Solutions for digital transformation in the NHS

Ben Riley, Director of Aventius Ltd, concludes a series of articles on digital transformation in the NHS, focussing on solutions to the challenges discussed so far

Welcome to the final part of this short series of articles on digital transformation in the NHS. In the previous parts, we’ve delved into some history, recent updates, and where I think it’s heading.

However, for this last part, I will try to bring all that together and present some possible solutions to some of the challenges we’ve discussed. These might not be easy solutions, maybe even impractical for now, but from my time spent in the NHS, this would seem to be what needs to happen.

Public data access and NHS internal data management

Starting at the top, we’ve got two main challenges: public data access and NHS internal data management. From discussions in the previous articles, the challenge of presenting a patient’s data to the actual patient themselves is in a reasonably good state – at least from the perspective of the patient, behind the scenes could be a total disaster or not. Still, the patient doesn’t know or care as long as it works. We’ve got some NHS (and GP) apps now that you can use to book appointments and so on.

I don’t think that much more attention is needed in this area.

The other challenge in this battle, which I think is vital, is the internal data management in the NHS itself. I’d also like to point out that what happens here has a strong bearing on the behind-the-scenes mechanics of the patient-facing apps, at least to a certain level. The main point here is that it’s not really a technical problem that needs to be addressed, although there are some significant technical issues; as I’ve said in the previous articles, it’s how the NHS works and is structured.

Pursuing digital transformation in the NHS: NHS business change

The NHS needs to be on a single system: the GPs, the hospitals, the community services, even the commissioners, all of them. Ok, problem solved. Oh, wait, actually, no, we tried this with NPfIT back in the early 2000s, and it didn’t work. Yes, this project was a failure, but why? Not because it wasn’t possible to build a single system, or even because the system wasn’t very good, it was because all the disparate organisations that make up the NHS all work differently.

There was some attempt at business change back in the days of NPfIT to try and get services to work the same and record the same data, but it fell short. However, even if the proposed system was superb and the other issues with NPfIT weren’t an issue, the business change needed was far too much for the NHS to entertain at the time.

The situation now is that the large single-system model has been mostly rejected, likely due to the stigma and failure of NPfIT having some part in that. Instead, the NHS is supposed to try to integrate all its different systems across all the different organisations in the NHS.

Having worked with data and IT systems in the NHS at acute/community providers, commissioners, and shared services, I can confidently say that this approach is, and will be, a nightmare to manage and maintain. Think of the most complicated intricate spider’s web of interconnectivity, and you’re some way there.

Fixing data and IT systems in the NHS

I think there’s a relatively straightforward way to get there, actually. However, it would take time, but not necessarily the same level of financial investment as with NPfIT. This plan would revolve around two main points: –

1. Any system should be designed in conjunction with the NHS. This may sound obvious, but what I’m getting at is that it should not be created by a system supplier who just designs a system they think would work for the NHS, but essentially a twist on that. Instead, the NHS designs the system with support from a trusted and experienced system supplier. From a development perspective, in essence, the NHS would be the systems analyst and the supplier to the programmer, or even take it one step further and create a dedicated NHS systems team within the NHS populated by experts in the field and not limited by the current salary restrictions of Agenda for Change which vastly restrict the amount that the NHS could pay expert developers. In other words, if you want the best coders, you must pay the best rates.

2. Start small; do not try to build the ultimate system right off the bat. I would suggest starting with a PAS (Patient Administration System) that can gradually be rolled out nationwide to support both primary and secondary care. With data outputs to support each part of the NHS. So, hospitals can get data extracts to monitor their patients; commissioners can see only pseudonymised data that they’re allowed to see. This can then be built upon for other more specialised modules down the line. To be honest, even if this were the only part of the system that ever went live, I’d imagine most hospital provider trusts would jump at the chance to move off their ageing (some of them are 20+ years) PAS systems that some are currently stuck on. I mean, who wouldn’t? You could get a new replacement for free instead of having to fork out several million pounds for a new PAS or EPR system. Then, slowly, over time, build the remaining modules and roll them out to everyone bit by bit, but closely tie this in with the appropriate business change needed to get all services working the same way.

Bringing ideas to the forefront of modern computing

I want to thank anyone following this series of articles. Hopefully, I’ve put some exciting points out there, if nothing else. After all the years I spent in the NHS, I’d love to see them brought to the forefront of modern computing, and who knows, maybe one day that might happen. I hope you’ve enjoyed reading. Take care.