Josh Tipple discusses why the NHS must reform and modernise.
Governments have tried to modernise the NHS for 20 years through its information systems and largely failed. Now, to borrow a phrase from Shakespeare it is 'once more unto the breach dear friends, once more'.
New Labour started digitising the NHS in 2002 with the National Programme for IT (NPFIT), spanning 9 years it was eventually dismantled in 2011 without achieving its aims. Jeremy Hunt set a target for a paperless NHS by 2018, also missed. Now a more general target of the NHS having a 'core level of digitisation' by 2024. This may seem far away, but given previous iterations, seems optimistic. All talk about how AI is going to change healthcare seems hard to swallow, given the NHS is still in the digital middle ages.
NHSX was launched in 2019 to 'speed up digital transformation in the NHS and Social care' and should be in phase 4 or ‘delivery stage’ of its plan (which runs until 2024).
A recent NAO document on digitising the NHS is interesting reading to those with an interest in NHS & IT (niche I know), just the fact that it is 53 pages long should tell you a lot. It refers to the fact that the government does not have 'a reliable understanding of how much funding is required', presumably because the government does not understand the scale of the problem in front of them. A problem entirely of its own making.
Over the last 10 years it has been almost impossible to conceive and implement the fundamental, far-reaching reforms in IT required. Budgets have been squeezed, frontline staff have been ringfenced whilst support services (e.g IT/administrators) cut; departments which are involved in IT improvement have been trimmed back.
Clinicians, generally, have a low level of IT literacy, spending their time treating patients not improving their IT skills. Also, there is no incentive for IT professionals to choose a career in the NHS (a good friend told me her brother-in-law works as an IT engineer in the City, and his end of year bonus was more than her annual salary as a senior physiotherapist).
Governments have been throwing money at IT for years, with little more than a fragmented and inefficient service fraught with bugs to show for it. It’s led to ‘a thousand flowers blooming’ as the NHS Five Year Forward View said. Competition will make things more efficient they kept telling us, but it had the opposite effect here. Most systems are not designed for the NHS, one I have used was developed for the US market, but then transposed onto our hospital. Frontline staff learn to use multiple systems, and then periodically re-learn another system when implemented/replaced, getting little support from overstretched and under-resourced IT departments.
The NHS’ most valuable resource is its staff; they have endured much and continue to make the health service work as efficiently as it can. There is an untapped pool of talent in front of the governments very eyes that it chooses to ignore in favour of wide ranging and lofty reforms that it dreams up with private companies behind closed doors. These reforms run into practical issues as soon as they are implemented, which may have been avoided if it was designed in part by those using it.
Root and branch reform is needed to reverse this deficit, the reasons why IT is such a challenge in the NHS are legion. This crisis has been festering away in a dark corner for a decade, the government needs a firm grasp on the enormity of the task in front of them and need all the help they can get. Unfortunately, NHSX looks like another unto the breach filling it with its dead, setting arbitrary targets whilst not fully comprehending the problem. NHS staff have shown remarkable innovation, throughout every level of the NHS, if this is embellished with exceptional IT literacy and robust IT support it could lead to an organic digital revolution on the frontline.
Josh Tipple is a Respiratory Physiotherapist based in Bristol, looking at ways of reducing Healthcare inequality through the use of technology.
He tweets at @jt_resp_physio