The UK Announces Its Vision For NHS Technology, And It's Not Sexy - Forbes

Last week Matt Hancock, the UK Secretary of State for a Health, announced the vision for the future of healthcare and the role that digital and data will play. Whilst many were braced for an “Oh no, not again” policy document about an unrealistic technology-enabled NHS, the vision has largely been met with great praise. The document was for many, pleasingly lacking in hype; including only four mentions of AI across the whole 12,000-word document. Yes, the latest announcement about what the future of NHS tech looks is anything but sexy, and this could not be a better thing. To summarise the announcement, the government wants to get the basics right, and the market, in collaboration with users, industry, NHS, providers and commissioners, will yield the right solutions, for the right people. Simple, right?

The "basics" are by no means basic and include the small challenge of all health and social care digital architecture, open standards, security, governance, and interoperability. This is layered with substantial hurdles to overcome in bringing the NHS to the 21^st century: legacy technology and commercial arrangements, a hugely complex organisational and delivery structure, a low-risk appetite inside the NHS, and poor trust in technology outside it, all underpinned by the perpetual reality of being cash-strapped as well a workforce which is inconsistently “digitally ready”.

Hadley Beeman, Chief Technology Advisor to the Secretary of State, advocate and architect for open standards said on Twitter “We have so many pockets of amazing digital services, ground-breaking AI, cutting-edge sensors and other innovations – but not the architecture to spread them across the NHS”. The document stated the “need [for] modular IT systems, where any module can be easily switched out, to create a market where providers compete on – and are rewarded for – quality.” This was music to the ears of a number of innovators interfacing with the NHS, including Nasrin Hafezparast, cofounder of Outcomes Based Healthcare, who argued, “at the most basic level, analysing NHS data is imperative to ensuring health systems are able to provide services that deliver the best outcomes for people. Without this insight, health systems do not know whether the services they are providing are actually improving people's lives or not”. With such a plug-and-play approach, a future where local organisations will buy technology to meet their needs within a common framework, and be rewarded based on smart outcomes, appears to be the direction of travel.

Matt Hancock at the launch of the new tech vision, held last week@DHSCmedia on Twitter

The document is of course long and fairly meaty, so here some highlights:

Architecture

If you geek out on architecture, this was the announcement for you: Putting tools in modern browsers; moving to mobile-, internet- and public cloud- first; keeping data where it was originally collected, accessible through APIs; and disaggregating the patient record between hosting, the data and the digital services, were all on the list. Addressing some of these issues could rectify everything from the need for huge migration projects for simple software updates, to improving access to data. Dr Hafezparast’s situation resembles that of so many other organisations, innovators and researchers who have found that “access to pseudonymised patient-data has always taken vast amounts of time, many months, and sometimes over a year, despite satisfactory information governance.” In healthcare, we like to feel special when it comes to the digital infrastructure required to deliver services, but as the vision argues, just as we can access our email from anywhere, the same should be for NHS data.

Standards

Infrastructure was really at the core of the new vision, with a lamentable landscape painted of the oft-described fragmented system, where patient care suffers. All fingers point to the patient record as no better example of this fragmentation when it comes to digital. Through the use of open standards, modular IT becomes much more of a reality where tools can be pulled and replaced with better alternatives, as vendors develop newer, cheaper or better products. There is a hope that this will be essential in altering behaviours of oligopolistic vendors to compete on quality, rather than being motivated by capturing and locking in users. This will also aim to make the rules of engagement clearer for new or smaller technology vendors. Ensuring compliance with open standards at the point of procurement will be top priority, but this is by no means a new threat. As was frequently warned by Matt Hancock’s predecessor, some criticisms have been raised as to what extent the vision will simply perpetuate the empty threats of open standards enforcement.

User-centred and co-development

It does not take long to understand how so often, NHS IT hinders, rather than helps service delivery. Speak to any healthcare professional about the number of separate login systems they require, and we see the bar is set very low. The document stressed the importance of iterative design, based on talking to the individuals using the service, starting small, testing and incorporating feedback, whilst always being focused on ultimately achieving the outcome. From a public-facing perspective, NHS.UK, the UK’s biggest health website, as well as the soon-to-launch NHS App, will help provide a more digital interface between the public and the NHS, and move away from the tidal waves of letters. But whilst considerable attention was given to the role frontline staff play in identifying and solving problems, numerous, readers have commented on the lack of genuine and smart patient engagement. Nevertheless, “collaboration and co-development” were said to be “at the heart of innovation in health and care”. But whether deep co-design with all users and effective deliberative democracy will be the way the vision manifests, is still unclear.

Helping The Outsiders Get In

Procurement, partnerships and proof were all touched on when helping innovators; big or small, interact with, test and sell to the NHS. The partnerships with innovators were thought to be “at the heart of the ecosystem”. One of the growing concerns from NHS England has been evidence for effectiveness, responded to by innovators who have struggled with testing and iterating their products in a sandbox environment. To be able to iterate the “wild” is so often at odds with the approach of trials, ethics and patient consent that reaching a consensus between these two approaches will be very challenging. Nevertheless, for those innovators providing better or cheaper products, there may be hope for simpler, clearer and faster ways of securing shorter, and smarter contracts.

Matt Hancock announces a future vision for a digital NHS-

Talent

It won’t be a surprise to anyone who has tried to recruit technical talent that finding the right people who have a melange of technical skills, clinical awareness and the ability to go between the two are hard to find; and that’s if you have a Big Tech salary to pay. A call for a “tech-savvy” workforce, who understand frugal technological innovation, was a must. In addition to this, was a call for the recruitment and retention of specialities such as data science and analysts, to make use of all the NHS data available.  A nod was given to the approach adopted by schemes such as the Clinical Entrepreneur Programme, to ensure frontline staff are supported to build solutions to the problems they experience. However, when it comes to attracting the young, best and brightest brains in data, Yvette Pinder, third year computer science student at University College London and healthtech enthusiast commented in her blog that the attitude of “[minimising] what you need to learn to build software and digital services for health and care” was the sort of statements that would put her off. She argues that socially-minded new graduates with technical talents are looking to apply their skills to solve challenges in sectors such as health, but are also craving opportunities to develop their technical skills. The vision focussed considerably on helping those currently working in the NHS developing and sharing the skills needed to be a “digitally ready workforce”, however many graduates like Yvette do not feel enough effort is being put in to build an attractive pipeline of talent for young computer and data scientists, given the complexity of working in health.

Leadership & Culture

The role of leaders at all levels in driving the vision was made clear.  With a focus on the local choice, senior support was seen as a must in order to ensure sufficient in-house know-how. It was argued that local staff should to be able to participate in discussions with developers and vendors, to align the needs, tools and implementation requirements they need, and to make informed and evidence-based choices about the technologies being discussed.  The role that culture plays in driving the vision was also highlighted: From a present culture of risk averse staff, to a future culture of digital-first in the way patients use the NHS, the shift in a nation’s mindset is no small aim.  Being transparent, open, collaborative and realistic in the innovations being developed was seen as key to creating a culture of innovation but doing so in a co-ordinated and controlled manner. A big shift in mindset has always underpinned the need for digital transformation, after all, this is about people, not tech

A future UK healthtech world where: every healthy person can stay healthy; individuals can manage long term conditions, easily; innovators and researchers can get on with saving lives through the better use of NHS data; a clinician or social worker can improve the way they do their job; and commissioners can make better decisions based on robust evidence, is the rosy future. As an openly draft-version document which has attracted comments from everything from the need to better regulate such a market-driven future, to the compatibility of this vision with current policies, the authors are looking for our ideas. Got a response? Thought you would…

Comments, complaints and praise can all be aired in this survey. And remember, behind every government document there are a group of smart people trying their best, so let’s keep it constructive.

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