The Department of Health and Social Care has published “A plan for digital health and social care”, setting out their vision for a digitally-enabled health and social care system, collating existing digital strategies, plans and guidance into a single action plan.
In the foreword Secretary for Health and Social Care Sajid Javid comments: “The long-term sustainability of health and social care is dependent on having the right digital foundations in place, and so digital transformation must be the linchpin upon which all of these reforms are based.”
The plan sets out “the four goals of reform” identified by Javid, that the system will be equipped to prevent health and social care needs from escalating; personalise care and reduce health disparities; improve the experience and impact of people providing services; and transform performance.
Here, we take a look at each section of the plan and share highlighted ambitions, and then explore the action plan in more depth.
Embedding digital technologies
The first section summarises central actions that are being undertaken to ensure that digital technologies are integral to the whole health and social care system by 2025.
It begins by describing how digital services provide people with more control over their lives, allowing them to decide when and where they connect with health providers, and supporting self-management of care.
The plan states: “Scaling and sustaining that cycle is essential if health and social care services are to manage capacity and continue to provide high-quality care, given our workforce challenges. Along with learning lessons from the past and building trust with people, it is the key to making health and social care services sustainable. For the cycle to gain momentum, there needs to be a faster flow of approved, high-quality digital solutions from industry into services; and regulatory mechanisms need to enable its acceleration.”
Digitising health and care records
At present, the strategy shares, 20 percent of NHS organisations are digitally mature, although 86 percent have a form of EPR (electronic patient record) in place. Only 45 percent of social care providers have any form of digital care records.
The goal, set out in the What Good Looks Like framework, is for all ICSs and their constituent organisations to have all the attributes of digital maturity by March 2025. The government also plans to explore how to converge on fewer EPR products to make it simpler for staff and services to interact with them, and increase the spread of digital social care records, aiming for 80 percent coverage by March 2024.
“We are also providing national support, including funding, for locally-led digitisation of frontline health and social care services,” the plan states.
A life-long, joined-up health and care record
The plan describes how digitising separate health and social care records will help to “create a functionally single, life-long digital health and care record for each person.”
It adds: “When all the people involved in meeting a person’s health and social care needs – including that person, their family and unpaid carers – can see what each of them has done and is doing, in real time, they can co-ordinate as one team to meet that person’s needs and preferences.”
By March 2025, all clinical teams in an ICS are expected to have appropriate and secure access to a complete view of a person’s health record. Non-clinical staff in social care settings will also have access to appropriate information.
This part of the plan aims to improve the accuracy of a diagnosis, bring tests closer to home, reduce the person’s wait for a confirmed diagnosis, and avoid unnecessary referrals.
“Our planned investment in new diagnostics capacity, especially in CDCs (community diagnostic centres), aims to deliver these benefits, in particular through image-sharing and clinical decision support based on AI,” says the plan. “This investment will also help to streamline planned urgent and emergency pathways, and support elective recovery.”
Emphasis is placed on the potential of artificial intelligence (AI) to help with waiting lists, productivity and levelling up, with the NHS AI lab currently helping to determine the areas where it has the most potential to be deployed. The lab is setting up the necessary regulatory frameworks and ethical assurances to ensure safe and effective adoption, including ensuring use of diverse datasets when training AI algorithms. The plans also sets out the government’s intention to “continue to explore how AI and machine learning can supplement the decision support systems already used for triaging patients on urgent and emergency care pathways.”
Robotic process automation (RPA) is another area of interest in the strategy. “As we automate basic manual and repetitive tasks to save time for staff, we will ensure that the way and reason automated decisions are made are understood by humans,” it states, adding that many clinical and non-clinical roles within the workforce are expected to evolve as digital technologies permeate clinical disciplines. “We will ensure our health and social care workforce have the right skills to apply these technologies successfully and our organisations have cultures that foster innovation.”
Putting NHS services in people’s pockets through digital channels
Action is being taken in this area, the plan says, by expanding and improving the two national digital health channels, the NHS App and the NHS website, and through measures to increase uptake of safe digital products.
“Our vision is to use our national digital channels to help people stay well, get well and manage their health.”
In addition, the government plans to make key social care information viewable on the app for people and their carers, and over the next three years, intends to increase the functionality of the app and website so that people can access resources proactively, have more control over their care, and benefit from personalised and preventative offers.
The initial focus for this year, the plan states, “is going to be on helping people manage their health – giving users access to their health record, the ability to manage their hospital appointments, receive notifications and messages, and amend their contact details and preferences.”
By moving towards a holistic and inclusive offer, informed by what users want and with best practice embedded, the government hopes that the app and website can be used to prevent needs from arising or escalating, and providing tailored advice and care if they do.
“Our initial prevention priorities focus on blood pressure management and vaccine bookings and reminders, and this will be followed by targeted digital health checks,” it says. “We expect our prevention offer, over time, to reduce demand for traditional NHS services and allow for a more efficient use of estates.”
Digital exclusion is raised as a potential issue; the plan comments that the Department of Health and Social Care will continue to work with partners to lower barriers, and that digital services will always be part of a multi-channel offer including in-person and phone services.
Scaling digital health self-help, diagnostics and therapies
The plan states: “We are supporting the rapid uptake across the health and social care sectors of proven, high-quality, easy-to-use, safe and effective digital products that offer value for money.” To speed this up, the government are working with MHRA, NICE and the tech industry to devise clearer policies for accrediting digital health technologies likely to be adopted nationally.
NICE is set to pilot a new early value assessment through summer and autumn 2022, initially focused on cardiovascular and mental health products, streamlining the evaluation of evidence for products that meet NHS priorities. This will enable NICE to conditionally recommend promising products to the NHS.
MHRA is also developing new regulations for medical devices, with the future regime aimed at increasing patient and public safety, transparency of regulatory decision-making, and alignment with international best practice.
Accelerating adoption of proven tech
By supporting research and development partnerships, along with better tech procurement, the government aims to spread good technology through the system faster.
The plan notes that a few NHS trusts and primary care groups have developed strong processes for partnering with innovators and venture builders to develop and configure sustainable solutions, and generating “crucial” evidence to demonstrate impact.
“We are committed to supporting and systematising this good partnership practice,” the plan says. “We are also working with regulators to speed the spread of well-evidenced technologies across the NHS. And we are supporting NHS organisations in their commercial negotiations with industry and funders to align the interests of all concerned behind products that make a real difference to people, staff workload and system productivity.”
The plan also sets out an intention to make it easier for NHS organisations to collaborate with industry on researching, developing and mainstreaming tech-enabled service innovations.
Buying tech better across health and social care
NHS and social care organisations purchasing digital technologies need to be sure that their purchased products ensure interoperability, usability, clinical safety, cyber security and sustainability. Tech sellers also need to know the technical standards their products must demonstrate to win NHS accreditation.
“We are setting and enforcing clear technical standards, including open standards to avoid challenges in changing suppliers,” the plan states. “We are also working with suppliers to champion climate-resilient and low-carbon standards, as well as business models with a ‘circular economy’ approach.”
The government aims to consolidate digital and IT procurement frameworks, simplifying the process, improving quality, removing duplication and reducing costs.
The plan states: “We are equally committed to helping adult social care providers buy appropriate technology for social care records and other priorities, and to scale technologies that have proven benefits… We will also work with sector partners to help local authority commissioners become confident and capable purchasers of care technology.”
Aligning oversight with accelerating digital transformation
In order to make and sustain the progress expected over the next three years, the government notes that it needs to include its expectations of digital transformation in oversight arrangements for trusts and ICSs, as well as communicating clearly how they will support compliance and intervene when necessary.
Using regulatory levers
With formal mechanisms for overseeing delivery of NHS digital priorities limited at present, the plan says that the government are exploring options to fill this gap by discussions with NHSE and CQC, as well as review and consultation with system leaders and frontline staff.
It states that regulatory levers needed to be used to signal that digitisation is a priority, identify the non-negotiable standards of digital capability, and explain how compliance will be monitored and supported.
The plan comments that it will “support the sector in understanding and meeting defined standards of digitisation, and explore how we can use incentives and levers to encourage providers to accelerate digital adoption.” In particular, “we are helping ICSs to understand their levels of digital debt, the consequence of not addressing or investing in digital properly, and help them quantify expected benefits from digital investments by providing examples.”
The key to making systems interoperable is “getting health and social care providers and their tech suppliers to adopt the same technical standards” to “ensure useable data can flow between IT systems in different organisations.”
Work is currently being undertaken to identify the ‘musts’ for the NHS along with how this can be enforced.
Legal powers to enforce technical standards among healthcare providers have been strengthened in the Health and Care Act 2022 to ensure compliance with any standards published as information standards notices. “These changes will result in data being in a standard form, both readable by and consistently meaningful to any reader anywhere in the health and social care system.”
In addition, the Department of Health will make further changes to the Health and Social Care Act 2012, including a power to apply technical standards to suppliers of IT systems and services. The changes will provide the power to enforce these standards through compliance notices and financial penalties, along with the power to establish an accreditation scheme.
Supporting social care
Engagement has indicated that digital skills and basic digital foundations such as connectivity are among the biggest barriers to digital transformation in social care, with over 60 percent of care homes still using internet connections that will not support full digital transformation.
An investment of at least £150 million over the next three years has been announced in the adult social care reform white paper, ‘People at the heart of care.’ This will be used to ensure that all care providers have access to high-speed connections, increased digital skills and confidence among the workforce, and better cyber resilience.
“With these enablers in place, we will support 80 percent of social care providers to adopt a digital social care record, and ensure the 20 percent of care home residents who are identified as at high risk of falls are protected by sensor-based falls prevention and detection technologies by March 2024,” the plan states.
Vision for a digital future
The next section of the plan shares a vision for the digitally transformed health and social care system in practice, by sharing the care journeys of three individuals. Using these individuals, the plan shows how “by 2028, we will have moved from fragmented health and social care services that vary significantly across the country to a seamlessly joined-up system that allows people who use it to continue living as they wish.”
It notes that a “vast amount of technology-enabled, largely automated activity will happen ‘in the background’, allowing the staff working in the system to spend more time treating and caring for the people they serve.”
To view the care journeys, click here and navigate to section two.
The vision includes:
- Anticipatory care that promotes prevention and independence, with digital tools such as risk-based screenings, digital health checks and at-home diagnostics used to improve outcomes for individuals, communities and whole populations
- Personalised care, with digital tools helping health and social care providers to plan, design and deliver personalised services which reflect individual preferences, reduce disparities and allow people to make informed choices about their care.
- Enhancing the impact on people providing services, with access to real-time data supporting staff in collaboration and digital tools reducing the administrative load for frontline staff.
- Continuously improving performance, with comprehensive data tracking and analysis used to evaluate new digital tools and services, and insights used to constantly iterate and improve services.
Action plan for delivering a digital future
Next the plan moves on to the action plan comprising key actions for the next three years. The strategy covers three elements: digitise, connect and transform.
The actions in this section “aim to aid ICSs and providers of social care in achieving the level of core digital capabilities and skills that underpin safe and effective care, and continuing on that upward digital trajectory.”
- Put core digital capabilities in place; constituent organisations of ICSs are expected to have core digital capabilities in place by March 2025, including an EPR and other critical systems, resilience to cyber attacks and fast connectivity. The plan sets out how the government intends to help ICSs achieve this, with actions including providing multi-year funding to ICSs based on need, publishing an assured supplier list and draft set of standards and capabilities, and working with tech industry partners to make sure the clinical EPR systems market offers products that providers can buy with confidence.
- Build resilience to cyber attack; the government will publish a Cyber Security for Health and Social Care, set out how they will enhance and extend existing national protections through the NHS Security Operations Centre, and fund dedicated cyber staff to work alongside local NHS and social care organisations to manage cyber risk.
- Ensure fast connectivity; health and social care systems will be supported to move to sustainable cloud services where they can benefit from the latest and fastest connectivity, and fibre broadband upgrades will be delivered to at least 1000 care homes currently dependent on poor connections by March 2024.
- Build digital skills; a national digital workforce strategy will be co-created with the health and care system, with other actions including the recruitment, retention and growth of the digital, data and technology (DDaT) workforce, the creation of a membership body for DDaT professionals to bring cohesiveness to disparate professions, the establishment and continuation of digital learning offers through the NHS Digital Academy, and the growth of a pipeline of diverse future specialists and leaders through graduate and apprenticeship schemes.
- Use NHS regulatory levers; in order to support and monitor NHS trusts in achieving core levels of digital maturity, the government will implement the recommendations from the Laura Wade-Gery Review, explore how digital could be embedded in the NHS Oversight Framework, work with regional teams to ensure that digital priorities are understood and discussed, and work with the CQC to agree a process for embedding digital maturity in their assessment framework.
These actions cover what needs doing in order to enable the sharing of information across the health and social care system, to support lifetime joined-up health and social care records.
- Maintain high standards of privacy and ethics; the new data strategy contains more than 100 recommendations on how to make better use of data to improve care whilst maintaining privacy and ethics standards. Actions include delivering the policy and requirements needed to implement secure data environments, developing a standard for public engagement that sets out best practice for communicating with the public about data, and co-developing a data pact to set out mutual expectations for the public and health and care system.
- Join up lifetime records; documentation will be published to set out who does what with regards to the roles played by NHS Digital, NHSE, regions, ICSs and frontline organisations in delivering a target data archive. Other actions include providing access to appropriate information from a person’s GP record to more social care professionals, ensuring that every newborn has a digital record, and ensuring that, within six months of a care provider implementing a digital social care record, they are able to connect to their local shared care record.
- Set standards for interoperability and architecture; organisations will be able to plan and future-proof interoperability by regular updates of the standard roadmap. A new end-to-end process for creating standards will be designed, the Version 1 Open Source Policy through Github will be published, a new digital service that allows care providers and suppliers to identify which standards they must conform to, and more.
- Build core national ‘connect’ capabilities; the government will enable more frontline staff to access and update health records, extend access to electronic prescribing to enable more safe and efficient care, drive uptake of NHS Number across multiple services, and work towards unifying staff e-identify across disparate IT systems.
- Deliver precision population health; ICSs will continue to be provided with new tools to free up clinical time and reduce waiting lists. A system of connected platforms will be specified to bring together information such as data and analytics capability for population health and personal insight. A three-stage procurement of the Federated Data Platform will also be undertaken.
These actions are designed to promote transformative changes to support the system now and help realise the vision described earlier in the article.
- Put the NHS in people’s pockets; the NHS App will be used as a digital front door to help people manage their health, and the website will provide support and resources. By 2024, the government aims to have 75 percent of adults registered for the app.
- Scale digital health self-help, diagnostics and therapies; the NICE EVA will be introduced to assess evidence for promising products; a single national procurement framework will be established to support further evaluation of NICE-recommended products; further implementation support will be provided for organisations adopting the products, and more.
- Increase connected, supported and personalised care at home; availability of digital monitoring for vital signs for people at home and in care homes will be increased; tech-enabled virtual ward services will be scaled; tech-enabled annual physical check for people with severe mental illness will be developed; and clinical pathways for people to self-monitor will be defined.
- Transform screening; a full digital delivery programme for screening transformation will be defined, with other actions including testing and evaluating AI technologies for screening in crucial areas such as breast and lung cancer, and developing technical architecture designs for breast screening.
- Make the right referrals; appointment management tasks in primary and secondary care will be automated, with the number of organisations using electronic referral systems increased and expanded into new settings.
- Make digitally-supported diagnoses; a plan will be created for the delivery of a national data registry, clinical decision support systems will be used in diagnostics to improve provision of the right tests at the right time, and digital infrastructure will be rolled out to enable diagnostic networks to make future use of AI to reduce repetitive tasks, increase speed and provide enhanced post-processing of imaging data sets.
- Reimagine outpatients; new pathways will be developed to clear the backlog of patients on non-admitted pathways, digital pre-assessments will be increased to free up capacity in clinics, more consistent and easier-to-use digital journeys will be provided, and more.
- Support intelligent urgent and emergency care services; collaborative working will be supported to increase integration of primary care with emergency services, with other actions including strengthening NHS111 as an entry point into urgent care and harnessing the power of data for real-time management information.
- Improve digital inclusion; the government plans to build on the expertise of local authority services to increase availability of private, accessible community spaces for digital interactions, encourage hyperlocal connections and approaches to empower individuals through their communities, and target and tailor offers to identified groups facing barriers.
- Promote user-centred design; a range of initiatives will be delivered to ensure that design is an established, recognised and valued approach and profession in the NHS, and understanding/adoption will be built by facilitating access to design expertise and strengthening the design standards expected of suppliers.
- Systematise tech research and development partnerships; actions include convening conversations with venture building and funding experts looking to partner with the NHS, providing funding for ICSs to pilot and build an evidence base for different types of care tech, and providing NHS organisations with guidance on the types of expertise and resources required to become effective at building and scaling new tech.
- Buy tech better; the required standards and assurance procedures will be clarified, contracting methods streamlined, and existing guidance amended and consolidated.
- Build long-term partnerships with suppliers; time and energy will be invested in this at national level, and a central hub created to support ICSs and NHS trusts in doing the same.
- Build a national research infrastructure; a three-year programme of activity will be launched in July 2022 to enhance positive patient and public support through public assemblies, focus groups and more. Other actions include publishing a Value-Sharing Framework, accelerating clinical trial set-up, and developing an England-wide network of trusted research environments.
National digital channels roadmap
Finally, the plan lays out its strategy to extend the functionality and features available through the NHS App and website, sharing an intention to take an “iterative, user-led approach – exploring, testing and refining our offer. Delivery is agile – what we develop depends on what users tell us matters most to them to manage their health, keep them well and get them well.”
The delivery roadmap is organised around the vision to manage health, stay well, and get well.
The plan lays out a timeline indicating what people can expect to see from the app and website, starting from June 2022 through to March 2025 and beyond. To see the timeline, click here and navigate to Appendix B.
That brings us to the end of the new plan – what are your thoughts on it? We will be running a comment piece to gauge reactions on the plan from across the health tech industry, so if you’d like to share your thoughts, please email firstname.lastname@example.org by 6 July.