The leadership, funding and even the standards of healthcare technology are built on shifting sands. Success will only come when technologists go with the flow, says Sonia Neary, Managing Director, Wellola.
One key lesson from the world of NHS technology is that you cannot build a castle on sand.
Destabilising leadership changes have been rife for years, and this has got markedly worse. Recent political upheaval has seen five new Health Secretaries in less than 18 months. Each has brought their own approach to reforming the NHS. NHS technology leadership is also fresh in post, with new ideas from the likes of transformation lead Tim Ferris and CIO Simon Bolton, which move the digital health goalposts. Meanwhile more than 6,000 people are expected to leave central NHS positions through restructuring announced in the summer.
Such changes make planning difficult for those who are charged with leading the digitisation of the NHS. Are we going for big bang systems or best of breed? Who signs off the business case? What tech is best for the backlog?
Uncertainty over health technology funding compounds the issue. In July we heard how tech investment would be raided to pay for much-needed pay rises. The current rate of inflation, together with the intention of the current government to ‘rebalance’ health and social care finances, means tech funding could well be cut even further.
People can cope with uncertainty if they know that some aspects of the relationship are simple. Yet processes seem to become ever-more complex, as can be seen in recent efforts to reduce the number of procurement frameworks.
Even now there are more than three dozen that a supplier could use to officially sell into the NHS, while trusts could still use the twenty that were cut. And technology standards are just as complicated – suppliers are told to adhere to around 30 standards by central policy holders, when five could do.
The situation is complicated with different definitions to core concepts. The current (at time of writing) Plan for Patients from the current (at time of writing) Health Secretary seeks to empower people by giving them data on the relative performance of their local hospital.
This is a partial interpretation of what NHS England’s former chief digital officer meant by patient empowerment, which would see people empowered to participate in their care using digital services that truly meet their needs.
Do we really need a league table to tell us how our local hospital is struggling? Or do we need tools that make our relationship with healthcare providers easier to manage? No wonder the likes of Babylon look for markets elsewhere.
NHS technology barriers can be addressed
So how can we take arms against this sea of troubles? Suppliers, buyers and system leaders have to take an approach that rides the back of strong tides.
Local NHS leadership in digital health technology is becoming more powerful, for example. Digital leaders have risen up the hierarchy through Covid, and are now starting to show their influence in areas such as data strategy and systems architecture. Suppliers and healthcare providers need to work with them to achieve targets around the elective backlog, and help put in the foundations for a digital-first future.
Funding is always going to be a challenge, yet the cash-strapped NHS will invariably pick cost before performance. This race to the bottom could be avoided if the NHS invested in a handful of health IT systems, which could be helped by the additional £3.3 billion of health funding promised by the chancellor in his autumn statement. Clinicians can work with digital leaders to develop such systems working to meet their needs, rather than have to master the dark arts of health tech procurement each time they want tech to do its job.
And whilst definitions about topics such as patient empowerment are always going to be in the eye of the beholder, most would agree that how the NHS applies health tech standards could be simplified overnight. Can we focus on a handful of core standards around safety and performance? Suppliers can aim for these and let the buyer decide what best suits their needs.
Be flexible to go with the flow
These are strong currents with which the shifting sands of health technology can flow. Only by responding to fluid agendas will we be able to build solutions around the needs of the end user.
Take the following scenario. Patient X has a long-term condition that needs regularly monitoring. A virtual outpatient service can use technology that reduces the need for an unnecessary hospital visit. The patient themselves can ask the hospital for an appointment if their symptoms are worse, giving them control over their follow-up care. And when the patient needs to know their current medication, they can access their records online.
Because of the shifting sands of health technology, there can be at least three systems involved in supporting such a scenario. One system, designed around the needs of the patient, will do.
People-centred care will be some way off whilst healthcare exists in a world of such complexity. However, if we recognise that this is where the river is headed, we can cope with shifting sands.