Turning the tide: can technology and digitisation help the NHS meet the public's expectations?
The NHS is one of the major winners of this week’s budget. With £22.6bn in additional day-to-day spending at its disposal, it will now be expected to deliver on the government’s promises to reduce waiting lists, increase productivity and tackle other areas which were highlighted by the Darzi Review in September as being inadequate.
Ultimately our healthcare system is facing a supply and demand conundrum. Resolving the supply side, by increasing slots, and enhancing productivity, is only part of the puzzle. The NHS will find itself constantly fighting to stay ahead of the rising tide of demand through the demographic pressures of an ageing population, as well as a steady rise in the prevalence of preventable conditions. One of the major enablers to tackle both challenges will be through new technology and digitisation.
In September, Secretary Wes Streeting made clear his wish to move the nation towards a “a digital healthcare service powered by cutting-edge technology”. The budget contains a £2bn provision specifically for technological and digital improvement to free up staff time, ensuring the deployment of Electronic Patient Records (EPR) and increasing productivity, which is still stagnating below pre-pandemic levels.
While these proposals sound promising, senior leaders in the Department of Health and Social Care (DHSC) and in trusts across the country will recognise the real challenge of translating this into measurable impact. Using technology to create efficiencies, for example through the use of AI, will be a phrase as familiar to those in the NHS as it is to all sectors over the last two years. But ensuring that proposed solutions take into account existing systems and processes, and are actually adopted by staff, will be difficult.
New technology has already proven its worth in increasing efficiency in the use of existing resources, such as theatre utilisation, optimising workforce rotas, and optimising current supply chains. New tools to improve depth and accuracy of clinical coding, the move towards EPR, and other initiatives such as patient booking portals have the potential to be transformative for trusts.
There are two major areas of consideration in ensuring this push towards digitisation brings benefits to the public as well as healthcare providers. The first is that new technology actually yields the purported productivity benefits: if technology is rolled out in isolation, and trusts have a poor grasp over the functionality of potential and/or existing tools, there is a danger of duplication or tools not being utilised to their full potential. Additionally, constant change in processes and tools typically also discourages adoption by NHS colleagues. Procurement and deployment of tools must therefore be done within the context of a digital strategy.
The second is that technology cannot be limited to making the NHS’s existing resources do more. Labour’s 10-year plan for the NHS has identified moving from treating sickness to prevention as one of its three tenets. Technology needs to feed into this preventative approach too.
In order to support research and innovation to tackle these problems at source, one of the major tasks facing care systems is to ensure all patient data is gathered into digital environments where it is secure but also easily accessible to authorised users. This will have to extend beyond the data in the acute trusts to present a holistic view of the patients’ journey through the system.
The use of pattern recognition software has already been deployed in trials to support early identification of cancer or dementia, scanning existing imaging data to great effect. Wider testing and deployment of such technology will be a key factor in tackling challenges such as the absence of progress made in diagnosing cancer at stage I and II between 2013 and 2021 as highlighted in the Darzi Review. Currently too many initiatives are contingent on individual clinicians and researchers testing hypotheses and encountering obstacles in gathering the data to do so. If we are to move to a truly preventative approach, systems will need to move to the next level and deploy teams to lead exploratory work on patient, operational and financial data to seek out patterns and lower rates of readmissions, identify diseases earlier and tackle key drivers of the rise in demand across systems.
In order to adequately support this ambition, we would need to ensure that:
· There is a unified approach across systems, collecting all data including acute and primary care data into secure environments and test novel approaches to data analysis
· Both patients and clinicians are consulted in the process and that the value of this work is tangible to them, failing which data will be withheld on and clinical guidance will be absent
The NHS now has a chance to invest in both the move towards a preventative model and the push for greater productivity. This will only succeed if they are not only supported by the right tools but by a fundamental shift in approach. Moving towards a holistic view of the patient and the interactions between different elements in the system will allow us to identify the changes that need to be made; becoming less responsive in the deployment of new technology and adopting a strategy where leaders have a clear view of the digital ecosystem and what system feeds into what will be essential in getting this right.