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Data: the oil of the digital age

Adam Steventon, director of data analytics at the Health Foundation, reviews the government’s digital and data vision for the NHS.

Digital technologies could transform healthcare over the next decade. Already this year we have seen the rapid rise of health and care delivered by mobile phone using videoconferences and artificial intelligence. The highest profile example, GP at Hand, now has over 30,000 patients signed up and has ambitions for fast expansion.  

2019 will bring more sophisticated artificial intelligence algorithms that gather and interpret information from patients on their signs and symptoms. How these work alongside clinicians is unclear, but one algorithm has already been found to be better at detecting eye disease from scans than specialist doctors. 

The secretary of state for health and social care is a clear supporter of these approaches, as well as other forms of technology in the NHS, and recently published his vision for more use of data and digital. While it is encouraging to see such an ambitious vision, there are some big questions that need to be addressed if the NHS and its patients are going to reap the benefits. 

What is the aim of using technology?

Improving access to technology is only a force for good if it helps the NHS tackle the most pressing problems. Unfortunately, advocates sometimes fall into the trap of pushing for ‘technology for its own sake,’ and this is unhelpful because it does not focus minds and resources in the right places.

The Health Foundation’s analysis has shown that one of the biggest challenges facing the NHS is the rapid rise in the number of people requiring care for multiple health conditions. Over half of NHS spending is for people with not just one, but at least two long-term conditions. One-in-three patients admitted to hospital as an emergency now have five or more health conditions, up from one-in-ten a decade ago. 

To get the most benefit for patients and the NHS, we should spend time thinking about where the greatest challenges lie and how technology can be employed to help overcome these.

What is the nature of evaluation? 

There has been lively debate this year on evaluation with the secretary of state recognising the need for evidence about new technologies, saying that “a commissioner, clinician or person using health and care services can rapidly access evidence on the impact of the digital tools they are being offered.” This seems to be a shift from earlier in the year and is welcome, though greater consensus is still needed on the underlying question: what kind of evidence is needed? And why? 

To advocates of technology, evaluation often seems like a rate limiting step, with wider implementation hinging on achieving a positive outcome. Yet, evaluation can also be an enabler, helping technology companies, the NHS and patients understand impacts in close to real time so that approaches to delivering care can be adapted as a response. The latter approach is needed for technology.  

In an emerging field, not everything is going to work well first time. Users of evaluation evidence therefore need to recognise that some iteration will be needed. Yet, there does need to be some robust tests to ensure that the approaches are safe, make good use of taxpayer money, and do not worsen health inequalities. 

When it comes to using technology to improve access to services, one risk is driving up demand for healthcare amongst the worried well, potentially taking away precious healthcare resources from those who need it most. The impacts could be serious, especially since the NHS is already grappling with more than a 40% increase in emergency admissions over the last decade. History is full of examples where new services have been introduced with the aim to prevent demand for more expensive forms of care downstream, and the opposite has been true.

The need for a reciprocal agreement on data with technology companies

The approach that the NHS takes to data sharing will have a profound impact on the future of healthcare in the UK.

Matt Hancock is clear that he wants the NHS to share data with technology companies, saying that in his ideal world "a developer, company or researcher who has hit a barrier around access to data or users can get rapid, responsive help to keep their project moving.” What is missing is reciprocity, since there is no corresponding statement about how companies should be expected to share data with the NHS in return. 

Data sharing is needed so that the NHS and its evaluators and regulators can assess the quality and safety of the services that are being provided. It will also help to achieve value for money for taxpayers. In the digital age, data is the new oil. If the NHS gives its valuable data away to private companies, the NHS has the right to demand something in return. 

Any use of data requires a balance to be struck between the need for privacy and the public good, meaning that it is vital that the public trusts how data are used. The public is unlikely to accept their health data being used by companies when there is not full transparency about it. Yet public trust and support can aid the development of new technology if the public is involved up-front. 

The need to boost analytical capability

One aspect of the vision is encouraging: there is a clear recognition of the need to ensure that those working in the NHS are trained and supported to use data and technology in their work and have the time to learn the skills they need. 

In the drive towards better IT, it is often forgotten that the NHS needs people who can make the best use of the huge amounts of data being generated, producing insights to help managers and clinicians tackle the problems they face, such as tracking the quality of care, or aligning capacity more closely with demand.  

The NHS has not historically invested in its analytical workforce, but the Health Foundation has been offering funding and support to analysts in the NHS and local authorities, and we have found it pays dividends in improved care. The NHS should do more of the same. Analysts have been stuck in the basement for too long – they have a vital role to play in supporting an evidence-based approach to how services are run. As well as this, clinicians and managers need to be supported to understand how data can help them practically in their work.

The NHS is at a significant moment when it comes to technology, and there is real potential to improve care, but only if the NHS proceeds in the right way. It will be critical to be clear about the aims, use evidence and data well, and address analytical capability in the NHS.

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