Comment

Prime for transformation?

The sustainability and transformation partnerships (STPs) programme should harness and drive digital innovation as a positive force to help overcome barriers to the integration of health and social care and improve standards of delivery, writes Professor Lord Patel of Bradford OBE.

In previous years, the promise of digital technology and innovation to unlock savings and efficiencies across the NHS and wider health service has been dogged by the hard bedrock of experience.  A trawl through historic reports by the public spending watchdog, the National Audit Office, into the £10bn National Programme for IT in the NHS makes sobering reading, even six years on. 

However, efficiency for the sake of progress in health provision cannot be delayed. Sheer demographic pressures, public finance realities and projected service demand call for a positive response in the present to forestall the needs of the future. 

In this context, the place-based STP programme, which allocates health and care resources across 44 ‘footprints’ in England, does hold out the real hope of a universal route to achieving transformation, through cost-savings, efficiencies and improved local health outcomes. 

The Breaking Barriers study into health and care integration, ‘Building a sustainable future for health and social care’, launched last year, highlighted three significant obstacles to achieving digital integration: 

• A failure to maximise the latent wealth of health-generated data;
• Closed systems, markets and approaches to adopting technology; and
• A crucial shortage of time and space in which to successfully foster innovative approaches. 

To follow-up on these findings, we held a roundtable in April on the future of STPs with a panel of experts drawn from the NHS, health regulatory bodies, local government and service and data analysts. 

It is evident that STPs could harness and drive digital innovation to help overcome barriers to the integration of health and social care and improve standards of delivery – in the face of known financial and demographic pressures. 

A consensus swiftly emerged that driving digital innovation is not about technology. Unlike the dot.com era, the tools are proven and are readily available. 

Digital innovation is an organisational change issue 

Digital innovation is primarily an organisational change issue, not a technology conundrum to be solved. Success in this arena is limited only by the ability of the NHS to transform itself – albeit while in the throes of a chaotic funding context and in fulfilment of the Five Year Forward View (FYFV). 

Since the ongoing financial woes of the NHS show the existing way of doing things isn’t sustainable, a real opportunity presents itself to embed dramatic digital reconfiguration over the next decade. 

At a fundamental level, effective information sharing and access across health and care providers will be crucial to delivering the digital potential of STPs, a contributor to the roundtable observed. 

Participants noted that better data is needed before any prevention strategies and community-based interventions can help decrease visits to A&E departments. One participant noted that in his area, the approach to “fracking NHS data” had opened a path to helping groups of people better support themselves. Although it was agreed that data is the health service’s biggest asset and ally, the challenge across the public sector is to effectively connect datasets.  

Among the general public, the expectation is that personal data is shared across frontline public services to a far greater extent than it is in practice. However, any attempts to harness combinations of public and commercial datasets to target public health interventions would require public consent and understanding. 

Amazon-style digital marketplace 

It was intriguing to hear the panel praise the ambition of establishing an Amazon-style digital marketplace for personal health and care off the back of the STP agenda. 

An open system marketplace like Amazon would make health commissioners think like retail and logistics experts about the consumer health experience. Indeed, one of the biggest current growth streams for Amazon is from people aged over 90 who are using electronic means to manage aspects of their healthcare. 

NHS procurement is bedevilled by instances of vast local variation in purchases of commodity products – 40% differentials on deep vein thrombosis stockings from one trust to another are nothing unusual. But by bringing all health providers together in an open, transparent marketplace, the thinking is that commercial negotiations can be funnelled through the technology to the price benefit of NHS purchasers. 

A proto-market revolution is already tentatively taking place around personal health budgets. Here, the buying of wheelchairs has become a trial area in which the market for goods is forcing providers to think more about the opportunities for greater forward planning and patients see greater power and choice. Health economies can be plugged into this, and schemes such as care-banking are ripe to be transferred into such an open marketplace. 

The trial use of Amazon’s electronic assistant ‘Alexa’ by pioneers has validated the worth of such technology in giving lonely people suffering from isolation not just companionship, but access to local public services. In practice, connecting devices to big data sets in complex environments is a bigger challenge than figuring out voice automation. 

Another participant stated that if digital innovation is so value-creating and cost-effective, digital change programmes – which don’t require huge amounts of funding – should be undertaken within the financial year. “We should not allow finance to be used as an excuse,” argued one panellist. 

However, it was noted that as public sector providers, there has to be an ethos of public service value creation, and the question must be raised about what the public sector ethos could bring to the table in running health marketplaces. 

Given the immediate cash pressures on the NHS, it must be understood that innovation won’t be an overnight fix and may require three or four years for profound service changes to manifest. How do public service professionals create an environment in which innovation can be fostered and where the freedom and headroom to innovate exist? This is a political and policy problem that will require more than a one-click solution, to say the least. 

Financial crisis should not forestall much-needed digital investment 

In conclusion, it is clear that the issue of delivering digital innovation inside the health system is not primarily one of technology. The tools are already available and proven. Instead, successful digital innovation in health will require a widespread cultural change across not only the NHS but also the entire interdependent network of public, private and third sector partners. 

The greatest asset for driving digital innovation in the health service is the vast trove of data generated, collected and stored by the public sector. We need to make the most of this latent potential and health service bodies should – subject to data protection regulations – be more open in sharing their wealth of data with the wider public sector and commercial providers. 

The financial crisis in the NHS should not be allowed to prevent or forestall the much-needed investment of effort and resources into digital technologies with the capacity to deliver more responsive, personalised and cost-effective health services. 

With this diagnosis, we offer three central recommendations for a healthy digital strategy. 

Firstly, guidelines for managing the digital transformation of health service delivery should be formulated and shared across all CCGs and the boards of all 44 STPs in England. 

Secondly, a new framework for effective data sharing and information management for health services – perhaps conducted in partnership with the Information Sharing Centre of Excellence – is now required to adapt to the new technological and commercial realities. 

Finally, a taskforce headed by digital industry experts should lead a commission to investigate ways of boosting capacity for digital innovation in the NHS and social care arenas.

“It is evident that STPs could harness and drive digital innovation”

FOR MORE INFORMATION

To download the Breaking Barriers report, click here.