At the beginning of October 2023, the UK government announced a £30 million ($36 million) investment into the National Health Service (NHS) to support innovation in medtech in the run up to winter. Iain O’Neil the former NHSX Digital Transformation Director and Managing Partner at TPX Impact shared his experience from his past role and discusses how and where this investment can be used to support staff and patients throughout the NHS.
Kiays Khalil: Why are the NHS’ IT systems outdated and what issues will these old systems cause?
Iain O’Neil: The NHS has always struggled with buying the right technology, its approach to buying technology is fundamentally flawed. The NHS approaches technology in a buy it and then implement it mindset, as opposed to redesigning the services that they deliver to include technology and find a way to either build or buy technology to support that new redesigned service.
The UK government are better at doing this than the NHS.It's a very fragmented landscape and oftenthere are multiple pieces of technology that do broadly the same thing, like storing patient data and managing pathways.
That's because one clinic might say we're a bit different, we need this piece of technology andthen another part of the hospital says we need a piece of technology that supports our pathways. The reality is around 80% of the pathway will be the same but you end up with two pieces of technology doing things differently because the suppliers are not incentivised to make their technology open or conform to open standards.
KK: How can the NHS become more unified in that decision of buying technology?
IO: Five years ago, when I was working in the Department of Social Care, we published a paper called ‘The Tech Vision for Healthcare. The right answer in those days, and still is - interoperability standards.
To an extent, suppliers are building blind and they build their system in the way that works best for them. When you put it up against another system for another department, it doesn't speak the same language;doesn't store data in the same way.
Denmark for example, have agreed on a set of standards for sharing data in healthcare. They say to suppliers anybody can come into this space, anybody can provide a piece of technology into primary care, or secondary care as long as you make the data available to the patient, and to the system, and their version of the NHS. You can add technology that meets the specific needs of patients and clinicians.
KK: What lead to this government investment and what were the contributing factors?
IO: A big part of what led to this investment was the election and making announcements that make government look good. Investing £10 million in technology sounds good. There is a recognition that winter is coming and if someone from the NHS frontline or the Department of Health has identified technologies that can support them through winter, they can ask for some of this funding for that tech.
The NHS works on an annual funding cycle. You've got to identify, procure, and implement, that technology between now and March, when hospitals are busy. Often, urgent procurements do not necessarily lead to good strategic procurements.
I worry a little about how the Integrated care systems (ICS) are going to distribute this money. It's £700,000 per ICS. It’s a lot of money but, it's not going to change the way health care is delivered using technology. It’s likely that it's going to be little bits and pieces that, add to an already complicated system. I wonder whether there could be some support around this at a national level.
KK: Do they need to move away from this annual plan and to a three or five-year strategy?
IO: If I could go back to when I was NHSX Digital Transformation Director, I would point to that strategy that we wrote five years ago, ‘A Tech Vision for Healthcare’ that says - interoperability standards, up skill staff, separate data, make everything internet based. I would have stuck to that and said, if it's not that then we're not doing it, and it may take us five years, but in five years, we'll be in a world that looks like the internet, not where we are now where clinicians are really struggling with their technology and often using paper as a result.
I think the five-year strategy is going to be difficult to sell. But the reality is, until we take a strategic approach, we've got to tackle the problems we've got now. But at some extent, we have to say our long-term vision is interoperability.
KK: How can this investment be used to bolster up cybersecurity across the NHS and its service while protecting patient data?
IO: I worked in the Department of Health during a cyber-attack that took out hospital systems up and down the country. In fact, the NHS’ lack of modern technology was one of the things that helped it through that. Some of the hospitals that were able to function were the ones that hadn’t upgraded their systems, and therefore, couldn't be hacked the same way.
Cybersecurity is key, I am not convinced that you would get much traction if you put in a bid for this pot, looking at improving cybersecurity, because it's for things that have an impact on patient care during the winter. There is talk in the press release about reducing the numbers in the backlog- that is unlikely.
There is also talk about virtual wards and improving care at home and pieces of technology that can support people with long term conditions. That’s what is going to get funding. Cyber security lives at that strategic level, as we talked this about with interoperability standards, you should have a bar and there is one that needs to be met by any piece of technology that's implemented into the NHS. I would hope that the department is sympathetic to anyone who puts in a request for funding elsewhere to improve cybersecurity.
KK: Should the NHS decentralise its technology?
IO: The the risk of the NHS decentralising all of its technology is that you end up with data silos, up and down the country. Every piece of technology has its own data store andthat's not the kind of way we should be moving. The answer to keeping your data safe or making it useful to NHS England is not to centralise it all. I feel like that's the path that we're going on. The real answer goes back to what we wrote five years ago, which is interoperability standards and permissions that say no matter where the data exists, we can get it if we want to, or we can use it if we want to, or we can read it, or we can share it or it's accessible. When it's needed.
KK: Is this enough of an investment or is more needed? How does this compare to previous investments?
IO: I think £30 million is a lot. Whether or not they'll get it all out the door, I don't know. £700,000 per ICS is less money but still, you could do quite a lot with it. There are a lot of ICS that have digital teams andhave ideas, and if you gave them some £100,000, I'm sure they can do something good with it.
They're investing more than £2 billion in electronic patient record systems - that's a lot of money. I think the money to some extent, is a bit of a red herring. It's like what is the money for and what is the outcome? How are we going to measure it? Is there any way to go back in a year and say what was the outcome of us spending it? What happened? Did we get improved patient metrics? Did we get staff time back? Throwing lots of money at stuff doesn't necessarily mean you get a better outcome.
KK: If you were in charge of this investment what would you do with the funds?
IO: NHS England views its role as distributing funding and it says, we're rich, we're in the centre, we'll distribute the funding to you and then to some extent, it doesn't feel any responsibility for the kind of outcomes and the consequences of what that money went on.
For example, an ICS, puts in a bid for £700,000 and it implements a piece of technology, that doesn't work and has to be decommissioned next year. I imagine that the ICS will get the blame for that. This modern approach would be shared ownership of it. I would say what's the NHS England's part in making sure that there is some benefit, as a result of this money coming out, or the department's part whoever the funding is coming from.
But that collective system should be saying, right, we've got this money, we will give you £700,000 or £650,000 and then we're going to fund a small team to come and support you to look at things like interoperability standards and the strategic side of technology implementation to look at what we can learn from this implementation in your patch and share widely to actually take that shared learning and roll it out in some form of roadshow and support others to implement the same or similar technologies. I should have, and I would put some sort of wrapper around it, to make sure we don't end up with just money being fired off into the regions.
