Driving digital in the NHS
Speech by the Secretary of State for Health and Social Care at the Digital Health Rewired Festival.
It’s a pleasure to open today’s session on digital transformation.
You’re right that I’m a tech geek, although my personal tech days are behind me.
I can code in COBOL, but these days that is only any use for bringing very old systems up to date.
The reason I want to speak today, and I’m very grateful for this opportunity, is because I think we have learned so much in the last year about the advances of the use of technology in the NHS.
And we’ve seen the opportunities, so now is a really important moment to push on and drive the agenda forwards.
But there’s another absolutely critical thing, which is that we must learn from the pandemic.
We must learn from the challenges. We must learn from the successes, like the vaccine roll-out.
And we have to put those things into practice because I think we have won a big argument.
Those of us who can see and believe in the power of technology to improve people’s lives and improve healthcare have long held that belief, but now it’s commonplace – everyone can see it.
So when I talk about interoperability, now I get a very positive response.
And when I talk about trying to make the NHS into a digital platform at which everyone can work seamlessly, that gets a positive response not just from people who are themselves techies and personally interested in technology, but now everyone can see it is important.
That is at the core of why now is an important moment.
In many ways, every day of the last year has been a session of digital transformation because of this shared experience of fighting the virus, and the vital role technology has played in the response.
If you think about it, this isn’t just about here.
Everywhere around the world, people have been forced to use every weapon at their disposal to stop themselves from being overwhelmed by this virus. And that has opened minds.
Thankfully one of the weapons we could call on, because of the work that had been done before the pandemic, was the force of digital technology.
This has been a difficult time for us all, but what we have found though is that the power of using the best available technology – and developing new technology quickly has proved its worth.
Saving lives and keeping our health and care service standing at a time when it was under unbelievable strain like never before.
Let’s think of some examples.
Perhaps the one that touches the public most of all is that GP surgeries could keep operating remotely, because of the huge strides that have been made in telemedicine and then were made in the pandemic.
Getting iPads into care homes to make sure people could stay in contact with their loved ones.
And we built on that digital infrastructure to make sure the testing and then vaccination programmes have been able to operate in a seamless way. And ultimately the data is at the heart of both of those programmes. Testing is merely the discovery of new data.
It is about the discovery of information about someone’s COVID status and the data about who has had a vaccine is critical, both to the roll-out and to the future, for instance, of international travel.
Opportunities ahead
It’s during these moments of exceptional change that we’ve got to constantly look at what has worked, and what we take forward.
And how can we build on this as a moment for digital transformation that turns into a movement.
Our whole relationship with technology has been transformed. So far I have talked about that about people within the system and it is very very important that we bring people with us. But this is also true of the public.
People who might use an NHS service, say once a year, have been using the COVID-19 app as part of their daily lives.
And over 20 million people have downloaded the app – nearly half of all adults – and it gives you a pretty seamless experience.
Although in my case one that made sure I had to be at home for another 10 days. But it is important and people have fully engaged with it.
We need to build on this engagement, and this interest, from the general public now, so I would urge all those involved to be bold.
There are 5 areas that I see as mission critical now, and I want to go into today.
1) Digitise more of the NHS
First, we need to digitise more of the NHS that is not yet digitised.
The starring role that healthtech has played in our response was no accident.
It comes off the back of the relentless investment in the fundamentals.
And the absolute commitment of a group of people across the NHS in the vital work of things that may seem unglamorous.
Like improving connectivity so we could keep services running virtually, and making sure we have the infrastructure in place to support millions of consultations that otherwise couldn’t have taken place.
I’ve heard from a whole range of frontline colleagues who have welcomed the changes we’ve seen, and the focus they’ve been able to give to patient care as a result.
In fact, a BMA survey during the first peak reported 88% of clinicians want to retain our use of technology.
And that 82% say we need to retain the reduced paperwork in the long term. And I say amen to both of those.
The critical task therefore is to make sure we do not let them down.
I’m also aware that nearly half, even as we saw those big numbers welcome this digital transformation, nearly half of those who were surveyed said they were hampered by issues like internet speed and infrastructure.
We can’t let the basics get in the way of the life-saving improvements that digital transformation can bring.
So we must go forward to get the infrastructure in place.
Last year NHSX launched the Digital Aspirant programme, tasked with boosting the procurement, deployment and uptake of technologies.
The first wave of the programme helped 27 trusts to boost their digital infrastructure and today I’m delighted to announce that we’re launching our next wave.
Thirty more trusts will be starting their journey and becoming a Digital Aspirant.
Seven trusts will get up to £6 million over the next 3 years, and the rest will get seed funding to start creating their plans.
And of course we’ll be offering further waves of funding in the years ahead.
To do this, we’ll focus on all parts of the NHS.
It’s very important this is across all parts of the NHS and indeed social care, including mental health and community trusts.
Which can feel the benefits of digital transformation just as much as acute trusts.
So we’ll keep driving this work across the whole of the health and care sector to make sure everyone has the digital capability they need.
And lay down those strong foundations, that’ll put us in a good place for the future.
That is the first thing. Making sure everybody can participate and getting the basics right.
2) Connecting the system
Next, we need to connect the system so data flows appropriately and freely, and we get the intrinsic benefits that high quality data and interoperability can provide.
Bringing together data, that once upon a time would have only existed in silos, was fundamental to the COVID response.
One of my lessons from the COVID response is that the pulling together of data that previously had been in silos is absolutely critical.
For instance, it helped us to identify those who are most vulnerable to coronavirus and ask them to shield, bringing together evidence from across government to understand who is most vulnerable and needed most support during the lockdowns.
It drove our NHS COVID-19 data store, which helped mean we had real-time data to allocate resources and co-ordinate our response.
It has powered vital, vital research. And if you think about it the opportunity for the UK here is massive.
Because we have one NHS, it meant we were the first country in the world to come up with clinically proven treatments – both the first and second set of treatments developed because of the data available in the NHS.
Yet that data architecture for research could be strengthened so much further and there is a lot more to do.
We need to fill gaps in interoperability where they exist, especially the link to social care and responsibilities of the NHS.
And we must streamline data to simplify the user experience within the NHS.
It is no good just focusing on the research end and the exciting frontiers.
We have to make it easy for everyone within the NHS to use data to help improve the care that they give.
That means if you’re a surgeon, a GP or a district nurse you need to be able to draw information from, or put information into, the same care record in a safe and straightforward way.
And for patients, that means people need to be able access the data that, after all, in principle, belongs to them. People need to be able to access their own care data. It is a principle on which we need to build.
To make this happen, we’re putting in place Shared Care Records.
This will mean patients only need to give their details once, and they’ll be captured in a local record that can be safely seen by those who are caring for them.
And every local system will have at least a basic shared record solution in place by September this year.
So we can avoid things like repeated questions and duplicated tests that can cause so much frustration, and so we can put patients in control of their data.
3) New digital pathways
Third, we must use technology to transform how care is given, rather than simply digitising pathways from the analogue age.
Anybody who has been involved in any digital transformation throughout history will say that what matters is not just the digital transformation, it is transforming the underlying business to take advantage of the opportunities from digital transformation.
And we must apply this to the core of the NHS too.
Digital technologies are not a bolt-on, or a nice to have.They must be a transforming force, that can help us fundamentally improve by reshaping health and care as we know it.
This pandemic has turned traditional models of health and care on their head.
Like the face-to-face consultations I talked about earlier, traditionally seen as the best way to treat patients, they became a threat to public health in some circumstances.
And so we had to make this radical change to totally reimagine the patient experience.
Some of these were temporary changes borne out of necessity, to protect the NHS in its hour of need.
But there are also positive steps that showed glimpses of what we can achieve in the future.
Take another example, ‘virtual wards’.
More than 300,000 pulse oximeters have been issued across England, so patients can measure their own blood oxygen levels at home.
This allows them to track their own symptoms and share results with their clinical team quickly and easily. In fact some areas of the country have gone further – West Hertfordshire didn’t just set up a virtual ward, but a virtual hospital. They managed around 1,200 patients at home.
This is a fundamental change in approach.
Supporting our prevention agenda, and supporting the integration of primary and secondary care, by putting patients in control of their own health and keeping them out of hospital if they don’t need to be there.
I want us to be radical about reimagining how care is given, taking on what we’ve learnt.
Just a few weeks ago, NHSX published a new procurement framework that allows images to flow from high street opticians to ophthalmology clinics.
And we’re working to help primary care clinicians safely share images with specialist dermatologists in secondary care.
Both of these are individual projects but they have a broader meaning. They mean quicker and more accurate advice for patients, and they will reduce unnecessary trips to hospital.
I want to see more of this big thinking about how we can use technology to fundamentally transform care.
We have one big opportunity here and this is because of common practice across the digital field, and the clinical field, that is masked by a different language.
The way clinicians think about patient care, they think about patient pathways and care pathways.
The way that tech people think about delivering services is they think about the user journey.
But if you think about it, these 2 are exactly the same thing.
The user journey is the care pathway for a patient.
And we should use this fundamental similarity of ways of working to improve the way that the core business of healthcare operates in a digital world.
This is about drawing digital transformation into the core business of the NHS.
In so doing, we need to question the traditional conceptions of a care pathway, and how care should be delivered.
And reimagine them, redesign them and then deliver them in the best optimised way given new technology in all its forms.
We will be putting our full support behind the pioneers in ophthalmology who are making this happen.
And we will work across all clinical pathways over time, in order to optimise them for digital technology in order to deliver better care.
It requires high-quality tech skills, the best use of data and of course deep clinical expertise.
And I’m looking forward to working with Stephen Powis and the team at the NHS to make this happen.
4) Building for the future
Fourth, we must build for the future, not just solutions for the present day.
In the heat of a crisis, it can be easy to focus on what’s immediately ahead, and getting things up and running as quickly as possible.
And even though our digital teams have worked at unbelievable pace during this pandemic – working on several of the biggest digital infrastructure projects this country has ever seen simultaneously – it’s been brilliant to see how they’ve kept their eyes firmly fixed on the future, and worked according to a series of principles to make sure that what we are building now is also useful for the long term.
These principles need to be a constant for anyone who works in the NHS.
Like using the NHS number across all services as the citizen identifier.
Using the NHS login to create a simple and secure way for people to access NHS services.
And giving patients the ability to update their contact details and their data electronically, with the changes feeding right across systems.
It’s really heartening to me that even in the clutches of this pandemic, we’ve been able to forge ahead with our mission to improve the patient experience, and streamline the multitude of systems that are in place.
And we do this, there’s another area that I want to explore too.
At the moment most live patient data is held by the companies who provide the electronic patient record systems.
But it isn’t ‘their’ data. And although isn’t ‘their’ data, too often these systems act as a barrier to accessing it.
And it means the data might not be accessible and can’t be properly shared, providing a barrier to the research – innovation we know has so much potential – and hampering the life-saving role that data can play in promoting patient safety.
We need to make it easier to write applications or create services that interact with data from different NHS organisations.
I want to explore whether we can remove this barrier to innovation, and separate the data layer from the application layer, so providers can offer the application software, but the data will be stored separately and securely in the cloud and then we have a consistent data platform across the NHS.
I know this is a big change. But this has been a year of big changes.
And I want to hear your views.
Just as I’d like to hear your views on our Data Strategy, which we’ll be publishing shortly.
This strategy set out our plans to reshape health and social care through the power of the use of data.
And we’ll be publishing it in draft, so we can hear perspectives from far and wide, to help us shape this vital work.
5) Make it easy for people to do the right thing
The last thing I want to touch on is the need to make it easier for people to do the right thing, and give them the confidence to drive changes where they work.
None of this matters and none of this can work without the people who are delivering care.
Over the past year, so many of our colleagues have worked in ways that they might never have expected to.
They’ve responded to the challenge with determination, with dedication, and with a mission desire to embrace whatever is available, whatever technologies are available, whatever capabilities are available to help us through this crisis.
And as we move forward, we want to give them the support they need to drive digital change where they work.
This means clear expectations for local organisations, like our What Good Looks Like project, advice to help organisations get value for money when investing in digital technology, through our Who Pays For What scheme. Because the money is important too.
And – crucially – simple, easy-to-understand guidance on information governance.
This is something we’ve worked hard to put right.
We did so much during the pandemic to simplify our information guidance, reducing it to one page of clear advice.
This simple guidance had an electrifying effect on the system, letting clinicians share data with confidence.
What we did was we wrote the guidance for a frontline clinician on a single page.
So that everybody could understand it rather than writing it through information governance experts, to make sure it was super simple on the frontline.
To give people the confidence to do what they needed to do to keep data secure.
But to focus on what we needed to focus on.
Which was data security and proper use of data rather than the intervening technology.
What matters is how you use data in a safe, appropriate and forward leaning way.
So we’ll keep working to simplify our guidance, and create rules that help, not hinder, the incredible benefits that the safe sharing of data can bring.
Conclusion
This pandemic was the time when healthtech really came of age.
Thanks to the hard work of so many people, including so many of you, it helped us through this crisis, protecting our most vulnerable and bolstering our NHS.
Now is the time to bottle the spirit we’ve seen.
The ingenuity, the creativity and the adaptability.
And put it in service of those solving the new challenges ahead.
Thank you very much indeed.