LSE–Lancet Commission on the future of the NHS calls for re-evaluation of digital health

The Lancet and the London School of Economics (LSE) recently published a report on its joint-commission, which was launched to independently evaluate the NHS – focusing on areas such as spending, sustainability, changing health needs, IT and digital technology.

Set up in 2018 for the NHS’s 70th anniversary, the commission’s research took three years, encompassing the pandemic, and has now released its findings, along with four health policy reports, and an editorial of lessons and learnings on health security.

Overall, the commission makes seven core recommendations as part of its long-term vision for the NHS to become a better, fairer healthcare system.

The key areas highlighted are: increase investment in the NHS, social care, and public health; improve resource management at national, local, and treatment levels; develop a sustainable, skilled, and inclusive health and care workforce to meet changing health and care needs; strengthen prevention of disease and disability and preparedness to protect against major threats to health; improve diagnosis, in circumstances where evidence exists to support early diagnosis, for improved outcomes and reduced inequalities; develop the culture, capacity, and capability to become a learning health and care system; improve integration between health, social care, and public health and across different providers, including the third sector.

Entitled ‘LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19′, the extensive publication says its aim is to look to the ‘NHS in 2030 and beyond’. This includes a full health policy report on ‘Health information technology and digital innovation for national learning health and care systems’.

The dedicated section on digital and tech is in line with other recent official releases and recommendations, such as those made by a recent House of Lords committee, which highlights the need for health information technology (HIT) to be complimentary rather than a replacement – “a means to an end and not an end in itself”.

“It is not a panacea for the challenges facing the UK’s health and care systems but, if thoughtfully developed, procured, and deployed, it can be used to support the wider goals of enhancing the quality, safety, and efficiency of health and care,” states the report.

Emphasising the need for both “bottom-up” and “top-down initiatives”, and the better use of data generated by the deployment of more HIT, the health policy paper focuses on the “practical aspects”, such as “improving usability and interoperability, handling, processing, and analysing data, and addressing privacy and security concerns”.

Its key messages include calling for all four UK countries to “re-evaluate their digital health and care strategies” post-COVID-19 pandemic. The suggested focus also encompasses:

  • Delivering on commitments to implement integrated electronic personal health records, with access for patients, carers, and health and care providers across multiple settings
  • Improving the usability and interoperability of health information technology systems to mitigate against error and burnout
  • addressing security and privacy concerns by improving cyber security and data governance to maintain public trust in how data are held, shared, and used
  • Developing easy-to-use platforms for individuals and communities at risk of digital exclusion, to ensure HIT does not widen inequalities
  • Collating routinely collected data into integrated datasets to support policy and planning, service delivery, and the precision medicine and public health agendas
  • Investing in HIT leadership, training and development of the existing workforce, and the creation of new roles such as data scientists and clinical informaticists
  • Understanding the benefits of AI and robotics but as complementary to pre-existing roles and to reduce the burden on staff.

In conclusion, the paper acknowledges that while the pandemic may have accelerated some aspects of digitisation and HIT implementation, there are still “persistent barriers, such as poor interoperability, concerns about privacy, and difficulties to get data to flow in real time”, which have “continued to restrict the ability of the UK to leverage HIT to support policy and planning”.

It stresses that the “next decade presents a major opportunity to strengthen the implementation of HIT systems” but that “the UK needs to learn from past mistakes and understand that HIT systems are complex interventions that need to adapt to local needs and contexts”.

“To avoid jeopardising progress,” it states, “everyone involved needs to be responsive to the ethical challenges and unintended consequences of HIT”.

Read the full digital health paper here, or view and download the findings of the entire commission.