Digitising 
Health and Care: now and next

Currently, we are refreshing our paper for release early next year, on what progress industry believe has been made and what is yet to do. This editorial reflects some of our early thinking on this issue.

MEASURING SUCCESS
One of the difficulties in measuring progress towards such a bold ambition is in understanding what lies beneath the ‘paperless’ banner. The NHS will never be truly paperless, nor should it be; there are very good reasons and necessary circumstances where paper is the optimal medium. The ambition cannot be taken literally; we interpret the ethos behind it to be: “The continuous pursuit of optimal approaches to the ways in which we acquire, store, share and use information across the health and care sector for all citizens, whether they be staff, patients, clients, carers or any other role they may have.”
    
Optimal is about “the best result possible with available conditions.” We think about this as “affordable quality”; the best thing we can do with what we have got and we know, and expect, the ‘bar’ will raise over time as we mature into the Digital Age.
    
A pragmatic measure of overall progress is to determine how optimally any given information in health and care is being dealt with. Whether ‘baby steps’ or ‘giant leaps’, it is all progress and should be valued and recognised.
    
All progress must add tangible value, to efficiency, effectiveness, experience, and preferably all of them. This value has to be tangible to the citizen, staff and NHS organisations, with demonstrable benefits to all of them.

THE BOUNDARIES OF HEALTH AND CARE
This ambition cannot be ‘bounded’ by the NHS; health and care is a diverse and complex environment where public, private and third sector organisations regularly interoperate, with citizens interacting with them all, largely unknowing and uncaring about the various organisational boundaries that exist over time.

The ‘paperless’ challenge must consider social care, third sector, private sector and any other sectors where health related care is planned or delivered. These care boundaries, largely irrelevant to patients and their families, themselves create information inefficiencies. Most importantly, the Paperless NHS challenge must include the citizen, as the ultimate owner of their care, and a huge and increasing consumer of care information.
    
We are still a very long way from this; the vast majority of work towards optimal information is not undertaken across the care boundaries; this will continue to create more duplication and wasted effort.

WHERE DO WE NEED TO FOCUS NEXT?
Almost a year closer to the date set and we have seen some substantial positives, such as more funding. The Government has already committed over £500m in new funding for NHS organisations to transform healthcare provision through technology and we expect more will follow if this demonstrates value.
    
Another positive is greater ‘executive’ commitment – information solutions and supporting technology are increasingly seen as ‘core’ to the business of health and care, not peripheral.  This ‘mind shift’ is vital; the business will not just be receptive to digital transformation, it will demand it.
    
Another positive is the continuing solid infrastructure foundations – the building blocks of information solutions in health and care are well established and ongoing; networks and core information components such as the NHS Number or example, but they need to ‘bridge’ the organisational domains better.
    
The willingness to think differently is also a great change. We are seeing emergent shifts in systems thinking, around ‘open’, platforms, standards and commoditisation for example, particularly in some of the newer strategic systems led by NHS England.

THE NEGATIVES
Regrettably however there are still some negatives. For example, in procurement approaches. Most procurements are still being run under old approaches and old thinking, with a preference for large scale, long term ‘prime contractor’ deals. “One throat to choke” in procurement terms is no longer the optimal way for the Digital Age.
    
Health and social care organisations are understandably highly risk aware and often quite risk averse. For information and technology solutions, innovation is directly associated with risk – some things work and others will not. Health and social care organisations need to reset their assumption about digital innovation; it is not always possible to sit back and wait for the solution to arrive, increasingly you have be on the journey.

Organisational silos still dominate digital thinking in health and care, yet the real potential of using utility technology, shared information and a portfolio of solutions/services within and more importantly between organisations will have a profound effect on efficiency and value. This is now beginning in central and local government; health and care is lagging far behind.
    
Currently, we are seeing open source as the principal interest of the NHS. This is one element of ‘open’, and is important, but all elements need to be progressed equally; standards, platforms, data and systems all need to embrace the philosophy of open digital services; too much focus in one area is not enough to make a difference.
    
Regarding information sharing, despite a lot of effort, it still feels we collectively are not much further forward on this critical issue.  Health and care services cannot perform optimally without necessary information sharing. While difficult, both legislatively and culturally, this remains one of the biggest obstacles to achieving a digital transformation in health and care.

A DIFFERENT WAY OF THINKING
From an industry perspective, techUK remain committed and supportive of this ambition.  We absolutely believe this is achievable but will require a very different way of thinking and acting, for users, buyers and suppliers of health and care solutions and services.
    
Why are we so confident? Healthcare is not in the digital ‘dark ages’; there are many examples – throughout primary care, social care and other health care areas – where information and supporting technology is being exploited and healthcare revolutionised as a result over several decades and it is still happening right now. What we still do not have is consistency and spread.
    
However, we think one of the biggest missed opportunities remains in stakeholders knowing what is possible, available and of value to them. techUK absolutely believe technology is not the constraint, nor are information solutions that are enabled by the technology. Our industry only exists through constant and rapid innovation and the UK is an acknowledged world class technology and information services industry.
    
There will always be many ‘right’ ways to get to a ‘paperless NHS’ and that is essential – one size will not fit all. A vibrant supplier market, fuelled by knowledgeable and discerning customers, will keep the innovation engine running, the result of which will be a portfolio of solutions and services, large and small, that together will deliver this optimal approach to acquiring, storing, sharing and using health and care information in the Digital Age.
    
We have a way to go, but it absolutely can be delivered, together between industry and its health and social care customers. Can the health and social care sector afford it? techUK believes it cannot afford not to.

FURTHER INFORMATION
www.techuk.org