots of members with experience of other sectors that can be brought to bear on this issue,” he says. “Just because something is broken does not mean that it cannot be fixed.”
Plus, he continues, it’s an area on which organisations like NHSX are keen to engage: “They recognise the problems and want to work with the industry as a whole on dealing with them.”
That’s important because techUK does not want this report to sit on the shelf. A foreword stresses that it is “not an exhaustive review of the healthcare technology landscape” but instead “a breakdown of what our members see as the biggest challenges in the space and a set of recommendations for how we can drive progress.”
Russell and Postelnicu are already shaping engaging opportunities and work programmes to take forwards its ideas, which round out with calls to find dedicated funding for health tech and investment in the “digital upskilling” of staff.
Russell argues there are other factors that could also drive change; including the government’s willingness to engage in the economy during the pandemic, and its apparent desire to revisit NHS reform and regulatory issues now Brexit is behind it.
“People are talking about Covid-19 burnout for clinicians, but I think there is something similar for tech,” he says. “Last year, we saw unprecedented effort from IT teams and suppliers, but people only have so much energy, so I don’t think it’s a surprise that we are seeing a bit of a slowdown.
“What we don’t want to see is things stop in their tracks; but policy making is a long game. I think this report will be our focus for some time. It will enable us to take steps that might be small but that should allow us, at some point in the future, to look back and say ‘we have done x, y and z’ and the impact of that has been positive.”