Whatever the result of the General Election on 4 July, it’s likely that we’ll have a new Secretary of State for Health in the next few weeks.
We asked eight digital healthcare leaders to tell us what they want from the incoming Health Secretary and how the digital healthcare agenda can be moved forward by the next government.
***
Digital healthcare has been on the government’s agenda for many years now. But, due to funding challenges, changing priorities, the impact of the Covid-19 pandemic, and staffing and expertise shortages, the implementation and impact of digital transformation has been variable.
As a new Health Secretary prepares to pick up the baton of digital healthcare, we asked nine digital leaders to outline the key issues that the Secretary of State should prioritise.
- The underlying operating model – change how and where funding is controlled and decisions are made
While it’s important for NHS England to establish and articulate the national agenda for digital transformation, the funding and decision-making powers for delivering it should be firmly in the regions.
“We need to move away from the national ‘command and control’ model we have at the moment and give Integrated Care Boards (ICBs) more autonomy to determine priorities to advance integrating care across their geography to best service their population. At a time where value for money is key, we shouldn’t be determining nationally what needs to be bought locally”, said Tracey Watson, Director of Consulting at Ethical Healthcare.
Reviewing and clarifying organisational roles and responsibilities is an essential part of increasing the effectiveness of digital programmes, says Beverley Bryant, Chief Digital Information Officer, King’s College Hospital and Guy’s and St Thomas’ NHS Trust: “We need to focus on creating an environment that will allow digital transformation to flourish across the NHS. The national role should be limited to providing funding and creating national buying frameworks that achieve best value for money. The regional role should prioritise investment based on broad digital maturity criteria and ICB readiness to deliver. The ICBs’ role should be to provide the leadership, case for change and overall governance to drive digital transformation across the patch, including benefits realisation and underlying infrastructure.”
Dr Tom Oakley, CEO of Feedback Medical Ltd and former NHS radiologist, agrees: “The funding for digital doesn’t even need to be enlarged (though it should be given the NHS percentage of digital spend is significantly lower to that compared with other OECD nations) but it should be very clearly ringfenced, pledged and sustained for an entire government term so that regional providers can plan and commit to change programmes with a longer horizon. Annualised funding allocations make meaningful, sustained change impossible because organisations can’t commit to programmes that run beyond, or deliver benefits beyond, a one-year horizon.”
These changes will require a shift in human resources. “We need to look at rebalancing the distribution of skills and resources”, continues Beverley. “This means pushing more people from the centre to the ICBs and frontline.”
- Don’t focus on AI – yet
Like most industries, the NHS is exploring the opportunities and application of artificial intelligence (AI) in its current and future operations. However, digital leaders believe there are more important issues to focus on right now.
“We can’t maximise the opportunities with AI when most healthcare organisations don’t yet have functional wi-fi”, says Dr Tom Oakley. “Before investing in shiny new technology, the basic infrastructure needs to be in place and made available to the people who want to use it.
“Prioritise mobilisation of the highly skilled workforce through the provision of suitable wi-fi and either devices or bring-your-own-device policies to allow the workforce to get out from behind a desk”, continues Tom. “Once you have done that, then you can talk about getting AI in front of those who need to do something with it.”
Andy Kinnear, Partnerships Director at Ethical Healthcare, believes more work is required to assess the implications of AI fully before significant investment is made in this area: “We need to ensure we enjoy the benefits of AI without inadvertently creating a monster.
“If I was the incoming Health Secretary, I would want a team of clinical, philosophical, academic and religious leaders to look at AI from a health ethics perspective.
“Those leading the AI journey need clear boundaries and principles setting for them. This space is going to get messy quickly without some kind of regulation and oversight.”
- Optimise and standardise clinical software
The NHS could achieve significant benefits from optimising the clinical software it already has and developing standards to improve performance and productivity across the board.
Thomas Webb, CEO of Ethical Healthcare, says: “There are tons of opportunities for the NHS to do things better when it comes to clinical software. This doesn’t necessarily mean introducing new software – rather, it’s about optimising the software it already has through proper training and improved clinical application.
“The NHS also needs to nurture the open standards community and take a tougher stance of mandating standards in clinical software to ensure there is a benchmark of quality and assurance in every organisation.”
Rachel Dunscombe, CEO of open EHR International, supports this point: “The future target operating model needs to focus on standards and data as the infrastructure for the future.”
Jim Ritchie, Chief Clinical Information Officer, NHS Greater Manchester, and Renal Consultant, Northern Care Alliance, believes this approach is essential: “We need to build evidence-based standards and criteria for commissioning new technologies and be clear about what the environmental success factors are.
“Digital is languishing in part because it always has to prove itself again and again. Wind is coming out of the sails because we’ve accepted evaluations based on vanity metrics not hard outcomes.”
- Take an integrated care approach
The spotlight has been on acute electronic patient records (EPRs) for a long time now – but there are other more pressing priorities that should be addressed to drive forward the digital transformation agenda.
“I would ask the new Health Secretary to shift away from prioritising ever-increasing EPR maturity as the answer to digital transformation at the expense of wider, more holistic frontline digitisation programmes that deliver far greater impact at a broader system level,” says Dr Tom Oakley.
“We need to recognise that patients are rarely managed within one provider setting and that our digital approach has to start thinking more holistically at a whole system level in order to enable the free movement of patients and their information across care settings”, continued Tom
“The focus should shift from delivering deeper digital maturity at an individual provider level to connecting the digital resources now available across settings for a more streamlined patient journey. This will not only help patient flow but will also allow clinical teams to work more cross-functionally within ICBs, optimising care pathways and reducing waitlists. These decisions need to be taken at an ICB level and reflect a need for digital decision-making to start to move away from individual providers and towards regional-based teams.”
- Tailor support for primary care
Primary care has a specific role in the healthcare system and needs specific digital systems to support its work.
“For too long, technology has been a rate-limiting step in primary care transformation rather than the accelerator it has been in other industries”, believes Dr Simon Bowers, Chief Medical Officer at Blinx Healthcare and practising GP.
“Practices and developing primary care networks (PCNs) don’t need AI, virtual reality or flying cars – they need fewer clicks, seamless integration and technology that saves time.
“They need the freedom to spend their commissioner’s money on NHS-validated digital products that meet their patient flow and critical quality needs, as opposed to the get-what-you’re-given culture that commissioning at scale tends to deliver.”
“Patients want their digital interactions with the NHS to be as easy as Amazon or Netflix”, Simon continues. “They also want human interaction with staff whose time is managed efficiently so those interactions are valuable.
“So, to any incoming Health Secretary, I ask for fewer big ideas or stuff you’ve seen working in health systems that spend two or three times what primary care does per head. Just give us the tools every other industry takes for granted and let us get on with the transformation that our patients and colleagues really need.”
Over to you, Health Secretary…
Moving the digital healthcare agenda forward doesn’t initially require lots of shiny and new solutions to achieve transformation. A number of hygiene factors need to be addressed before flooding the system with further digital asks.
We need (as with the economy overall) financial stability and sustainability, so we can plan strategically.
The overall operating model needs to be addressed; at the moment more time seems to be spent on investment assurance and navigating the various levels of red tape than readying organisations for change and deploying technology. Ensuring the right accountabilities sit with the right organisations or system entities will be critical. Those responsible for system performance should be able to determine how best to prioritise need.