What Digital Means For The NHS

We can’t change the world but we can be part of the solution

Digital technologies present ever increasing ways of improving business processes, better management of information and more dynamic ways of communicating, both within organisations and between the citizen and service providers. Data sits at the heart of this process, and therefore how data is held and managed is crucial.

Aaron Allaway, Engagement Director at Crown Hosting, shares insight into the digital transformation of the NHS.

1. How would you define digital transformation within the specific use case of the NHS?

Using data, information & technology to improve the way clinicians, patients, and UK citizens manage health & care. Digital health will increase clinical prevention as much as treatment.

2. Why is digital transformation so necessary in the NHS? What pressures and challenges are it facing that digital technology and models can help it with?

Today’s ‘Information Generation’ has demanding requirements of businesses and organisations from which they choose to buy or use products and services, and they expect the same from the NHS. The millennial generation makes up 1/3 of the UK population and its growing. The millennials demand convenience and better ways to solve problems or obtain information and digital is their path of choice. This is whilst ensuring the NHS doesn’t lose touch and the balance with the personable services it’s renowned for across all generations.

3. What are the biggest challenges to successfully implementing digital transformation in the NHS?

The complexity of the organisation, constitutional culture and legacy IT systems. Digital requires the NHS to embrace new ways of working, innovation and then applying it at scale

Traditionally the NHS has been built on a patchwork of technologies and processes. At the moment, the majority of NHS organisations don’t have the technology infrastructure in place to form the foundations for new types of services so hence are looking at the means to change this. It’s not all about the technology, business change will only be successful if it is accepted and adopted by everyone, and otherwise all the time, money and effort spent could be wasted. Everyone that touches the NHS from management, clinicians, staff, supply chains and patients need to combine to yield the greatest value to the individual.

4. Digital transformation, particularly in a mammoth organisation like the NHS, can end up being very expensive, with the costs ultimately footed by the taxpayer. How can the NHS ensure costs don’t spiral out of control and budget allocated to digital transformation is spent affectively?

The NHS is trying; Vanguards, Test Beds, GDE’s, STP…. are groups and programs whose common goals are ultimately to drive towards best practice, savings, efficiencies, innovation and supporting new ways of working to deliver better health & care outcomes.

Successful digital transformation would involve planning with the end in mind but avoiding procrastinating about all the challenges that lie ahead for too long as it stifles progress towards the goal. It’s the trusts that are making some simple and tactical decisions first that are currently ahead, already delivering cost savings, reducing operational risk and increasing security.

A recommendation is to build a transformation platform that provides security and commercial flexibility that supports transformation when the NHS is ready, not when individual contracts or managed service partners dictate they can. An example is Crown Hosting Data Centres which is government accredited common platform which means a single solution can be used by all in the NHS.

5. To what extent has digital transformation already been implemented across the NHS?

Specific programs and groups, along with some investment has started already. Multiple procurement frameworks and IT programs have also been revamped to deliver choices, better value and improved services.

There is still a long way to go for the NHS but plans are afoot to try and tackle the challenges that exist and that will no doubt lie ahead.

Change is already visible and more services are putting the patient at the centre of their treatment and care. More and more online services emerge, smart wearables are common, digital applications continue to evolve, its paper free at point of care in hospitals, NHS wifi footprint is growing, cloud adoption is growing (albeit slower than expectations) and legacy system refreshes are happening, so there is a lot going on. Each area is backed up by concerted plans to drive business & process change to allow the opportunities digital will provide to be more widely available and therefore adopted.

6. What have been the results of that so far?

Mixed. Commissioning agility needs to be addressed within the NHS to keep pace with the agility of the technology it wants to implement. The good news is that the NHS does have success stories to tell, but largely they are still at the start of their journey so there is a long way to go, it’s now time to accelerate the many plans into production at scale.

7. What is the current state of digital transformation in the NHS – what’s being done right and what’s been done wrong?

The NHS realises it has to change, and continues to engage and learn from industry and technology partners to manage transition, transformation and integration across the whole health spectrum so this is positive. Funding has started to drip feed out although many areas of the NHS still feel left out in many cases. Likewise, many strategic programs and partnerships deliver current uncertainty to the future of trusts roles which employees and patients worry may leave certain areas behind.

Success stories are growing on how patients’ lives have been saved, and care & wellbeing improved by the use of technology. Data and its uses continue to dominate discussions. The NHS wants to use the data of citizens/patients to deliver proactive, not just reactive, health care. The goal is to increase the quality of care, make it easy to interact with the patient and overall increase the end user experience whilst ensuring the data is absolutely secure.

8. Are these advancements fast enough to ensure ever-rising pressures are elevated and patient care is maximised?

Probably not, certainly if compared to the speed of patient expectations. Many still believe that NHS decision making remains bureaucratic and convoluted which continues to pull against the need for culture and behavioural change across the organisation. This leads to a sense of scepticism if the NHS can achieve its goals with current funding, organisational structure and current leadership. The NHS cannot afford to push against change and innovation otherwise it will lose ground on being one of the most respected health organisations in the world.

In physical terms the legacy infrastructure in many cases is aged and the ability to change, evolve and transform isn’t necessarily a quick and easy one. Procurement frameworks are getting better to enable the NHS to get commercial terms that drive savings and efficiencies but problems of the past and uncertainty on the now seem to cloud the thinking!

9. GDPR is fast approaching and with the amount of personal information on file, is the NHS ready for such stringent data protection laws?

Public trust is critical, as citizens must have complete confidence that their data is secure and shared only when appropriate. The NHS will face challenges and uncertainty along the way and, although perfection is not possible, the focus must be on doing the right thing to ensure transparency, accuracy and accountability. GDPR is an ongoing process and organisations need to change the way they think about data with the focus on ensuring

consistency in searches, keeping records consent, having audit trails, and managing the volume of requests. Transparency and trust come from getting the design right and are hugely important to ensure the NHS has the confidence of patients and citizens.

10. With the biggest ransomware attacks in history bringing the NHS to its knees, what needs to change to ensure this isn’t a growing problem in the future?

Leadership is required, as security cannot be ignored in the new world of digital. Information assurance is critical to the NHS. Major focus should be applied to end user education on awareness of threats, and a focus on best practice to minimise the threats. Ongoing management of user rights and access need to be monitored and well managed. Technically, ensure patches are updated and latest version of software are implemented, whilst sitting alongside a solid change management process.

Physical security of IT assets shouldn’t be underestimated either. Let’s say a few recent visits to trusts on prem ‘data centres’ have left me feeling rather queasy.

11. What new technologies over the next few years will make the NHS more efficient, both in cost savings and processes, and ultimately help it provide better healthcare to the UK?

A lot is talked about AI, Machine learning, Big Data, predictive analysis, bio tech etc and its true they all will revolutionise how we manage health & wellbeing of society. However solid foundations must be built first to enable these to be adopted. If this is not achieved the ability to integrate will be costlier and complex than ever before.

Best practice would dictate that the NHS trusts need to fully discover and understand their existing assets and importantly who is reliant on the services they deliver and support. Understanding the current commercial obligations across the whole infrastructure would be ideal too because these largely dictate the timelines for transition and transformation. The trust or org can then start to plan their target operating model (what does the desired end state look like) and work out a strategy to how they can, and who can help them, manage logically the transformation by ensuring that the most appropriate technology, platform, partner, framework is used for each use case its attempting to address.

Whilst the GDS cloud vision will deliver multiple benefits to the NHS it’s clear that legacy IT is as much a challenge as a need to embrace new technologies. Some critical systems and applications just don’t move to cloud so easily (unless they are native) so it will take time. Managing the transition, integration and overall transformation will mean running and supporting a hybrid environment of mixture of on-prem, hosted, public and private cloud services.

Luckily government has already thought of this and has implemented an incomparable and unique single supplier framework for government accredited data centres ‘Crown Hosting Data Centres’ which acts as a transformation platform for as long or short as they need it.

12. How do you see digital transformation in the NHS evolving and playing out in the coming years? How will UK citizens ultimately feel the difference when receiving care?

It’s a balance for the NHS because there is a lot of complexity and work to fix and build in the back end that people can’t see which must be completed well before more front end services can be delivered.

Transformation will be challenging and take time. Managing the expectations of patients will be key. It’s inevitable the NHS will not get things right first time in all cases so how they learn

from any mistakes will be key, on the reverse how they accelerate success will ultimately deliver the improvements at the front end to patients and the associated hearts & minds.