A report released this week by MPs on the Health and Social Care Committee provides a realistic view of what’s required to embed digital change across the National Health Service (NHS). On the one hand the Committee is optimistic about the Department of Health and Social Care and NHS England’s commitment to ‘digital’ as a key lever to ensure the future success of the NHS, but on the other highlights a number of key structural issues that will make this incredibly difficult.
Some of the core challenges raised in the report include skills and the level of pay required to attract digital and data professionals, the need to invest in new systems and interoperability, the risks associated with shifting to the use of ‘healthcare apps’, and motivating the full range of healthcare professionals to recognize the importance of digital change.
What’s interesting is that none of this is new or unknown to those who have been working in or following ‘digital’ within the NHS over the past decade. Ever since the failure of the National Programme for IT in 2011, wasting taxpayers billions of pounds, numerous attempts to ‘digitally transform’ the NHS have been undertaken.
However, one thing that’s changed since then is the COVID-19 pandemic, during which time the government was able to persuade huge swathes of the population to engage with the health service digitally. This includes the NHS App, which was used to show a person’s vaccination status, and will now operate as a ‘front door’ to health care services across England and Wales.
However, that success isn’t a given going forward, and the Committee rightly argues that the government and NHS England need to highlight continued value for people in order to sustain its success during the pandemic. New functionality without new sign-ups or downloads is pointless.
Equally, a health app that provides a pathway to healthcare services will ultimately fail if the other structural challenges highlighted aren’t addressed. In particular the report highlights that parts of the NHS still lack even the most basic, functioning IT equipment. Equally, the NHS should scrap pay scales for digital and data staff, in order to attract the best talent on the market.
Chair of the Health and Social Care Committee Steve Brine MP said:
We find reason for optimism in the government’s approach to the digital transformation of the NHS. We know that the NHS app was hugely successful during the pandemic and the government has big plans for it to do more to bring real benefits to patients.
However, there are major challenges to overcome. On a visit to the US, we saw digital patient records being used seamlessly in hospitals. Here, it can take more than 15 minutes for a clinician to turn on a PC because kit is outdated. The lack of skilled digital professionals is a further barrier. Until the NHS can offer higher salaries to compete with the private sector, it won’t be able to attract the people to deliver the transformation that’s needed to run a modern health service.
The long-term sustainability of the health service depends on getting this right but there will be people who decide that digital services are not for them, and we are clear that they should not find themselves excluded by future developments.
The Committee highlights that successive governments have attempted digital transformation in the NHS, but notes that progress has been slow and uneven, with substantial variation between organizations. However, it adds that this attempt has the potential to drive change, if a number of issues are addressed. These include:
Innovation in digital healthcare – the Committee urges the government and NHS England to demonstrate continued value of the NHS App. It recommends that a timetable for introducing a new ‘native’ NHS App is outlined and a plan for communicating its benefits and features is drawn up.
Systems and interoperability – the report states that the government, NHS England and the country’s Integrated Care Systems (ICSs) should work together to develop a standards framework to be adopted by all ICSs, with the aim of improving interoperability and data sharing within and between systems.
The Digital, Data and Technology workforce – given the shortage of skilled digital professionals in the NHS, the Committee recommends the government apply to implement a new pay framework that would allow additional pay measures including bonuses and capability based allowances. In addition, investment in these specialists needs to be matched by investment in the wide workforces’ digital skills, including professional training.
Digital exclusion – the Committee rightly points out that the NHS is a universal service and that people should not be unable to access it because of wider challenges around access to technology, connectivity and digital skills. It encourages cross-government collaboration to address digital exclusion, as it’s not just the responsibility of the Department of Health and Social Care, and says that non-digital channels should remain available, especially as it develops and implements its digital offering. Equally, the government and NHS England should work to understand what models would work best for supporting patients to use and access technology in different settings both in and outside the health service.
I’ve said it before, but it’s worth reiterating that one of the fundamental issues with implementing digital change across the NHS is that the NHS is not a single entity. It is made up of dozens of organizations that have their own unique needs and local requirements. The top down approaches of the past have largely fallen flat because of this failure to understand that mandating blanket requirements, without engaging with professionals across all sections of the NHS, was never going to work. A flexible standards based approach, with a focus on interoperability, whilst upskilling all sections of the workforce, is a sensible one. However, with the NHS under significant pressure post-COVID-19, ongoing pay disputes, and a lack of funding – there is a risk this digital ambition will be drowned out by other challenges. The government needs to address all of them simultaneously for the digital shift to take hold, or else it risks becoming just another ‘good idea’.