Insights

Chris Rose: 6.5 minute read

Will NHSx make a difference?

Sounding like an extra from the next Terminator film, the new NHS Unit (NHSx) has been tasked with, ‘Driving forward the digital transformation of health and social care’. A noble cause and one that we applaud. Fax machines belong in a museum and not within the confines of a modern healthcare organisation, especially one that deals with an average of a million patients every 36 hours.

Technology can unlock efficiency savings but is the new unit ready to enact change or will it be lost to history?

What is wrong with the status quo?

Population growth and increased need versus budget cuts and increased debts. The NHS is at breaking point with debts that would break the average family. It cannot continue with mini cash injections from the government. These keep the NHS afloat but they do not allow it to grow and expand in the areas that it needs to. Waiting times are increasing and unless the service is transformed, then it will fail.

Throughout everything, the NHS has needed to prioritise the care of those who are most in need, forsaking preventative measures in some cases. When budgets are as thin as they are, you need to ensure that the basics are completed, keeping to the mission statement of the service. The founding principles of the NHS from inception have been:

  1. That it meets the needs of everyone
  2. That it will be free at the point of delivery
  3. That it will be based on clinical need, not the ability to pay.

We would argue that the NHS has stayed true to its founding principles but it is treading more water as the days pass. The introduction of the ten-year plan and NHSx are welcome developments, as whilst care is being provided, it is being done so against increasing demand. This has resulted in increased waiting lists and when it comes to health, delays can be deadly.

NHSx; Cool name, but what will it actually do?

Before they launched, the NHSx team spent a month, visiting Health and Social Care teams seeing how they use technology, and understanding the challenges. Matthew Gould, the CEO is not starting from scratch and will build upon what other government agencies have already achieved.

The NHSX brings together Money, Projects and mandate. His focus will be more of a guardian, overseeing and supporting innovation and technical standards, rather than build as they have done with the NHS App. The NHS App will be maintained, but he sees the future functionality coming from Health innovators and not the NHS. NHSx will do some developing but it will be on a small scale as he wants to keep the centre thin.

The five missions that NHSx will focus on at the start seem relatively simple, but as we know, you need to get the basics right before you can do anything.

  • NHSx Mission 1
    Reduce the burden on clinicians. Logins and performance are currently terrible

  • NHSx Mission 2
    Put information in the hands of the citizen

  • NHSx Mission 3
    Patient data can be accessed from wherever the professional is

  • NHSx Mission 4
    Help in the effort of patient safety

  • NHSx Mission 5
    Help increase productivity.

First and foremost they will conduct a review of existing systems and create learnings from this. These learnings have already been completed and we applaud the direction of travel that NHSx is headed in with regard to detailing standards. They have a clear message to focus on the areas that will have the biggest impact first.

  1. Set standards when selecting technology
    These will be around interoperability

  2. Screening programmes
    NHSx see these as something they will build at the centre

  3. Ensure Health and Social Care employees have the support they need.

Earlier this week I attended an NHSx event and I believe they will focus on solving;

  1. Interoperability
    The need for modern open systems.

    Siloed systems do not create a full picture of the patient. We have known this for years and have been pushing for interoperability and open APIs within our technology. The news emerging from NHSx that the number one need emerging from their research is that, interoperability is key to see the full picture of the patient is welcome.

    Having all of the information about the patient in front of the clinician will save time, money and most importantly, lives.
  2. Usability
    Systems that are easy to use.

    It is all well and good, designing the most open systems in the world that can easily talk to each other and transfer data but if they are harder to use than the average parking machine, then you have a problem. Why? The user will then spend time each day simply attempting to log in using the system, negating any benefits gained through interoperability.

  3. Productivity
    Systems that reduce unnecessary administration and solving the most simple issues in the NHS.

    The administration is a key, yet at times, an infuriating task in our daily lives. It helps us to see trends, ensure that payments are made and that a patient’s history can be easily seen. It is important and by utilising technology such as mobile responsive design, you can ensure that the technology you use is available, at any time and from anywhere.

    You can reduce the time it takes to log in and update data through this simple change in the process. It will no longer have you ‘chained to your desk’. What we mean by this is that you will not be required to always be in the office to update your notes, you can be on the road for longer. You can update notes from your phone, tablet or computer from wherever you are in the country.

Creating a stable core

The trifecta of Interoperability, Usability and Productivity will create a central pillar to the NHS. One that will in the ideal world create certain standards that all technology will need to adhere to in order to be utilised by the NHS. By creating this pillar and not dictating what technology systems different Trusts should utilise, you keep innovation active within the sector.

What you are doing with the introduction of this trifecta is creating a stable system that will provide clinicians easy access to information. Suppliers that do not adhere to these ideas will then be left by the wayside and rightfully so as the consequence of bad investments in the NHS is waste.

Wasted money in the NHS is borderline criminal as people’s lives depend on the expediency of information. X-rays need to be analysed, alongside tests as quickly as humanly possible and the results sent to the patients. Notes and observations from other frontline services such as schools and the police should be shown, in addition to social workers. The full picture is needed to create the best diagnosis possible and it was about time that the NHS was offered the chance to see this.

What savings will be made?

That is difficult to say at this stage in terms of the exact amount but what we can do is reference similar studies to build the picture.

A hospital bed costs the NHS an average of £400 per day.

Delayed Transfers of Care, which are when patients that are fit enough to be discharged from a hospital but no ongoing care has been provided, cost the NHS in England an estimated £1 billion per year.

By utilising a technological application that moved the discharge process online, a top local authority in England saved the equivalent to 350 bed days in six months. This is a saving of £140,000 or £280,000 over the course of a year.

Another top NHS Trust looked at case recording in its 0-19 service, moving from paper to electronic, completing an extra 70-80 appointments each day as a result. In less than five months of utilising electronic recording, they have been able to save 70 hours each day. Time, which now means that they can complete up to 350 additional appointments each week and a reduction of up to 480 miles travelled each day. This reduction in travel has both a positive financial and environmental impact.

Conclusion

We welcome the direction of travel that NHSx is moving in and ensuring that person-centred care is met through reducing unnecessary administration. Their projects and focus seem sensible, at least a lot more than the recent project announced by the What Works for Children's Social Care team of the impact of free coffee. Whilst we are appreciative of free coffee, much like the next organisation but a study into the impact of free coffee is rather erroneous in terms of benefits for those who need to be cared for. What benefits will be passed on to the service user from this?

Technology will play a huge part in the future of the NHS and we are ready to support them. The development of a central core based on the trifecta of Interoperability, Usability and Productivity is one that we applaud. Retuning the technology to bring it up to date is a challenge and it is one that needs to be completed sooner rather than later.

NHSx needs to be provided with the support that it needs in order to transform the heart of the NHS. What we hope is that it doesn’t end up like the last Terminator film and left in the bargain bucket, forgotten about and left to flounder. The NHS needs a change in order to continue caring for those who need help.

Our missions to NHSx

OLM is in favour of what NHSx is saying around usability and interoperability, ECLIPSE already meets all of the areas discussed; easy-to-use, high performance and ability for multiple agencies to access the information they need it.

After NHSx’s nice words, however, must come the action.

Our three missions to NHSx are: 

  1. Have the grit and teeth to deliver real change
    If the standards are just guidelines then they won’t be followed and it will fail. Standards must be set and adhered to, focusing on delivering the benefits of modern cloud computing. What will be the punishment be if someone buys a solution that fails these standards?

  2. Be clear and detailed with your plans
    How many different NHS websites are there? Trying to find information about a project is a game of skill, pot luck and internet logistics.

    Where can we go to get the detail on a project – it really should be simple. Our other recommendation is don’t announce anything until you are clear. For example, screening? The information released provides a high-level view, but not enough. Releasing a lack of information stifles the very innovation and progression you are trying to cultivate. The market won’t do anything until NHSx releases further details many months and even in some cases years later.

  3. Don’t forget Social Care
    Health and Social Care are two sides of the same coin. Whilst the different languages used in Health and Social Care might be a very difficult element to crack, focus on quick wins. Ensure that all systems are operating at the same level. Modern platforms are required across all services for person-centred care to flourish.