By the technophiles, digital is seen as the holy grail that will save our NHS, but is technology the answer, and how long will it be before we have a digital NHS?
The NHS is in crisis. Plagued by increased demand, an ageing population, budget restraints and low staff morale, it has become increasingly clear that change is needed.
According to NHS bosses, the change that will save our health service will come in the form of digital technology, which will lift a struggling health service out of its misery and deliver a new golden era.
Speaking at the NHS Expo in Manchester, NHS England’s national director for operations and information, Matthew Swindells, went as far as saying that without digitising the NHS, we are “condemning people to die”. Going fully digital, he believes, is the only way to save the NHS.
Digitising the NHS could, and probably will, help improve current conditions. It could lead to better, joined-up care, provide quicker and more accurate diagnosis, create more time for clinicians to spend with patients, lead to patients spending less time in hospital, and could empower the public to take charge of their own health.
So what is the problem? According to Swindells’s speech earlier this year at another conference, it is that the NHS is currently failing to deliver basic IT. Too many people across the health service “consider it a success if they can keep their emails under control”, he said. This begs the question: is the NHS really ready to be digitally transformed?
The NHS initially set itself the target of becoming paperless by 2018. This was then pushed back to 2020. An NHS technology review by US professor Robert Wachter in 2016 called on the NHS to push back the target by three years to 2023, saying the current goal was “likely to fail”.
Moving on from poor legacy
There has been no formal push-back of the target, but it’s looking increasingly likely to be at least 2023, probably later, before the entire NHS is paperless.
In his recent speech at NHS Expo, Swindells said that two years ago he would have said the UK’s “hospital IT was about on par with Chile” and that we needed to get the NHS out of the “post-traumatic stress disorder” it was suffering on the back of the National Programme for IT and Care.data.
That the NHS has a chequered history when it comes to IT programmes is no secret, but the government has done a lot to improve conditions over the past two years.
The Sustainability and Transformation Partnerships (STPs) that ensure local health and social care providers come together to join up services have ensured the beginnings of a culture change in thinking of care as being patient-centred, rather than provider-centred. The Local Health and Care Record Exemplar (LHCRE) regions are also working to raise the bar “for how the NHS can improve care through technology”. And some of the global digital exemplars are on track to become “near paperless”, in the next few months.
Funding fairness in question
Despite the successes, there are still trusts lagging far behind. One of the key criticisms of the funding packages the government has pumped into a digital NHS is that they tend to go to those trusts that already have good, if not great IT.
“I can understand why leadership would shy away from grappling with technology, given the history, but we must get back to driving this transformation. The biggest risk is in not driving digital transformation”
Matt Hancock, health secretary
This was also the case with the most recent funding, announced by health secretary Matt Hancock at NHS Expo, which promised a further £200m for the next round of global digital exemplars, following the then health secretary Jeremy Hunt handing out £10m each to 12 trusts that would lead the way in becoming global digital exemplars, also known as centres of excellence, last year. The number has since grown to 16 trusts, with 17 “fast followers”, as well as a few mental health and ambulance trusts becoming digital centres of excellence.
In his announcement of the latest funding, Hancock said he wanted NHS leaders to help change the culture in the NHS.
“I can understand why leadership would shy away from grappling with technology, given the history, but we must get back to driving this transformation,” he said. “We must drive this agenda, and you need to know that I’ve got your back. The biggest risk is in not driving digital transformation.
“We need to build in-house capacity to lead design and delivery, and this will also enable good providers to work more effectively with the NHS, deliver more successfully and operate with less risk.”
Funding has also been given to the LHCREs, which will receive up to £7.5m in national investment over two years, which they must individually match.
Daily struggles ongoing
In the midst of all this, however, there are staff and leaders at NHS trusts who feel they are being completely bypassed.
There are NHS trusts where staff don’t know how many people are on their waiting lists, and there are hospitals where staff don’t really know how many beds are free, or how many patients are lying in them, Swindells revealed earlier this year.
One clinician Computer Weekly spoke to at NHS Expo said these issues were not simply happening at a few “poorly performing” trusts, but even some of those hailed as being digitally advanced.
“The government wants this all-singing and dancing digital NHS, but there are struggles with IT on a daily basis in most of the hospitals I have worked at,” the clinician, who wants to remain anonymous, said.
In his speech, Hancock recognised that many trusts struggle with the day-to-day IT systems, describing NHS IT as “clunky, clunky, clunky”.
“In many parts of many NHS trusts, workstations have two screens not because they are as cutting edge as a City trading desk, but because they have two separate computer systems running side by side,” he said.
“Staff waste hours logging on, transcribing vital clinical data by hand or over the phone, the systems are slow, fail to communicate with each other, fail to reconcile accounts and identities, and rely on expensive, out-of-date, badly managed contracts with low-grade suppliers that don’t understand the core business they’re intending to support.”
Low morale among NHS staff
Hancock also touted the all-singing and dancing NHS app, which is due to be piloted in five regions across England before being fully launched in December 2018. The app will give patients easy access to NHS services, letting them book appointments, order repeat prescriptions, view their medical records and get advice online.
However, many see this as simply putting lipstick on a pig, and feel NHS leaders are failing to tackle the real issues.
Morale is low among staff in the health service, the clinician added, saying that it was frustrating to hear the government talking about how amazing a digital NHS will be, when frontline staff feel there are many other issues that should get priority, including pay, working hours, Brexit and the day-to-day running of the health service.
Shadow health secretary Jonathan Ashworth was also critical of the way funding is being given, claiming the new £200m is not, in fact, new money, but will come from already existing NHS trusts’ budgets.
Rather than prioritising dealing with staff shortages or ever-growing waiting lists in the NHS, “the health secretary is insisting new IT systems must be paid for by already over-stretched budgets”, he said.
“This isn’t a serious plan for technology and innovation in the NHS – it’s a pipe dream.”
Will a digital NHS become a reality?
Whether or not a digital NHS is a pipe dream or a future reality, it’s clear that we are a long way off from getting there. The NHS has always been brilliant at pockets of innovation, and the digital exemplars may seem like nothing more.
The clinicians Computer Weekly spoke to at NHS Expo said they felt that those that are doing well were well rewarded for doing so, while those struggling were being left even further behind.
It is hard to imagine a digital, paperless NHS by 2020, where care is seamlessly transferred from one provider to another and patient data is available at clinicians’ fingertips, when trusts in the middle of 2018 can’t even tell how many patients they have in their hospitals at any given time.
Most will welcome a digital NHS when it does arrive, but whether the health service will exist then as we know it now remains to be seen.
Matt Hancock will announce a £200m fund for further digital centres of excellence and plans to pilot the NHS app across England, but shadow health secretary Jonathan Ashworth calls the plans a “pipe dream”.
