Successive governments have attempted digital transformation of the NHS but progress has been slow and uneven due to the preponderance of legacy IT in the NHS, a shortage of skilled digital professionals, and the challenges of building an inclusive digital health service.
Indeed, in the Department for Health and Social Care’s (DHSC) A plan for digital health and social care policy paper (2022), the former Secretary of State for Health and Social Care Sajid Javid said that the long-term sustainability of health and social care ‘is dependent on having the right digital foundations in place’, and that ‘a health and social care system that will be much faster and more effective, and deliver more personalised care’ is an aim ‘that we can all get behind’.
Since digital transformation encompasses both digitising services and processes, as well as integrating new technologies, the time is ripe for innovative digital health services to be developed and deployed across NHS settings for a range of purposes.
Already, companies such as Google, Apple and Nike are working with organisations including the NHS to drive forward digital healthcare. In June, a deal negotiated by NHS England will mean all NHS workers, including doctors, nurses, clinicians and support staff, can benefit from the full suite of Microsoft 365 workplace productivity apps, making collaboration easier and maximising time for care – which NHSE says ‘will also provide the opportunity to introduce further innovative tools from other suppliers in the future’.
With so many digital and data services on offer to systems in the NHS healthcare space, what do ICBs need to think about when it comes to deploying digital and data in primary care?
NHS Arden & GEM Commissioning Support Unit (CSU) is headquartered in Leicester and provides a wide range of commissioning support services across England, with business intelligence including data management, advanced analytics and reporting a significant part of its work. In addition, it provides digital transformation support and evaluation services for projects that use technology and artificial intelligence (AI) to improve and enhance NHS services, with major customers for data services including ICBs and NHS England.
Helen Duckworth, Director of BI Transformation, at NHS Arden & GEM CSU, says the digital and data services on offer to systems in the NHS healthcare space fallbroadly into the following categories:
Point of care data capture. These are systems that collect information at the point of care delivery such as the National Immunisation Vaccination System which captures flu and COVID vaccination information, or the Calculating Quality Reporting System (CQRS) GP payment system. Often these systems are commissioned by NHS England but ICSs are expected to deploy and use the information to support service planning and delivery.
Secure data management environments. This includes systems that hold patient level linked data records and the supporting data management provision including processes, security, and supply of data models.
Tools that automate end to end analytical processes and provide reporting. Arden & GEM’s health intelligence platform, Athena, for example, provides reports and dashboards including:
- Population health
- Risk stratification
- Population segmentation
- Capacity and demand
- Benchmarking (outcomes, spend etc)
- System quality and performance monitoring.
Analytics and/or advanced analytics. This involves providing tailored analytical support to health and care partners. Arden & GEM deploys analytical teams to meet a client’s specific requirements, often interpreting data and providing insights to directly support care planning. Advanced analytics encompasses more complex data analysis such as health economics, data science, modelling, and other bespoke project work.
Information Governance. Understanding requirements and establishing the right data sharing agreements is both complex and critical and a key area of expertise for our organisation. Support includes understanding policy requirements and what can and can’t be done, technical assessment, data management as well as data sharing agreements to underpin system relationships.
Digital services are similarly broad, but Helen says principal areas of focus are:
Digital transformation: advising the NHS on how to successfully implement new solutions and ways of working at a national, system and local level. This includes supporting NHS England in evaluating national programmes and funds to accelerate digital transformation. Working with ICBs to develop and implement digital roadmaps. And also delivering value from local projects through effective change management and incremental deployment.
Navigating digital solutions. Supporting ICBs in understanding the products and services that would benefit their system, ranging from shared care record and connectivity solutions, through to digital interventions such as wellbeing and self-care apps. Solutions can be national or local, and with so many options available, ICBs need access to expertise to help bring multiple solutions together to support care across a pathway or system.
Digital also encompasses ensuring that the structures and architecture are in place to support transformation including moving solutions to the cloud, making use of automation and putting robust cyber security in place.
Workforce skills and structure are also vital. ‘Across both areas, we advise and support ICBs on the structure and development of their digital and data teams and analytical network,’ says Helen, ‘and this is increasingly important for ICBs given the rapid increase in demand for digital and analytical skills, not just within the NHS and public sector but across all industries and continents.’
A fast-changing market
As already seen, the market for digital and data products is expanding exponentially and attracting lots of national investment, which can put healthcare leaders under pressure to build policy, invest in digital solutions and spread best practice – and to deliver that quickly.
‘Technology is expanding significantly with the use of AI, which has a major role to play in advancing business intelligence and supporting clinical decision-making,’ says Helen, ‘and another area of expansion is the application and use of privacy enhancing technologies that improve our ability to manage and protect data.’
The resulting challenge for ICBs is an overload of choice, which Helen says makes conducting valid assessments more complex: ‘For example, the market for BI and digital intelligence tools is saturated, so while these tools bring major benefits, there is often overlap or duplication, particularly as organisations work together more closely as systems.’
Helen says ‘population health management, patient record sharing and interoperability between hospital and practices’ are three of the top issues for ICBs to consider when commissioning services around digital and data in primary care.
‘Primary care implementation is particularly challenging’ she says, ‘partly due to a lack of capacity to use the intelligence available, so in designing solutions, we need to give as much consideration to change management and demonstrating value as we do to developing the technology so that deployment is realistic and achievable and primary care staff are empowered to access the tools and information available.
‘For example, when Cheshire and Merseyside wanted to 357 GP practices to share data, they invested time and effort in building trust and developing a deployment approach that delivered success in stages. This meant starting with just 20 data items for just one purpose before starting to roll out to look at broader initiatives such as population health.’
With the ramping up of challenging targets around capacity, demand and access, Helen says ICBs also need ‘operational policy solutions that don’t just focus on improving the health of the population but also enable organisations to understand the demand on their service and find ways to make it more efficient.’
While interoperability that enables timely discharge summaries and links between primary and secondary care is improving through shared care records, she says it also ‘needs to enable better information sharing between practices in support of national policy around primary care network (PCN) delivery.’
And although information governance and robust data sharing are critical in helping practices and PCNs to work together effectively and make the most of the digital and data tools available to them, Helen says this needs to be considered from a multi-disciplinary team perspective: ‘For PCNs to make best use of population health, for example, appropriate training and empowerment to utilise data and digital tools can help realise the benefits of proactive, preventative care to reduce the longer term burden on services.”
Helen’s top 5 tips for system leaders to keep in mind about digital and data products:
- Ensure you get value from your digital and data solutions. Systems are scaled to enable this to happen but that means being aware of any legacy systems and navigating the technology and organisational challenges to achieve a better, system-wide solution.
- Invest in good Information Governance advice. This is about more than having a Data Protection Officer. Systems need the right expertise that incorporates a multi-disciplinary team approach so that leaders have easy access to policy advice and best practice data management procedures. This means having the technical expertise to manage data and understand how the pseudonymisation process works, for example, rather than simply understanding the data protection policies to apply.
- Know your market. There are lots of options, particularly when it comes to digital and data services. Take the time to do a thorough assessment and learn from other ICB colleagues who may be further ahead in the process to help spread best practice. Procurement advisers can help you develop market testing and weigh up the pros and cons of different approaches so that your investments are sound and deliver the outcomes you seek.
- Be prepared for cultural change. Technology, data and systems are all secondary to the change management that is required to make best use of digital and data. Clinical leadership and effective engagement with frontline staff are key. Establish your networks and make sure the right people are around the table to develop and agree the strategy and act as ambassadors throughout the organisation to achieve the required change.
- Plan for incremental change, focusing on the areas that will deliver most benefit most quickly. Trying to achieve too much too quickly can easily derail a project. Instead, find pockets of success and build on them.
Dr Mateen Jiwani is a practising GP and Non-Executive Director and Senior independent Director at Essex Partnership University NHS Foundation Trust – as well as member of BT’s Clinical Advisory Board, working with the technology supplier to ensure its healthcare solutions meet NHS needs, resulting in improved patient and system outcomes.
From his 360-degree perspective he says the digital market is showing ‘a lot of agility’ when it comes to data services and intelligence, but that the NHS ‘is yet to see evidence-based longevity in many of the systems that are coming about’.
‘This is often hindered by existing success, efficiency, financially and also integration into existing data form sets and systems’, says Mateen, ‘and there is also an issue with needing digitalisation of existing paperwork and electronic forms, which often rules out new systems.’
The solution, he says, is that large-scale transformation needs ‘collaborative efforts that understand the financial and clinical economy of data utilisation’, and this is something ICBs need to bear in mind when commissioning digital and data services around in primary care.
‘Integration and interoperability of existing datasets, health outcomes management – including population health risk stratification, work flow, patient flow, data analysis on front end for usability and usefulness of data for the intended clinician [are vital]’, he says, ‘and it’s also important to think about patient portals and sharing of information.’
Mateen’s top 5 digital and data tips for system leaders are:
- Look for clinical benefit with economic benefit. IT should be useful and relevant – that itself will drive efficiency.
- The clinical implementation programme is essential – not just IT training. Focus on clinical-based delivery of training and user champion models for sustainable use in the organisation.
- Interoperability is key (both inward and outward facing) – with good relationships with existing market occupiers for systems.
- Never underestimate the value of data intelligence tracking and decentralisation ability.
- Put safety profiles in place for high risk and identifying those at risk with pliable processes.
How the NHS is organised, and the need to scale digital and data services, all impact this fast-changing market. The solution for healthcare leaders, it seems, is to understand the demands, do your research, and co-design digital initiatives with staff that can be rolled out neither too fast or too slowly to ensure they offer workable improvements.