Technology and the NHS: A framework for digital ‘lock in’
I recently gave evidence to the Public Services Committee in the House of Lords on how the coronavirus pandemic will affect the future role, priorities and shape of public services.
A number of key themes and issues were raised during the session that will be important in the months and years ahead. Many of these reflected the findings from our report Ending the Divide which provided some early insights into the impact of the pandemic on the Government’s health and social care agenda.
The potential of new technologies to transform public services has long been evident but the experience of the public sector and in particular the NHS in adoption and diffusion has been mixed.
Driven by a clear need, the pandemic has led to a dramatic and welcome transformation in the use of digital health services.
The expansion of virtual consultations for GP and outpatient appointments have been the most visible ways of technology being ramped up quickly to benefit patients and staff. Digital services, including 111Online, have been central to the effort in identifying virus symptoms. Within the NHS, staff have been better connected through the rollout of Microsoft Teams and digital tools have been provided to help staff under acute strain with their mental health and wellbeing.
Alongside this, new initiatives have been rapidly launched to tackle the health fallout from the pandemic particularly isolation and support for shielded groups. The TechForce 19 programme from the Department of Health and Social Care has helped support carers in their day to day duties and cancer and rare disease patients with their treatment.
The challenge now is on how to lock in these gains and the progress that has been made. A four-part framework for this may well be: evaluation, need, investment, commission (and then regular repetition) as set out below:
Evaluation: An evaluation of what has worked well and less well in the digital response to COVID 19 will help produce an evidence base that supports further adoption and diffusion across the system. This will require both quantitative and qualitative assessments of services and local and national input. The impact of digital service changes on different demographics and patient cohorts through capturing user feedback should also be a core part of this.
Need: The healthcare needs of the population have been impacted in a series of known and unknown ways from the pandemic. In my piece for Paul Corrigan’s blog, I set out five categories for this. Lining up the role of digital health in supporting the meeting of these needs feels like a critical exercise for NHS leaders to ensure patients do not fall through the cracks in the system and that care backlogs and the wider health impacts from the pandemic are addressed, taking account of clinical, emotional and practical needs.
Investment: The Government will need to look at investment in capital infrastructure and digital skills at the Budget and as part of the Spending Review. 40 new hospitals will continue to attract the headlines, but the wider health and care estate, particularly primary, community and social care needs urgent and overdue attention to. A series of regionally focused (rather than institution led) upgrades and support packages could help transform care pathways and underpin the digital changes that are needed. Alongside this will need to be commitments to widespread investment in staff training in technology and some funding to underpin the ambitions of the People Plan.
Commission: For those services where the evidence points to substantive benefit, there will need to be clarification regarding where these services are most effectively commissioned. The overarching ambition needs to be one of simplicity of approach, reducing waste and maximising patient and public benefit. Given the speed of the digital health response to the pandemic, some overlap and duplication of approach from agencies is understandable but has also demonstrated the challenges of responsibility and accountability in the current NHS. The movement towards more integrated care systems where risk and reward can be shared across care pathways in regions, creates opportunities for thinking differently in how to use new technology at scale to support improved population health.
The NHS and social care services have rightly received credit for moving quickly to embrace digital health opportunities during the pandemic. There is a huge among of goodwill to ‘lock in’ the gains that have been made. To do so will require commitments to learn, invest and simplify. Such an approach will see digital health playing a major role in both the next phase of the pandemic response and beyond.