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The ability to digitise the health sector has changed dramatically. Andy Kinnear, chair of the BCS Health & Care Executive, explains why he is optimistic about the growing opportunities and unlimited potential in digitising the NHS
I know I sometimes get accused of being overly optimistic, but I genuinely believe this is the most exciting time ever to be working in the digital health and care space. This is my 27th year of NHS service, man and boy, and I honestly cannot remember a time where the ambition, the opportunity, the national and local organisational alignment and the wholehearted belief in our ability to deliver was quite so tangible.
So what is going on? Well forgive me a brief historical review. When I came in, 1991, technology, and especially the clinical software, was an in-house business. Whether it was entrepreneurial clinicians writing their own software or large regional ‘Computer Centres’ the digital health process was full-on DIY. Market forces and government commitment to private sector saw that change through the 1990s but progress remained frustratingly slow culminating in the most famous six minutes in history and the formation of the NHS National Programme for IT (NPfIT). Let’s not unfurl that particular flag but suffice to say some good stuff happened, some bad stuff happened, but overall we failed to truly digitise the health and care system. And so we reached this decade and this time it is different, it really is.
Firstly, technology has changed and public expectation has changed with it. Digitising the health service is no longer simply about improving the efficiency of its day-to-day mechanics or about ensuring information flows to support planning and financial management. The public we serve expect to interact digitally for the services they receive, why shouldn’t they, they do it in all other aspects of their lives. We have passed the point where by providing services ‘online’ is considered a value-add, it is simply the norm. This public expectation has to be welcomed as it brings huge opportunity with it.
We are already seeing interesting examples of digitally driven changes to interfaces with patients that are radically changing the way the NHS provide services. The ‘my medical record’ work of the team at University Hospital Southampton is one stunning example of how by shifting to a ‘personal health record’ approach it is driving a different set of behaviour from clinician and patients alike. This system, co-designed with patients, is thoroughly empowering. The NHS is only really at the start of the PHR journey but it is coming and is truly a game changer.
Secondly, the clinical community has changed. The IT system is no longer the preserve of Dr Geeky enthusiastically challenging colleagues to embrace its functions and being casually dismissed. The clinical leaders emerging in the digital world today are products of a digital generation and readily embrace the opportunity technology offers healthcare. The publication of The Wachter Review last year told many of us what we already knew, that delivering the technology was only a fraction of the journey and irrelevant if the adaptive changes within the clinical professions did not follow. The new breeds of Clinical CIOs not only grasp the opportunity before them, but also readily take on the challenge of helping their clinical colleagues embrace the change to their working patterns and behaviours. Wachter said this takes time, but it is now fully underway and will only continue to gather momentum in the years ahead.
The clinical leadership is part of a wider leadership model. At national level we have seen visionary leaders in NHS England, NHS Digital & other ALBs publicly champion the role digital can play in the future of health and care and that penny has dropped at the very top too. For the very first time in my career I sat in a room in Manchester last autumn to watch a health minister talk passionately about creating Global Digital Exemplars in England, about creating a group of organisations that could be compared with the very best in the world.
Emulating global excellence
I recently visited the first hospital outside the USA to achieve HIMSS level 7, the Seoul National University Hospital in South Korea. They had done this by building their clinical system themselves, developers working hand in glove with clinicians and managers to create world class product. We have every opportunity to emulate this kind of achievement again and again across the UK by working with our suppliers.
Moreover, we have an opportunity to do this at a scale that stretches beyond the boundaries of individual hospitals. The biggest prize is not to simply achieve exemplar status at hospital level but to achieve it at city, then region, then national levels. The biggest challenge we face is also the biggest opportunity we have, namely how do we get the plethora of clinicians, teams, departments and organisations providing care to one population to work together seamlessly and effectively. The creation of the Sustainability and Transformation Plans (STPs) programme affords us the opportunity to bring forward these plans at pace, and critically to underpin these plans with a digital platform. We have an opportunity to create a digital driven health and care system at city or region level for the first time in decades, let’s not miss that.
Eagerness to take opportunities
The last reason I think it is different this time is because there is a willingness, an eagerness one might say, to invest in the professionalism needed to realise this opportunity. Many of us have seen digital success up and down the country, but too often than success has been linked to one or two key people driving it forward, almost in spite of the system. Going forward we cannot trust to hope or luck, or rely on individuals to develop themselves and drive selflessly for success. This is now changing. We are already seeing investment in the development of a Digital Academy to support the development of the CIO and CCIO professions. The commitment to the ‘building a digital ready workforce’ programme is another tangible example of investing in professionalising our workforce for a digital world.
The professional bodies are playing their part and my own attraction in taking on my role with BCS was driven by a desire to see us drive up the standard of digital leadership across the health and care sector. Before the end of my career I would like to see mandatory professional registration for NHS CIOs, adherence to professional standards, recruitment guidelines that require NHS Boards to appoint appropriately qualified people. Many of my colleagues have argued that digital will not be taken seriously in health until CIOs are on the Board of NHS organisations. My view is that CIOs will not be taken seriously until they develop themselves into a profession worthy of demanding a seat at the Board.
Am I right to be optimistic? Who knows, I guess time will tell. But this is not blind optimism or some kind of unwavering faith. My belief is based on years and years of experience, on what I see around me and what I hear people say. This time it’s different, this time its better.
BCS Health & Care Executive is part of BCS, The Chartered Institute for IT.