Will the NHS ever really embrace digital tech?

Of all the reports on the future of the NHS, none exudes more opti­mism than Prepar­ing the health­care work­force to deliv­er the dig­i­tal future. Pub­lished hot on the heels of the NHS Long-Term Plan, it is a gal­vanis­ing, inspir­ing vision: a ral­ly­ing call to help NHS staff max­imise inno­v­a­tive tech­nolo­gies such as arti­fi­cial intel­li­gence, dig­i­tal med­i­cine and robot­ics.

This lat­est review, chaired by Eric Topol, pro­fes­sor of mol­e­c­u­lar med­i­cine at the world-renowned Scripps Research Insti­tute in San Diego, Cal­i­for­nia, envis­ages patients increas­ing­ly gen­er­at­ing their own health data with the help of algo­rithms. Arti­fi­cial intel­li­gence, says Pro­fes­sor Topol, will stream­line the speed, accu­ra­cy and scal­a­bil­i­ty of data inter­pre­ta­tion.

The NHS Long-Term Plan, launched in Jan­u­ary, high­lights dig­i­tal as the way for­ward. Indeed, between 2014 and 2018, there have been a suc­ces­sion of reports, from the Nation­al Infor­ma­tion Board, NHS Dig­i­tal, the Depart­ment of Health and Social Care, and Pro­fes­sor Robert Wachter, author of The Dig­i­tal Doc­tor: Hope, Hype and Harm at the Dawn of Medicine’s Com­put­er Age, each empha­sis­ing the ben­e­fits of inno­v­a­tive tech­nol­o­gy.

But it is crit­i­cal to see this avalanche of doc­u­ments in con­text. When gov­ern­ments do not know what to do, they com­mis­sion more and more reports, reviews and green papers, so no one can accuse min­is­ters of doing noth­ing.

Crit­ics main­tain, how­ev­er, that despite the many words of advice, there has been much gov­ern­ment inde­ci­sion and lack of progress in imple­ment­ing dig­i­tal.

Digital technology long been a major part of any NHS plan 

This is not the first time the gov­ern­ment has tried to rev­o­lu­tionise the way the NHS uses infor­ma­tion. Launched in 2002, the much-hyped ear­li­er NHS plan, the Nation­al Pro­gramme for IT, pledged to rev­o­lu­tionise use of tech­nol­o­gy, paving the way for elec­tron­ic patient records, dig­i­tal scan­ning and inte­grat­ed IT sys­tems across hos­pi­tals, pri­ma­ry and com­mu­ni­ty care ser­vices.

Despite all the good inten­tions and the bil­lions of pounds of invest­ment from gov­ern­ment fund­ing, this NHS plan was dogged by data man­age­ment issues, patient con­fi­den­tial­i­ty con­cerns, con­trac­tu­al wran­gling and numer­ous missed dead­lines.

Ten years lat­er, when min­is­ters began the incred­i­bly messy process of dis­band­ing this NHS plan, costs were esti­mat­ed at £6.4 bil­lion, but this rock­et­ed to £9.8 bil­lion.

MPs on the Pub­lic Accounts Com­mit­tee con­demned the NHS plan as one of “the worst and most expen­sive con­tract­ing fias­cos” in pub­lic sec­tor his­to­ry.

Why then is it prov­ing so chal­leng­ing to bring NHS dig­i­tal capa­bil­i­ties in line with oth­er sec­tors such as bank­ing or retail?

Digital funds often swallowed by more pressing needs

There has prob­a­bly nev­er been a worse time to intro­duce expen­sive new tech­nol­o­gy. Sev­er­al times since 2010, cash ini­tial­ly ear­marked for dig­i­tal devel­op­ment has been snatched back to meet more imme­di­ate needs.

Dig­i­tal seemed an easy tar­get because of Whitehall’s reluc­tance to invest fur­ther after the ear­li­er sham­bles and because dig­i­tal projects rarely deliv­er an imme­di­ate ben­e­fit, unlike giv­ing hos­pi­tals more mon­ey to spend on staff.

Dig­i­tal has been swim­ming against the finan­cial tide since 2010. Dur­ing this time the health bud­get has been grow­ing by 1.2 per cent in real terms a year. Accord­ing to The King’s Fund, the inde­pen­dent think tank: “This is far below the long-term aver­age increas­es in health spend­ing of approx­i­mate­ly 4 per cent a year above infla­tion since the NHS was estab­lished and the rate of increase need­ed based on pro­jec­tions by the Office of Bud­get Respon­si­bil­i­ty of 4.3 per cent a year.”

In a refresh­ing­ly hon­est report in 2018, the Depart­ment of Health and Social Care says: “Tech­nol­o­gy sys­tems used dai­ly across hos­pi­tals, GP surg­eries, care homes, phar­ma­cies and com­mu­ni­ty care facil­i­ties don’t ‘talk to one anoth­er’, fail fre­quent­ly and do not fol­low cyber­se­cu­ri­ty prac­tices.”

Accord­ing to a for­mer NHS doc­tor: “Doc­tors have mixed feel­ings about tech­nol­o­gy. They have an ingrained dis­like of any­thing such as arti­fi­cial intel­li­gence that reduces their pow­er and author­i­ty.”

Recognition that NHS long-term plan has to make digital a priority

But there is increas­ing recog­ni­tion that dig­i­tal is the future and it must eclipse a work­ing cul­ture weighed down by out­dat­ed process­es, resis­tance to change, staff work­ing in iso­la­tion in so-called silos and a lack of joined-up think­ing.

These prob­lems are exac­er­bat­ed by severe staff short­ages, even though, with some 1,500,000 staff, the NHS is report­ed by the Nuffield Trust to be the world’s fifth largest employ­er, after the US Depart­ment of Defense, the Chi­nese Lib­er­a­tion Army, Wal­mart and McDonald’s.

NHS Improve­ment, which over­sees NHS and foun­da­tion trusts, esti­mat­ed there were 97,000 NHS vacan­cies in 2017, includ­ing 10,000 for doc­tors and 35,000 for nurs­es. A dig­i­tal rev­o­lu­tion could relieve staff pres­sure, but many clin­i­cians can­not rec­on­cile dig­i­tal hype with see­ing it all go wrong.

Polit­i­cal lead­er­ship is essen­tial to dri­ve progress. Matt Han­cock, sec­re­tary of state for health and social care, like his pre­de­ces­sor Jere­my Hunt, is firm­ly com­mit­ted to dig­i­tal. What­ev­er step he takes, the poten­tial ben­e­fits of the dig­i­tal rev­o­lu­tion are huge.

Embracing an NHS long-term plan for digital could revolutionise healthcare

They could be as far reach­ing in tech­no­log­i­cal terms as the ther­a­peu­tic rev­o­lu­tion of the last 70 years has been in pro­duc­ing inno­v­a­tive treat­ments rang­ing from antibi­otics to clot busters, from oral con­tra­cep­tion to in vit­ro fer­til­i­sa­tion, and from laser surgery to organ trans­plants.

While the pos­si­ble gains are huge, so are the chal­lenges. Min­is­ters and NHS lead­ers must resist the temp­ta­tion to snatch back mon­ey allo­cat­ed for dig­i­tal projects. Instead they must show courage and invest in tech­nol­o­gy even though the full ben­e­fits may not be imme­di­ate­ly appar­ent to patients, per­haps for years.

The impor­tance of an NHS long-term plan for dig­i­tal can­not be over­stat­ed. Indeed, unlock­ing the full ben­e­fits of the dig­i­tal rev­o­lu­tion will very like­ly be the key to the sus­tain­abil­i­ty of a UK health ser­vice fund­ed by tax­pay­ers, free at the point of care. This is sure­ly some­thing worth fight­ing for.