“Too busy to improve?” – What chance of a ‘digital transformation’ of the NHS?

Amid the mass of uncertainty, we can all agree that Covid-19 has driven home the importance of digital technology.  This is certainly true of the NHS, where technology has become embedded at a rate that previously seemed impossible.

But, while Covid-19 is on everyone’s minds, the ups and downs of recent months shouldn’t blind us to the longer-term challenges that the NHS faces.  Driven by an ageing population and an obesity epidemic, those challenges will be with us long after Covid has passed.  The application of technology is key to meeting them.

The NHS’s digital strategy has to be seen in this context.  Covid-19 has given us glimpses of what a digital NHS will look like.

The words “digital strategy”, however, will strike fear into anyone who is familiar with the history of this area in the NHS.  And those who read the National Audit Office’s report ‘Digital Transformation in the NHS’ published in May will not be any less afraid.  It doesn’t make for pretty reading.

The scale of the technology challenge faced by the NHS is massive.  This is an organisation which uses a decade-old obsolete version of Windows, such that it has had to negotiate a private deal with Microsoft to continue supporting it.

As the National Audit Office notes, the NHS’s previous attempt to achieve a digital transformation, between 2002 and 2011, “was both expensive and largely unsuccessful”.  At a cost of £9.8 billion, “expensive” is no exaggeration. The National Audit Office point out that the NHS has “not made the expected progress” in the years since then.  They describe transformation as “inherently difficult” and say that they are “not convinced” that all the lessons of previous failures are being applied now.

The National Audit Office’s report points out that digital transformation “is essential to the NHS’s Long-Term Plan to improve services and will need a high-quality implementation plan”, but it notes that “there is no digital implementation plan setting out how this will be done in clear detail, including the role of national bodies, and to a realistic schedule”.  They say that not enough resources have been allocated and that there is a significant risk that trusts won’t be able to find the money needed.  They describe national governance arrangements as “confused” and say that the NHS’s legacy IT systems are “especially vulnerable to cyber-attack and loss of data” and that “although work has been undertaken to improve cyber security since the 2017 WannaCry attack, it remains a concern.

We are currently working with a number of trusts to implement our digitisation of an important patient safety process – investigating harm to patients from incidents.  In Verita’s experience, getting the NHS to use new technology is a difficult task.  Challenges range from technical, information governance to procurement.  That is no criticism of the people involved – many of whom achieve an amazing amount which what they are given and would love the opportunity to implement a system that makes their life easier.  Rather it is a direct result of an organisation running at capacity for a long period of time – something that Covid will inevitably worsen.

To put it bluntly, there is a danger that the NHS is simply too busy to be able to improve.

Adoption of new technology is essential if the NHS is to recover from Covid and meet its long-term challenges.  Covid indicates the way for what can be achieved.  But Covid also makes it harder to actually deliver change.

Although money is an issue, the fact that nearly £10 billion was spent on a failed programme indicates that it is not the main constraint.  In our experience, the missing element is giving staff the time, focus and support to try something new.  If it takes all the effort of staff simply to keep the daily show on the road, how can we expect them to implement new digital strategies?  Initiatives like the Nightingale hospitals have shown that the NHS can make big changes to service in a very short period of time – if they are given the right priority and resources.

The NHS’s technology transformation challenge is big and the importance of delivering it crucial.  Many staff would love the opportunity to carry it through.  But what chance is there that there will be the time and space to make it happen?  This represents a massive challenge, but also a massive opportunity.  We have to makes sure that the actions are taken to make the opportunity a reality this time.

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