The plan to transform the NHS in England over the next decade will rely heavily on various technological developments that are now fit for the job, NHS Chief Information Officer Will Smart tells journalist Adrian O'Dowd.
The use of tech in the NHS is a given these days and its role is not only growing but is set to be indispensable to the changes set out in the NHS Long Term Plan,1 published in January of this year.
Putting it plainly, tech is front and centre of the Government's plans to transform healthcare in the next decade, and is no longer merely a useful bonus in delivering services.
The Plan says: "Technology will play a central role in realising the Long Term Plan, helping clinicians use the full range of their skills, reducing bureaucracy, stimulating research and enabling service transformation."
Just how central tech will be, is made clear by Will Smart, Chief Information Officer (CIO) Health and Care in England at NHS England.
"An important part of the Long Term Plan is that digital and technology are integral to the delivery of the whole of the plan. It's not an optional extra, it's at the heart of what we need to do," says Smart.
"The key to this transformation will be data – via local health and care records – which are a core part of the Long Term Plan. These are critical because we need that data to support real-time care for our citizens, as well as understanding the services required to support local population's health needs."
One of the centre points of the NHS in terms of its technological future is the NHS App, which was piloted last year and is now available to the public on Google Play and Apple app stores, with all GP practices due to be connected to it by July of this year.
It allows (or will allow) users to:
- check their symptoms using the health A-Z on the NHS website
- find out what to do when they need help urgently using NHS 111 online
- book and manage appointments at their GP practice
- order repeat prescriptions
- securely view their GP medical record
- register as an organ donor
- choose whether the NHS uses their data for research/planning.
Digital access to health services is a major plank of the Plan as Smart explains: "It is fundamental in all parts of the system.
"It is essential because this is about using tech to enable patients to take control of their health and care, and is also critical to enable clinicians to more effectively and efficiently undertake their tasks.
"The NHS App is at the heart of this digital access. It is a door into the NHS, but we want other innovators to connect to the app and make their services available so that we have an eco-system.
"One of our challenges is we need to try to avoid creating a plethora of entry-points into the service and causing confusion, so the app has got an important role in being that single front door.
"Clearly, the NHS App and video consultations are areas that are changing the way that citizens engage with services and are fundamentally important. We also have all the analytics and AI (artificial intelligence) developments that require that basic fabric to be in place."
The NHS App could also help staff do their job better, argues Smart: "We have seen a number of good examples of that with the app, particularly for reception staff at GP clinics, where it is making their workload easier to manage thanks to the ability for patients to make appointments with the app."
Asked if all the technological changes can be delivered in the plan's timescale, Smart says: "The plan is hugely ambitious and technology does not necessarily have the best reputation for delivery, but over the last three years, through the digital transformation programme, we have done a lot of work already so I am confident that we will make in-roads into all parts of the plan.
"The conundrum is that for the national team to be able to do something, we need the politicians, the Department of Health & Social Care, and NHS England to be clear about what it is we expect the NHS to deliver.
"This will require local organisations to step up and that requires capability, capacity and investment. In the industry we also need large IT companies, as well as the small-scale innovators, to deliver this. Most of all, we need the talent of our staff and their enthusiasm to help us through the transformation."
DIGITAL FIRST PRIMARY CARE
The phrase "digital first primary care" is mentioned in the Plan and also explored in DAC Beachcroft's recent Digital Healthcare Technology report,2 published in April, which looks at digital healthcare technology and how it is enabling clinicians and empowering patients.
"Rather than the first place that I go when I feel ill being my GP surgery or emergency department, I would define this as something that provides a route through a digital channel that makes sure that I am properly cared for and I am effectively directed to the most appropriate place for my care," clarifies Smart.
Digital solutions set for expansion as part of the Plan that Smart is especially keen on, include the Global Digital Exemplar (GDE) programme.
This has supported 16 acute, seven mental health and three ambulance trusts to lead the national drive to make England's hospitals the most IT-advanced in the world.
Seventeen (soon to rise to 24) trusts have been designated 'Fast Followers' to work with and learn from the GDEs so these advances can be spread through the NHS.
"Now through the GDE programme, we have a handful of acute organisations that are blueprinting their experience and digital development, so that others can understand the steps they went through to digitise the questions they asked and the answers they got, as well as lessons they learned and what they would do differently," he says.
Video and phone consultations for patients are a good example of how technology will be able to help improve healthcare in the coming years, says Smart.
"We are already seeing some organisations doing that. St Helens and Knowsley are using video consultations for stroke patients and on a recent visit I spoke to one of their patients via their video-consultations system. From the patient's perspective, video consultations meant he had a ten-minute consultation and didn't need the two hours each side of that consultation to get to and from the hospital.
"I think we are increasingly going to see patients interacting in that way. Clearly, we need to make sure it's used only when appropriate and we shouldn't make people go on video when they need to be physically with the doctor."
The Plan implies that the NHS could be enhanced by using data collected from home-based and wearable monitoring equipment to spot and predict health problems. This could include using data from patients own wearable tech such as Fitbit and Apple Watch devices.
Smart explains: "We want to empower patients to take control of their health, and certainly we are seeing a range of devices such as Apple Watches possibly doing ECG monitoring. We want to be able to use those devices – some will be medical devices, some will be consumer tech – to enable patients to engage more effectively with the service.
"For example, I was in Australia recently with one of the research institutions there and they are looking at ways of being able to monitor frail elderly people to keep them in their own home for as long as possible, and to enable the health service to intervene when required."
The general population is likely to accept these technological developments in the NHS, Smart believes, saying: "We see the general population embrace technology in every other aspect of their life, so I wouldn't expect healthcare to be any different.
"It is right that they are concerned about how we use their data, security and transparency issues, and the quality of the care that they receive, but I don't see much indication that the vast majority of citizens would not see this as a positive development.
"Our challenge in health is that we will still need to retain non-digital channels for our services and maintain equal access for everyone, rather than some people feeling like second class non-digital citizens."
Asked how easy or difficult it will be to achieve a system where all trusts and GP practices use the same electronic patient records system to share information safely, he says: "We are not expecting organisations to use the same systems, but we are expecting them to comply with open standards.
"The way that we see creating the single record is through the local hospital record programme, which is about creating data that aligns with all the key health and care events for a citizen that is normalised, accurate and available where and when it's required through that patient's treatment."
Technology is already established in the day to day NHS and will only continue to grow its role as the Plan starts to become a reality in the next decade, concludes Smart.
"I have worked in technology in the NHS since the early 1990s and I'd say that in the last few years, we've seen technology mature into a state where it is capable of delivering the things we have been talking about for some time. I am excited to be at a point where we can begin to deliver the vision.
"The hard part is changing hearts and minds. It's about supporting our staff to have the confidence to work in new ways using digital tools. For example, we are seeing some really interesting and exciting new technologies – augmented intelligence and having algorithms to read images to support clinicians in their clinical decision making."
Will Smart is Chief Information Officer (CIO) Health and Care in England.
A joint appointment between NHS England and NHS Improvement, Smart is responsible for providing strategic leadership across the whole of the NHS to ensure that the opportunities that digital technologies offer are fully exploited to improve the experience of patients and carers in their interactions with health and social care; the outcomes for patients; and improved efficiencies in how care is delivered.
Prior to taking up this role, Smart was CIO at the Royal Free London NHS Foundation Trust for six years.
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