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NHS strategy for digital: here we go again

08/01/19

Michael Cross Correspondent

Analysis: The NHS Long Term Plan’s ‘digital first’ ambitions will attract inevitable comparisons with previous aspirations 

Stethoscope on iPad

In 1998, it was 2005. By 2003 it was 2011. It was then 2020 and 2023. We are now looking at 2024 for hospitals in England to be “fully digitised”, under the Government’s Long Term Plan for the NHS.

In fact, the time lag between aspiration and reality is even longer than that: back in the mainframe 1970s, London teaching hospitals were seen as obvious low hanging fruit in the process of computerising healthcare. 

In the event, thanks to a combination of unsuitable technology, institutional politics and contractual incompetence, big hospitals proved one of the trickiest parts of the health service to digitise. The main reason for any optimism about the latest target is that it is part of a programme of broader change including to the status of the secondary care “disease palace” in relation to community care. 

What else has changed? Looking back at the early IT plans for the NHS in 1992, 1998 and 2002, the big difference is the change in emphasis from technical standards to patient demand; specifically for “digital first” primary care. It is taken for granted that the underlying infrastructure of coding, patient identification and bandwidth capacity will be there.

Cutting edge

That these can be taken for granted is thanks to an assumption unthinkable in the 1990s that the private sector will be at the cutting edge. This includes the new framework for suppliers to offer digital platforms on standard NHS terms. 

A telling extract of the plan reads: “It’s easy to be cynical about the achievability of these big technology driven shifts in outpatient care. But there are now at least four reasons not to be.

“They are already happening in parts of the NHS, so this is clearly ‘the art of the possible’. There is strong patient ‘pull’ for these new ways of accessing services, freeing up staff time for those people who can’t or prefer not to.

“The hardware to support ‘mobile health’ is already in most people’s pockets – in the form of their smart phone – and the connection software is increasingly available for the NHS to credential from third party providers.”

That is all very well. However, the plan resembles its predecessors in skating around a vital feature of the landscape: personal health data.

Previous strategies tended to deal with the cans of worms with a brisk reference to the importance of “security and confidentiality”. Now the era of big data driven machine learning obviously requires a more nuanced approach, and the long term plan lists among its practical priorities deploying decision support and AI to help clinicians, along with predictive techniques to support local health systems. 

Privacy issue

Next in the list is to “protect patients’ privacy and give them control over their medical record”. How the two priorities are squared remains to be seen. All we get is a further priority: “The use of depersonalised data extracted from local records, in line with information governance safeguards, will enable more sophisticated population health management approaches and support world leading research.”

Apparently this will be achieved by “automating and standardising the generation and storage of data”. But in the current climate this may be as impractical as the computerisation of London teaching hospitals was, three decades ago. 

Onwards and upwards…

Image by Marco Verch, CC BY 2.0 through flickr

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