Matthew Honeyman: Saving paper, saving money, or transforming care?

Yesterday we published a briefing on the digital agenda that has been pursued by the NHS since 2013 – the year Secretary of State for health Jeremy Hunt challenged the NHS to “go paperless.” We chart progress made to date and look at some of the barriers and opportunities presented.

This comes two weeks after the Wachter review of health IT was published. Much of the commentary on Wachter’s review has been focused on its messages about unrealistic timetables and insufficient funding. But it also calls for a re-launch of the government’s digital agenda with a new name by the end of this year. Could the “paperless” branding finally end up in the bin?

While this term has often been used to provide clarity around some of Jeremy Hunt’s desired outcomes, it gets in the way of articulating a more fundamental case for change. It begs the question “what for?” And that’s something we think continues to be a challenge for national NHS bodies. Wachter’s review agrees:

“The campaign needs to emphasise that the goal is not to ‘go digital’, ‘go paperless’, or even ‘save money’. Instead, digitisation is an essential tool for meeting the needs of patients, their families, healthcare professionals, and the entire nation—in short, to improve the way care is delivered in the NHS.”

Mixed messages on central funding have also undermined credibility. The government announced £4.2 billion funding in January, but there has been little clarity about when and how this money will be allocated—and with the funds being backloaded to the end of parliament this could potentially slow down progress.

Signals that central funding will be allocated to digital roadmaps and sustainability and transformation plans that aim to support quality improvement have been superseded by messages that plans to save money and reduce demand will be favoured. It’s the former that the case for change should be based on, but the latter reflects the competing priorities facing the NHS.

With little immediate prospect of more funding from the Treasury, and in the unlikely event that this would be directed to the digital agenda, what else can be done to make progress in this area?

As we’ve argued before, engagement of clinicians is a point on which all successful healthcare transformation hinges. It is emphasising quality improvement and benefits to patients that will bring clinicians on board. Wachter has proposed that a cadre of information-specialist clinicians trained at a new digital academy should drive the development and roll-out of technology in such a way that it fits better into clinicians’ ways of working. He’s probably right in that that this could help, but training takes time and such a proposal must be a viable career path for clinicians.

As well as building that workforce, making progress on updating or adopting systems so that they share information in a standardised way is a must. Carrots are being offered to secondary care through the £100+ million funding announced for the “exemplar” trusts who are expected to lead the way and spread good practice—including on ensuring interoperability within their region. Sticks are also sternly recommended by Wachter, which would see penalties eventually implemented for “suppliers, trusts, GPs and others” for obstructing interoperability in exchange for relaxing the timetable. Those incentives in acute care and industry-led initiatives such as the growing new group INTEROPen might be an opportunity to avoid getting those sticks out, as long as ambitious words are matched by deeds.

The ambitions of the government’s digital agenda have always commendably gone beyond simply making the system paperless, and include:

  • a national portal for online interactions with the NHS that builds on the spread of NHS Choices
  • interoperable systems that can support local clinicians delivering more integrated care
  • online access to health records and transactions for patients
  • standards and interfaces to support a diverse array of apps that securely plug into the clinical systems in practices and hospitals and help patients or clinicians make use of the information there
  • some process to assess and signal the quality of these apps to doctors and the public.

While the timetables might be relaxed in line with Wachter’s advice, the goal is still an ambitious one—to create a digital ecosystem that will ultimately transform NHS services and the experience of patients. It’s this ambitious vision that a re-launched digital health agenda should evoke. To me, the language the NHS Five Year Forward View and NHS England tends to use is better. It talks about “harnessing the information revolution,” alluding to the changes that the public, patients and professionals are already experiencing across society.

Whatever the new programme is called, it needs to have a strong focus on communicating the fundamental purpose of these efforts. We’re not trying to avoid cutting down trees (as important as this is), we’re trying to transform and improve care.

Matthew Honeyman, research, policy, The King’s Fund. 

This blog first appeared on the King’s Fund website here.