Helen McKenna, Senior Policy Adviser at The King’s Fund, asks how the NHS digital strategy can be implemented at a time of great financial pressures
Jeremy Hunt is a man on a mission to digitise the NHS. Back in 2013, just a few months after taking up the role of Secretary of State for Health, he challenged the NHS to ‘go paperless’. The NHS five year forward view followed, outlining ambitions to ‘exploit the information revolution’, to be led by a newly established National Information Board. Personalised health and care 2020 provided the framework for action to underpin this vision, committing to implement a range of proposals including online access to GP records for all and digital real-time and interoperable care records.
Making better use of information and digital technology in the NHS is clearly a priority for Hunt. While we are accustomed in so many areas of our lives to interacting digitally with services (for example, 70% of flights are now booked online), we continue to engage with health and care services using more traditional methods, with reports suggesting that only 2% of the population have had any digitally enabled transaction with the NHS.
So is the digitisation of health and care services just around the corner? The answer is complex. On the one hand, some services are further ahead than most people may realise. For example, the vast majority (92.1%) of GP practices now have the technology in place to enable patients to access their records online (Health and Social Care Information Centre 2016). The problem is that patients aren’t aware that this functionality exists (only 5.2% of patients report being aware that their practice offers this) and even fewer (0.9%) report ever having used it (NHS England and Ipsos Mori 2016). A similar picture exists in relation to booking GP appointments and ordering repeat prescriptions online.
There is still a long way to go in secondary care too, which lags significantly behind primary care in relation to digitisation. In our recent briefing (Honeyman et al 2016), we identified a number of barriers that stand between where we are now and the vision for a ‘paperless’ NHS.
Perhaps the most important of these is the broader context in which NHS organisations are working, specifically regarding the financial and operational pressures they are under. In 2015/16, NHS providers and commissioners collectively recorded the largest combined deficit in their history and are struggling to meet key performance targets. Organisations’ inevitable focus on stabilising performance in the short term risks crowding out efforts to digitise. There is also a risk that funds earmarked for capital investment are switched to support day-to-day spending.
Other barriers to progress include a lack of clarity about the funding available to support this agenda, and a lack of incentives for NHS leaders (particularly those in acute trusts) to attempt large-scale digital transformation.
In our briefing, we also identify a number of things that need to happen if the digitisation dream is to become a reality. The first is to give the NHS more time to achieve it. The recent review chaired by Professor Robert Wachter called for more realistic deadlines, including a phased approach to digital implementation in acute trusts and an extension to the timetable for achieving digital maturity from 2020 to 2023. In principle we support this recommendation, although if accepted by the Secretary of State we would urge that care be taken to maintain local momentum.
Also, a renewed effort to articulate the fundamental case for change to local leaders and clinicians may be needed. Clinical engagement is vital to any effort to secure better value from NHS care, and efforts to develop and spread technology are no different. This should be based around the principles of user-centred design, whereby clinicians are involved in developing systems rather than having them presented as a fait accompli.
So where does this leave us? The government and national bodies have set out an ambitious vision for a digital NHS. Although there are a number of obstacles ahead, not least the backdrop of unprecedented financial and operational pressures against which implementation will take place, there are also opportunities to progress, which could bring the vision within reach. However, for the NHS to get there, ministers and national leaders must now set out a definitive plan that clarifies priorities and funding, sets credible timescales, and is achievable within the current climate.
Health and Social Care Information Centre (2016). Patient online management information (POMI). Available at: http://digital.nhs.uk/pomi (accessed on 11 October 2016).
Honeyman M, Dunn P, McKenna H (2016). A digital NHS? An introduction to the digital agenda and plans for implementation. London: The King’s Fund. Available at: http://www.kingsfund.org.uk/publications/digital-nhs (accessed on 11 October 2016).
National Information Board (2014). Personalised health and care 2020. Using data and technology to transform outcomes for patients and citizens: a framework for action. London: Department of Health and National Information Board. Available at: www.gov.uk/government/publications/personalised-health-and-care-2020 (accessed on 11 October 2016).
NHS England, Care Quality Commission, Health Education England, Monitor, NHS Trust Development Authority, Public Health England (2014). NHS five year forward view [online]. London: NHS England. Available at: www.england.nhs.uk/ourwork/futurenhs/ (accessed on 11 October 2016). NHS England, Ipsos MORI (2016). GP Patient Survey – national summary report July 2016. NHS England.
Available at: https://gp-patient.co.uk/surveys- and-reports (accessed on 11 October 2016).
Senior Policy Adviser
The King’s Fund