What’s on the horizon for the NHS – Digital transformation or stagnation?
Digital transformation is at the top of the NHS agenda for this decade. Over the years, several reports and frameworks have specified various policy commitments to improve the health and care system. But it’s often difficult to evaluate if these commitments ever have the desired impact.
However, the recent independent review, by the Health and Social Care Committee, set out to examine commitments made by the government on the digitalisation of the NHS. This includes, the roll-out of the NHS app, the use of digital home monitoring, and commitment in workforce digital literacy among others.
The committee’s expert panel assessed the progress that had been made across four primary policy areas, including care of patients and people in receipt of social care, health of the population, cost and efficiency of care, and workforce literacy and the digital workforce.
The policy areas were chosen based on the framework on optimising health and care system performance that set out four goals of better care, better health, better value for money, and better workforce wellbeing.
Although, with ratings from “inadequate” to “outstanding”, the committee concluded that the government had made inadequate progress overall against its pledges. From variations in digital maturity of health and social care providers to workforce shortages, they identified five inter-related issues that were impeding progress – let’s take a closer look…
1/ Poor progress towards national interoperability
The review found that there was poor progress towards national interoperability preventing digital systems from transferring information and connecting with each other. This affects the effective flow of information between hospital providers, GP providers, community providers, and social care providers.
Achieving interoperability is a key enabler of the digitisation of the NHS. It allows patients and clinicians to access information when it matters most and use digital tools across health and care settings.
2/ Variation in digital maturity of health and social care providers
Significant disparities in digital maturity within and across different sectors of care were also observed. The review concluded that the current approach of delegating responsibility for digitisation to Integrated Care Systems (ICS) was without clear expectations for delivery. This risked maintaining or even increasing variability in digital maturity.
Identifying these gaps and prioritising areas for investment and improvement are essential in order to implement and drive digital change in the long term.
3/ Insufficient planning to prevent digital inequality
A lack of effective planning to mitigate against digital exclusion was also highlighted. Particularly for groups of the population experiencing health inequalities, and around the accessibility of digital products. It raised concerns that the health of these groups could decline further as health and social care becomes increasingly reliant upon digital literacy and having access to technology and the internet.
The evidence suggested that while some patients benefit from using the NHS App, over-reliance on the app could exacerbate health inequalities unless support and non-digital solutions are put in place for those who cannot or choose not to use it.
4/ Poor digital maturity in social care
Another issue that was highlighted by the report was poor digital maturity in social care. Whilst local authority social care authorities have had a requirement to have electronic social care since the end of 2004, recent work to enable electronic records amongst social care providers is still a work in progress.
Social care services are frequently overlooked in the Government’s commitments to digitalise, resulting in them being poorly integrated with the wider health system. This causes problems when patients move between health and social care settings, and within the social care sector for staff who move between providers – as they need to learn a new system every time.
5/ Workforce shortages
Lastly, the report refers to the national shortage of staff, both in numbers but mainly with the relevant technical skills, to deliver digital services and to benefit patients and people in receipt of social care.
Although digital technologies are being procured, there are often not enough staff with the skills to use them. Staff shortages coupled with increased demand also means that staff don’t always have the capacity to undertake training on how to use digital systems and technology effectively. This highlights the need to produce an effective workforce strategy to train, recruit and retain digitally competent staff.
The overarching conclusion is that most key commitments have not been met or were not on track to be met. Evidence shows that progress towards national standards and frameworks is in fact happening, but is perhaps happening too slowly and too fragmented in nature.
However, positive steps have been taken in the digitalisation of the NHS and there is momentum to transform the way healthcare services are delivered. This review highlights the need to address resource allocation, health inequalities, governance and workforce issues; and, fundamentally, it calls to question integration, whole system thinking, and innovation.
The opportunities and efficiencies offered by digital transformation are crucial for the NHS. But it’s no secret that the reality of it is gradual and complex – one that asks for significant and consistent change. It requires not only an investment in digital technologies but also a commitment to support staff at every level with digital skills that allow them to leverage systems and tools to support new ways of delivering care.
Whilst progress against four of the nine commitments were rated inadequate and the other five were rated as requiring improvement, each remains vital to the Government’s aim to digitise the health and care system. Better care, better health, better value for money, and better workforce wellbeing? There’s definitely some room for improvement.