As the NHS approaches its 70th birthday, the anniversary reaffirms its importance to the health of our families and friends. Looking forward, the NHS faces major challenges. NHS leaders are now talking about 'technological revolution' to help address these. In health, and across local services more generally, digital transformation is a top 10 priority now being written into strategies, according to new research. But in healthcare, the vision is not being realised fast enough.
Since the launch of the NHS seventy years ago, major changes have taken place that challenge the financial sustainability and quality of care the health service can deliver.
Life expectancy is 13 years longer than it is was in 1948.
Expenditure on the NHS has risen substantially. In the first full year of its operation, the Government spent £11.4bn on health (in 2016/17 prices) in the UK. In 2016/17, the figure was £144.3 bn - over ten times that amount. Growth in health expenditure has far outpaced the rise in both GDP and total public expenditure: each increased by a factor of around 4.8 over this period.
Demand on the NHS continues to grow. A 65-year-old costs the NHS 2.5 times more than the average 30-year-old. An 85-year-old costs more than five times as much. By 2044, just under 25% of the population will be over 65 compared to approximately 20% today.
To meet these challenges, the NHS must drive transformational change, including realising the potential presented by digital solutions to improve patient health, patient care and financial sustainability. As NHS England Chairman, Sir Malcolm Grant, states “We are at a tipping point of how we provide care”. And Jeremy Hunt said recently “The NHS must use extra funds to lead a ‘technological revolution’ in order to ‘weather the storm’ of the biggest challenge to face the health service in 70 years”.
New research shows progress towards digital transformation and integration is slow
Earlier this year, I presented the findings from new research on digital transformation in the health and social care sectors at the HSCN Summit in London. Commissioned by BT, this looked at perceptions of digital transformation and how strategies are evolving.
The findings suggested that, despite big ambitions for service innovation enabled by greater connectivity, progress towards delivering digital transformation is proving slow for NHS trusts. This isn’t helped by the fact that projects are still being driven largely by IT teams, a finding endorsed by attendees at the HSCN Summit.
The vast majority (68%) of NHS trusts plan to integrate their IT systems with other local health and care systems within the next couple of years as part of their migration to the new Health and Social Care Network (HSCN). Yet only a minority have a firm plan in place for managing this transition.
HSCN can act as a springboard for digital innovation
As well as charting digital progress generally, we wanted to find out how trusts plan to use HSCN as a springboard for greater transformation – for example, by rolling out more mobile collaboration, and/or using the cloud to make it easier to adopt new ways of working.
But while three-quarters of respondents saw greater collaboration between health and social care providers as one of the top three benefits of the new network, almost half of organisations were still at the ‘scoping’ stage and had not really moved their plans forward.
This seems surprising, given the anticipated impact of using more flexible technology. Our research into broader local service transformation shows that benefits include reduced administration, greater automation, easier access to higher-quality information, and improved community collaboration. In health and social care, it could mean seeing more patients or accelerating critical decisions.
We picked out some of these themes at the HSCN Summit. We considered why health services are holding back with mobility adoption when almost two-thirds of trusts have a mobile strategy, and 84% expect mobile adoption to increase over the next 1-2 years. Attendees observed that the focus was often on operational matters with insufficient time to look at new ways of working. Even though they acknowledged that operational efficiencies can be realised with new ways of working.
Embracing the cloud could be transformational
Compared to other public services, the NHS’s take-up of the cloud has been relatively slow. Attendees at the HSCN Summit observed that the emphasis on capital budgets, and the need to extract continued value out of legacy systems, are contributing to these low adoption levels – as \well as concerns about security. Yet cloud-based services have come a long way, and the ability to layer the latest security on top of them means that organisations using cloud services benefit from up-to-date tools and capabilities automatically. The major WannaCry security incident, which disrupted so many NHS appointments and operations last year, is a sobering reminder that internal systems can be more vulnerable if not kept up to date.
Short-term steps can drive progress towards long term goals
As trusts move closer to HSCN and start to add detail to their plans, it’s a good opportunity to review what else they can achieve for their people and patients as part of the transition. This should form part of their overall plans to maximise the benefits of digital transformation. Given the pressures on NHS budgets, as well as the practical barriers trusts have highlighted, the best approach is to keep long term objectives in mind when formulating the transitional steps. Initiatives on avoiding unnecessary admissions through more effective digital communication with citizens and the ability for staff to access key information remotely and securely will realise short-term benefits in care outcomes.
Early adoption pilots to test the patient and financial benefits, such as freeing up staff by using chat-bots to give information about hospital services, will provide insight on the future direction. Some pilots will succeed and some will fail. Most importantly, given that digital transformation can mean so many different things, trusts must develop a clear picture of their business goals to make a difference to their people and their patients. How can internet-era technology, big data, artificial intelligence (AI) and the Internet of Things (IoT) most effectively support their overall goals?
Empowering those at the frontline of care is critical
Having clinical and other frontline care stakeholders, not to mention CEOs, driving and collaborating together on initiatives will give the needed focus on patient outcomes. This will generate a more empowered multi-disciplinary team to develop and deliver the most benefit beyond the current boundaries. Organisations must consider the people, culture and process elements of a successful strategy; ensuring appropriate training, knowledge and processes are in place. What is it that they want to achieve, or need to do differently? How could new digital initiatives, including more flexible and intelligent connectivity, make it easier for them to work more efficiently and deliver better patient outcomes?
Enhanced mobility, 4G, Wi-Fi and 5G can allow individuals to access and update information from wherever, and whenever, they need to, saving busy staff from returning to their offices.
Faster connectivity in and out of the home combined with connected medical devices (the Internet of Things) means that care information can be captured and shared between citizens and health professionals in real-time, facilitating preventative care and putting the citizen at the centre.
Improved connectivity and collaboration can allow multi-agency teams to work together beyond the walls of traditional care settings to form a care-ecosystem to deliver the best care. It allows health and social care teams collaborate more effectively in the community. Enables new digital channels to keep patients and their families informed about care plans.
The ability to fund and truly transform the NHS is essential if it is to continue to enhance people’s lives over the next 70 years. The ‘technological revolution’ will only succeed if it is decisive, supports transformational change to key patient outcomes and preventative care whilst empowering frontline staff.
Long live the NHS!
To delve deeper into the survey findings, follow the links below:
· BT Ingenium Report: a survey of senior executives and IT leaders across 50 NHS organisations
Kieron Salt is CIO Health at BT
