Digitising the NHS - Never Waste a Good Crisis

Dr Jonathan Bloor

Under normal circumstances the National Audit Office report ‘Digital Transformation in the NHS’ would have drawn immediate headlines for its castigation of the sluggishness of NHS progress.  Covid-19 has put paid to that. Ironically, by the time attention turned to the report’s detail weeks later, it was already clear that in the last three months there has been more digital transformation in parts of the NHS than in the previous 10 years combined.  Hospitals with complete digital infrastructures and electronic patient records have been set up in weeks and primary care has reinvented itself as a digital-first service.

But why, and how, has so much been achieved so quickly?  

Tech adoption is often as slow as getting a new drug from benchside to bedside  

First, we should note that nearly all the technology that has been deployed is well-established - video conferencing, eObservations systems and clinical collaboration tools have been around for a long time. The lesson here is that we sometimes get wowed by the promise of the shiny new thing at the expense of focusing on widespread adoption of what we know already works.  Over-reliance on the fax and pager has long been a nightmare - we launched CareFlow Connect in 2007 to provide an alternative care coordination platform to the pager - yet we are only now, finally, getting the central procurement framework for the NHS to buy these systems in volume.  There is a danger that technology adoption takes as long as getting a new drug from benchside to bedside.  

The intensity of change over the last three months suggests that digitising the NHS is not really a technology problem or a capability problem after all, but rather an organisational and political one.

The new organisational drivers to digitisation 

So, what are the organisational and political changes that have finally made it possible?

1. Digitisation has become a board level issue.Senior execs of all disciplines are now driving the use of technology to do things locally that can’t be done in any other way
2. ‘Major incident’-style structural changes meant quick and practical decisions were made, with the removal of traditional blockers like IG, data sharing and perverse incentives/disincentives
3. There has been a significant shift in the incentives to adopt digital technologies. For example, the risks to patients and staff of not virtualising primary care far outweighed the risks of deploying new virtual models
4. Technology was seen as a key enabler to support new clinical workflows and ways of working rather than deploying technology for technology’s sake
5. Money was made available centrally but non-prescriptively, allowing for local choices

Historically, the hard commercial incentives that have driven other sectors to transform digitally have simply not been there in healthcare.  Hospitals do not go bust and job security is very high.  It has taken the risk to us and our own, together with a realisation of how important the NHS and its staff are to the nation, to bring about radical change. 

Embracing innovation and the new possible

Inevitably not everything has worked, but a lot has.  As the Institute for Public Policy Research argues in ‘The Innovation Lottery’, the lessons from Covid-19 must be applied to the adoption and spread of innovation going forward. We also need to guard against reverting back to the way things were done before.  There really is no need for the NHS to spend over £100m each year on postage when most people are happy to receive their communication electronically.  The NHS does not need to be the biggest purchaser of pagers on the planet or the cause of 5% of all road traffic.  

The pandemic is far from over and it will take the NHS and society many years to recover but hopefully some good will come from what has happened. Let’s ensure a digitally-enabled NHS is one of those things.