The NHS has been allocated £1 billion over the next five years to spend on technology. NHS England’s rhetoric is overwhelmingly positive about digitisation, but what is the NHS health technology landscape really like for those who work in it?
The real issue we, as businesses, healthcare professionals and/or NHS managers, face, is not so much innovation but the slow pace and arduous process of adoption and diffusion of digital technology and its applications across the NHS.
On the face of it, an NHS that maximises the effective use of data and technology to improve health outcomes and the efficiency of care is both necessary and inevitable. And small and medium-sized enterprises (SMEs) are an important source of innovative solutions in this space. The key issue – particularly in terms of the growth prospects for SMEs – is the pace at which this digitally enabled NHS emerges.
With digital technologies there are major opportunities to re-invent, adjust or tailor to suit the local context, without diminishing the potential benefits. Therefore there are major opportunities to collaborate.
– Rob Berry, head of innovation and research, Kent Surrey and Sussex AHSN
Digital health – a definition
The digital health market can be broken down into four inter-related segments:
- Digital healthcare (telecare and telehealth): support and assistance provided at a distance using ICT and the remote exchange of clinical data between a patient and their clinician.
- mHealth: mobile applications relating to health and/or wellbeing, and connected wearable devices.
- Health analytics: the software solutions and analytical capabilities needed to assimilate big data.
- Digitised health systems: digital health information storage and exchange of digitised patient medical records.
Source: Digital Health in the UK: An industry study for the Office of Life Sciences, Monitor Deloitte, September 2015
Why do we need to digitise the NHS?
The prize – and the fundamental case for a digitally enabled NHS – is that it will:
- Make a real difference to people’s health by giving them greater control and better access to information; and
- Create a sustainable patient-focused system, built on effective use of digital technology and use of healthcare data to drive quality and efficiency; and
- Help build great British companies and encourage the growth of a thriving digital tech sector.
NHS England’s influential Five Year Forward View and the National Information Board’s Personalised Health and Care 2020 set out a clear roadmap for the NHS. The key messages for digital health are these:
- The application of digital technology has much to offer in addressing the health and wellbeing gap, the care and quality gap, and the funding and efficiency gap.
- The technology challenge is inextricable from the financial, staffing, safety and other challenges facing the NHS.
In reality, this is not happening across the NHS – yet. One of the reasons for this is the prevalent belief that ‘bad IT decisions cost people their jobs’, which makes NHS IT managers highly risk-adverse. However, tech projects in the NHS have typically failed because:
- They are not interoperable.
- They are not scalable at the back end.
- They simply reflect bad decisions or bad advice.
The centre can empower the local NHS to do this, but the centre can’t do it for us
– Jonty Heaversedge, GP and chair of Southwark Clinical Commissioning Group
Leadership is key. While successful digital transformation will probably continue to depend on inspiring individual leadership, it is only when digital becomes a standard element of board-level deliberations and decision-making that the adoption of digital health will accelerate and be sustained.
Digital record-keeping and using technology to engage with people can then become the new normal; it is, after all, how most people – including doctors and patients, old and young – run significant parts of their lives.
It is the boards of both commissioners and providers in the NHS – ideally across localities – that need to truly embrace the technology challenge and make it a core part of their visions for delivering better health and care for their communities. It is only when digital becomes a standard element of board-level deliberations and decision-making that its adoption will accelerate and be sustained.
What are the barriers for SMEs?
It has become standard to discuss and describe the barriers to innovation and its adoption. The Accelerated Access Review, which is being conducted by the Office for Life Sciences with the aim of speeding up access to innovative drugs, devices and diagnostics for NHS patients, sets out a neat and comprehensive summary. Another useful analysis that explores the barriers and enablers around the diffusion of innovation is set out in Cracking the innovation nut from the AHSNs and NHS Confederation.
Talk of ‘barriers’ tends to imply that someone somewhere else simply needs to get on and remove them, or enable them to be removed. This may be true in some instances; a good example is the National Information Board’s focus on setting interoperability and data standards and the ‘electronic glue’ that enables different parts of the system to work together. This is an essential underpinning for digital health to flourish. It’s also true that the incentives for innovation adoption need to be transformed as emphasised in the Accelerated Access Review.
However, it is important to recognise that it’s often not barriers but the inevitable tensions that need to be managed – whether you are an NHS manager worried about procurement rules, an entrepreneur concerned about how to keep your start-up afloat or a clinician who needs to be convinced of the evidence. The truth is that there will remain resource constraints in the system; silo thinking is never going to be completely absent and risks will need to be taken with any decision to invest in digital.
This is a shared challenge, for SMEs and the NHS
It is not surprising that aligning NHS challenges and SME solutions is tricky. The typical NHS organisation is grappling with a set of strategic challenges at population and system level, whereas SMEs often offer a specific product to address a specific need. This is one of the main challenges faced by those wanting to spread technology (the purchaser), and those trying to access this market (the vendor).
Managing this tension requires individuals and boards in the NHS to have a vision for transforming the way the system works and the way they engage with people – so that they can see how a range of digital products can slot in and enable the transformation. It also requires SMEs to help articulate a strategic case as well as a business case for their particular offering.
The technology challenge is inextricable from the financial, staffing, safety and other challenges facing the NHS. Collaboration and partnership is key, as is a shared goal and mutual interest. As Oliver Smith, director of strategy, Guy’s and St Thomas’ Charity, said: “If you want to be commissioned by the NHS, you have to be interested in what the NHS is interested in.”
Good deals between the NHS and SMEs will always depend on both parties working together to recognise and manage some inevitable tensions.
– Rob Berry, head of innovation and research, Kent Surrey and Sussex Academic Health Science Network
No counsel of despair
Despite the challenges, there are SMEs who are active in the NHS market and NHS organisations leading the way in adopting digital technologies. The focus of learning and support should be on this leading edge, exploring why and how they are doing it.