The NHS in England has published its much anticipated Long Term Plan with a significant focus on technology. We asked industry leaders for their comment and reaction.
Our contributors include: CCube Solutions, InterSystems, Allscripts, Ingenica Solutions, Draper & Dash, Isosec, DrDoctor, System C & Graphnet Care Alliance, Channel 3, FDB, Inhealthcare, IMS MAXIMS, Now Healthcare Group, Enovacom, Nuance, PatientTrack and Ieso Digital Health.
Nicola Hall, founder and COO, Ingenica Solutions
“It’s great to see this long term plan come out and we are sure all the NHS and its stakeholders will be digesting to interpret what that means for them. The emphasis is to be on primary care and improving the services that prevent people needing to go to hospital in the first place, that’s a long term strategy . The issue is how will the NHS deal with the day job as it is today, and make these changes going forward; ensuring new projects are resourced properly has always been a challenge in our experience.”
Vijay Magon, CEO, CCube Solutions
“The Government’s latest 10 year plan for the NHS offers a pragmatic direction and evolution towards a more modern NHS which focusses attention on Mental Health, GPs, and community care services. It supports enhanced use of technology to help connect patients to access healthcare – use of digital assets and mobile apps to involve patients in their own health care. This finally focusses attention on transforming the huge volumes of legacy records into usable digital assets where developments in data mining and AI can assist practioners to use knowledge buried in legacy records and help improve patient care. At CCube Solutions, we have been promoting use of document & records management technologies for several years and have helped Trusts achieve realisable benefits amounting to millions of pounds and improve patient care. The focus on digital services will hopefully yield the necessary funding for other Trusts to attain similar benefits.”
David Hancock, Client Engagement Director, InterSystems
“The contributors of the long-term plan have delivered a plan that looks to creating the NHS of the future – one that can support the increasing pressure created by our citizens as they live longer. We welcome the positive plans to equalise physical and mental health (and the increased focus on prevention) and look forward to publication of the social care Green Paper – a vital part of the integrated health economy.”
“We expect to see the ambitions in the plan turned in to positive action by the forthcoming local plans and we know that technology will be important in realising the commitments to improve patient care. We are committed to working with, and supporting, the NHS and other software suppliers in delivering the vision. “
Markus Bolton, Joint CEO, System C & Graphnet Care Alliance
“We welcome the focus on IT in the NHS Long Term Plan and every component builds on the work already underway. In particular, upgrading hospital clinical IT, sharing records across health and social care systems, population health and increased patient engagement are already making significant improvements in the quality and efficiency of care and we believe that this central support and increase in pace will be transformational.”
Tom Whicher, Founder, DrDoctor
“The plan is exciting, as it solidifies the recent rhetoric of using digital to transform services. Combined with a focus on integration, commitment to system change through extending the vanguard models and shining a light on prevention, I hope this marks the beginning smarter, more person centric ways of working. This could usher in a gentle revolution in service provision, helping us provide better, more effective care for everyone.”
Michael Latimer, CEO, Isosec
“Isosec welcomes the NHS Long Term Plan in general as it reflects the long held belief of the UK Health IT sector that real change is needed to drive better patient care and much needed operational efficiencies.”
“The Plan sets out to encourage a ‘World Leading Health IT Industry in England’, however to achieve this we think there needs to be a greater shake up within the ecosystem that currently exists between individual NHS organisations and NHS Digital. Isosec are lucky to work with more than 75 NHS Trust customers, but I still feel that the risk governance process can be antiquated and, at times, running for the sake of it just because ‘it’s always been this way’. This makes it extremely difficult to launch innovative technology into the NHS without barriers that could easily be adjusted. Our absolute position is that technology must be secure and fit for purpose, however policy and guidelines should allow NHS organisations more freedom to make the right decisions for better patient and operational outcomes, with those supporting bodies positively driving to nurture innovation and change.”
“The overall outcome must be that the NHS invests in the best technology available and we are pleased to start to see the eradication of monopolies and duopolies in terms of vendor; which are bad for everyone except those vendors. Smaller vendors still often find it very difficult to drive sustainable revenue from the NHS and are often restricted to boutique-style engagements that stop way short of major deployment. In conclusion, Isosec support any initiative that can help create a more open and innovative market.”
Shane Tickell, CEO, IMS MAXIMS
“The much-awaited Long-Term Plan for the NHS sets out an impressive ‘digital first’ health service that will provide welcomed impetus to the success of important initiatives that can drive forward this change, such as the local health and care record exemplars and global digital exemplars. And rightly positions digital as an integral part of the changes needed to improve patient empowerment, productivity and clinical outcomes.”
“It sends a clear message about the necessity of open standards and cyber security standards, cloud computing and the latest innovations such as artificial intelligence in making the health service more integrated, digitally secure and patient centric. Whilst we’ve seen some demand for Cloud as a Service and AI in the NHS, and the work of INTEROPen has made great strides in breaking down information silos, this mandate will help expedite these advancements.”
“The central funding commitment for the digitisation of secondary care, including the acceleration of the roll-out of electronic patient records, is also very positive news, but the devil is in the detail, and without specifics on the financials it’s impossible to foresee its impact right now.”
“Likewise, the fact this is a 10-year plan designed around a 5-year funding settlement cannot be ignored. The plan promises a host of impressive improvements across maternity care, children’s services, community care and mental health to name a few, but the concern is that not all of these will be achievable, particularly considering increasing demands on everyday services.”
Jessica Bradshaw, Managing Partner, Channel 3
“Overall, the NHS Long Term Plan is ambitious, and its proposals to shift the focus more towards prevention are to be welcomed. The digital ambitions are clear and the principle of ‘digital first’ is positive, provided, of course, that appropriate exceptions are in place to ensure no one is excluded from care. The Plan puts forward bold targets around investment in and adoption of new technology, supported by strong digital leadership across NHS organisations.”
“This level of ambition is needed to drive progress, but must not ignore the fact that the complex network of organisations that make up the NHS all have different levels of digital maturity. In some cases, significant investment in core infrastructure and training will be required before organisations can take advantage of new applications. Furthermore, digital adoption on the scale envisaged in the Plan will require major cultural shift, with staff and patients needing appropriate support to manage the changes.”
“Notwithstanding the significant challenges ahead – some of which are acknowledged in the Plan – the digital proposals are impressive. The real test will be in the detail of how these proposals will be funded and delivered.”
Bryn Sage, Chief Executive, Inhealthcare
“We welcome the Long Term Plan’s recognition that technology is central to creating a sustainable health and care service over the next decade. As a company which has been working hard with individual NHS organisations throughout the UK since 2012 to pioneer digital health and remote monitoring services, it is good to see this message coming from the top of NHS England.”
“We believe leadership will help technology such as ours to be culturally embraced by the workforce as an enabler for health and care in the same way as medical equipment.”
Orlando Agrippa, CEO & Richard Parker, COO, Draper & Dash
“We spent time as a leadership team working through yesterdays NHS Long Term Plan. The ambition it sets out is welcome, with many long-standing areas of concern and health inequality receiving the attention they both deserve and will require to improve the health of the population and reduce the burden of ill health in the next decade. Whilst the commitment to an increasingly digital, interoperable system was signposted well in advance of the publication of the LTP, there are clear and exciting opportunities for those of us committed to improving healthcare through the tech and analytics space.”
“Many of the initiatives outlined, whilst unquestionably positive, will be challenging to deliver. For example, all patients having access to their care record and communications from care professionals through an NHS app by 2020/21, and this being the main way for people to interact with the NHS has enormous implications across all sectors.”
“Schemes to target improvements in stroke and cardiovascular disease build on areas where the NHS has historic competence in delivering real change. Moving forwards, investment in genomics projects for Familia Hypercholesterolaemia and the systematic roll-out of thrombectomy services for stroke victims again reflects a commitment to 21st century solutions that should save even more lives and reduce disability.”
“Another positive area in the LTP is the focus on mental health provision; parity of esteem in terms of services for people with mental health problems address another long-standing concern. Similarly, investment in cancer diagnostics and associated pathway improvements will help to improve outcomes relative to other global healthcare systems.”
On the flip side our initial concerns around the plan fall into three main areas:
- Delivery and the lack of a ‘guiding hand’: The LTP is ambitious but there is little or no mention of the transformation resource that will be required to deliver this scale of change. Some of the most impressive changes in the NHS in the mid-2000’s were supported by a change model and infrastructure. Whilst one can debate the exact approach required, a failure to properly address this will put delivery of the plan at risk. Similarly, the ‘nudging’, ‘encouraging’ and ‘incentivising’ systems and providers to ‘work together’, and be ‘supported through consolidation exercises’ will work to an extent but it’s likely to take time and rub against the timelines outlined in the plan.
- Capital: Whilst there is an acknowledgement that capital allocations have been low in recent years, the system for allocating capital is both opaque and, at times a little nonsensical. For example, some of the least digitally mature parts of the country received little or no funding to address this in the last capital allocation rounds; this will need to change and quickly if the plan is to deliver at the pace it intends.
- Workforce: This is a real problem for providers right now. It was disappointing to read that the comprehensive workforce plan will be released at a later date. Healthcare is a hands-on business and without people, or a detailed plan to secure the right people, there has to be a question around the overall deliverability of what is otherwise a sensible set of proposals.
Mark Smith, Business Development Director, Enovacom
“It is an ambitious plan and lack of resources is of a major concern for the decision makers. The movement to an ICS (integrated care system) will need to be supported by proven and scalable interoperability technology used across the whole of the health economy, something Enovacom is well positioned to support the NHS given its expertise in other countries.”
“With the lack of resources technology needs to enable automation supporting front line staff at the point of care, this requires real time information shared securely across many areas in a patients journey to ensure the journey is optimised with a high level of care. As a key focus Mental Health is relevant as Enovacom supports the initiative of the GDE, and is an international partner of Oxford Healthcare , driving innovation and spreading across the NHS.”
Darren Nichols, Managing Director, FDB
“Further investment in primary care announced in the NHS long term plan is welcome, as too is the recognition that decision support technology can help frontline clinicians apply best practice, eliminate unwarranted variation and reduce costs. Thousands of GPs and clinical pharmacists in CCGs and community healthcare providers last year reached £100m of savings in the medicines they prescribe, by choosing safer, appropriate medicines suggested by OptimiseRx. This is about more than saving money: healthcare professionals can use prescribing decision support aids like this to address risks such as anti-microbial resistance, overmedication of people with autism or learning disability, and incorrect use of asthmatic medicines – all challenges outlined in the long term plan. As the plan notes, the NHS will use digital technology to ensure that best practice is followed, generic medicines are used where possible, and duplication is eliminated as it bids to deliver value from the £16bn it spends on medicines.”
Donald Kennedy, General Manager, Patientrack
“Patient safety has been deservedly recognised as one of ten priority areas in a strengthened efficiency and productivity programme, described in the NHS Long Term Plan. A new ten-year national strategy is now expected in 2019 focussing on improving patient safety and reducing harm. With emphasis throughout the long term plan on the role of digital as an enabler, this is an opportunity to reflect at a national level on how parts of the NHS have pioneered in the use of technology to keep patients safe and support healthcare professionals in delivering care. Patientrack has collaborated with many hospitals that have innovated with digital technology to reduce risks to patients from deadly conditions such as sepsis, acute kidney injury, and avoidable cardiac arrests. Through helpful reminders and early warnings such as NEWS2, better visibility of patients that need intervention and real-time support for clinical pathways and the patient journey, many of these hospitals have transformed clinical practice, and have created a strong evidence base for how technology can be used to avoid harm and help with patient care. This opportunity to expand such best practice to the wider NHS must be embraced.”
Lee Dentith, CEO and Founder, Now Healthcare Group
“We were delighted to hear that technology and making the NHS ‘fit for the future’, was one of the key themes coming out of the NHS long-term plan yesterday. The NHS 10-year plan revealed millions of GP visits and hospital consultations could be conducted through Skype-style videos to save cash. Now Healthcare Group have been in this space for some time now, supporting the NHS and empowering patients by offering video GP consultations and prescription ordering and delivery via our innovative technology. These developments should enable us to grow at pace, enhance the patient journey and enable us to play a small role in revolutionising UK health care.”
Dr Simon Wallace, Chief Clinical Information Officer, Nuance Communications
“This year, the NHS must demonstrate how it can encourage a culture shift to ensure that technology is being used to effectively boost efficiency, improve patient care and reduce the stress and burnout seen across the healthcare profession. To achieve this, it is important that budget allocated to digital health is utilised in this way, and not clawed back to fund other reactive needs, such as winter pressure.”
“With the proposed backing, the NHS will be able to increase the adoption of electronic patient records, integrate patient data in a meaningful way and link with social care systems to provide a complete citizen overview – helping clinicians provide a better services at the point of care.”
Alan Fowles, International President, Allscripts
“It is encouraging to see that the long-term plan recognises that the NHS needs a new service model for the 21st century, and that this model needs to make full use of digital technology. Allscripts is already working with health and care communities that want to use shared records to join-up and co-ordinate their services, and to reap the benefits of population health management.”
“As the plan itself acknowledges, this is a developing area; but it is one that holds out exciting possibilities to stratify populations, and then tailor public health programmes, screening, or new services to where they are most needed.”
“At the same time, it is good to see that the long-term plan recognises that work is still required to complete the digitisation of hospitals, because it will not be possible to achieve the plan’s efficiency targets, to generate the information required for integrated services or advanced analytics, or to create “digital first” offers for patients, until this is done.”
“We therefore welcome the plan’s commitment to creating a core level of digitisation for all providers by 2024, and to an accelerated roll-out of electronic patient records to support this. Allscripts has created a clinical wrap strategy to support trusts that want to digitise without scrapping their existing IT investments, and we are talking to a significant number of organisations about how this can help them to achieve their digital ambitions.”
“We also welcome the expansion of the global digital exemplar programme. Our partner, Salford Royal NHS Foundation Trust, has said that its work on this programme ‘is saving lives’, so it is good to hear that other trusts and fast followers will be able to benefit from the GDE approach.”
“The long term plan is a long document with many ideas and a lot of detail that will be worked through in the coming years. However, it has a clear vision and achievable digital milestones and we look forward to working with health and care organisations to achieve them.”
Stephen Freer, UK Clinical Lead, Ieso Digital Health
“Almost every industry has been improved through the careful and strategic introduction of technology, and the UK’s health system shouldn’t be any different. We support any government initiatives that facilitate innovation, and ultimately enable patients to access treatments more easily, and get better quicker.”
“Improving access to and the quality of care must be the government’s objective, which will be a challenge as it tries to be as efficient with its budget as possible. However, introducing technology that will offer patients more choice in their treatment, increase access to it and drive up standards of care, whilst also encouraging costs reduction as the NHS shifts towards a digitally-led future.”
“The government is also planning to expand its IAPT programme. This must include new technologies to increase patient access to treatment and ultimately improve outcomes. Recovery rates for CBT have remained stagnant at around 50% for the last 30 years. Incorporating digitally enabled treatments methods that are not only accessible to the patient, but provide accountability and measurability for the clinician, can help change this. We have seen this already through the application of data science techniques to chat-based therapy sessions.”
“Finally, the government must remember to keep people at the centre of its thinking, and understand that for many this will be a step change in how they interact with the NHS. But, with the right education and tools, everybody can benefit.”
— Thank you to our contributors and we will be continuing this reaction shortly with Part Two —
