NHS England’s board met 1 February 2024 with progress around current digital programmes as a topic of discussion; key takeaways include a need to focus public communication on the Federated Data Platform around existing case studies and benefits; a reported rise in AI decision support tools from five percent in 2019 to 90 percent in August 2023; and the possibility of reallocating funding from improvement and transformation programmes in light of financial pressures.
On the topic of financial performance, the board noted that the NHS has “absorbed an almost four percent reduction in funding which is driving significant financial pressure across the service”.
To manage this, the board discussed the possibility of reallocating funding from improvement and transformation programmes as well as reducing investment in technology. Members raised a need to review this “to ensure sufficient focus on technology and digital programmes to establish more efficient processes, support self-managed care, and help transform care delivery across the NHS.”
Federated Data Platform
Dr Vin Diwakar, interim national director for transformation, joined the session to share insights on the current state of the digital portfolio. On the Federated Data Platform (FDP), he stated that pilot adoption sites have shown how “this type of software can help local teams better prioritise waiting lists, manage theatre capacity and identify their staffing needs” and added that the FDP has helped local health and care teams to understand community health and support personalisation and prevention efforts.
He noted that alongside the awarding of the FDP and associated services contract in November, a separate contract has been awarded for privacy enhancing technologies. “Following a highly complex procurement, this service will now enter delivery through Q4 and into the 2024/25 financial year and beyond,” the board states, “delivering significant productivity and other benefits to trusts, building on those seen in the pilot sites.”
Remaining on the topic of the FDP, the board discussed the arrangements in place around data protection and sharing. The impact of individuals opting out of data sharing was discussed, particularly for direct care; the papers note that the board also looked into the current rate of opt outs and discussed planned communication with the public on this topic.
The board considered the next steps planned for the transition to and mobilisation of the FDP and its associated services. An independent “check and challenge” group has been set up with the purpose of defining, supporting and checking the use cases to be taken forward for the FDP; work is also underway within trusts, integrated care boards and wider regions to drive adoption rates and optimise functionality. In particular, the board considered incentives that could be offered to support adoption rates, and noted that workshops are underway to support this.
A takeaway from the discussion is that members requested that the focus of NHSE communications on FDP adoption should be drawn more clearly from existing case studies and evidence of benefits from pilot projects.
Primary care
With regards to the primary care access recovery plan, the launch of the Pharmacy First service – planned for early 2024 – was discussed. NHSE’s national director for primary care and community services Amanda Doyle, alongside chief pharmaceutical officer for England David Webb, made a report on this topic; they shared that 9,918 pharmacies had signed up as of mid-January, reported to be over 92 percent of all pharmacies in England. Doyle and Webb shared their confidence that IT system suppliers “will have the digital infrastructure ready for the Pharmacy First service launch, sharing that investment is being made to “significantly improve the digital infrastructure connecting general practice and community pharmacy to streamline referrals, increase access to more parts of the GP patient record, and improve how GP records are updated following pharmacy consultations.”
They added that their team is working alongside general practice and pharmacy IT system suppliers to update clinical systems in order to support the launch of Pharmacy First, sharing that throughout February, pharmacies are to become “the first care setting in the NHS to be able to send structured updates into general practice”. These will “arrive seamlessly into workflows for review before being automatically filed into the patient record,” the report says, which is expected to save “significant time” for general practice teams. In addition, suppliers are receiving support to develop capabilities around sending GP referrals directly into community pharmacy workflows; and NHS Pathways is to upgrade the clinical triage system to send electronic referrals from NHS 111 and urgent and emergency care settings to community pharmacy where appropriate.
Also on primary care, the board heard from Dr Diwakar how, as of December 2023, 68 percent of practices (599) working with the modernising primary care team have signed contracts with a cloud based telephony supplier, as part of the move from analogue to digital outlined in the primary care access recovery plan.
Looking at the digital registration service, the board share that 2,249 GP practices are currently using the digital registration service – exceeding the national target for 2,000 practices to be using the service by December 2023. Additionally, over 640,000 patients have used the service, and practices “have reported increased list sizes”, with data indicating “increased registrations from patient groups that we traditionally find it difficult to provide services to.”
Digital records
On digitised health and care records, Dr Diwakar shared a number of achievements, including highlighting how “evidence from EPR implementations over the last seven years shows that introducing EPRs led to a 3.5 percentage point reduction in average sepsis mortality for surgical inpatients”. Additionally, he noted that through the urgent and emergency care recovery plan, NHSE has installed digital smart system control systems to support integrated care systems in using data to respond to emerging challenges, to deploy ambulances during surge pressures, to optimise discharge and to identify hospitals in need of extra support.
The papers state that NHSE has invested over £400 million to date to support 150 trusts in implementing, optimising, extending or replacing EPRs, with 189 now having a “modern” system. Dr Diwakar also commented on how the frontline digitisation programme achieved the target for 90 percent of trusts to adopt electronic patient record systems on schedule, previously covered by HTN here.
On a related note around data, NHSE highlights how 91 percent of trusts are now submitting data to the Faster Data Flows system, which the board says will “reduce the administrative burden on providers by improving the way data is submitted to commissioners.”
NHS App
Speaking on the NHS App, the board heard that 33.6 million adults in England have downloaded the NHS App, with monthly logins rising by 53 percent from 14.8 million users in December 2022 to 25.8 million logins in November 2023.
The board states that NHS App messaging is now available for 97 percent of GP practices, with 52 million messages sent via the app in 2023. The NHS also reports that 24 percent of appointments for COVID-19 and flu vaccinations were booked via the app by the end of November, and four millions secondary care appointments were viewed and managed using the NHS App in December 2023, which the papers refer to as “approximately three-fold increase” since the previous December. On future plans, Dr Diwakar commented on a new feature which will allow users to generate a barcode for one-off prescriptions, which can be shown at any pharmacy without the need for a paper prescription.
Research and development data
Here, the board comment that patients are “receiving faster more personalised treatment that meets their needs through the NHS Research Secure Data Environment (SDE) Network”, sharing an example from the London SDE which has approved researchers validate and deploy predictive artificial intelligence models on a large scale.
Additionally, the NHS England SDE is “providing better access to more researchers and life science companies,” the papers note, with eight organisations currently onboarded covering 284 users and 55 research projects.
The board calls AI “one of the biggest opportunities to transform care for the better”, and add that 17 AI studies are already underway in the NHS Research SDE Network.
Artificial intelligence
Moving on to other updates in the area of AI, the board heard how the NHSE England AI Lab, in collaboration with the Department of Health and Education, is working on programmes including the AI in Health and Care Awards, which has awarded over £123 million to 86 organisations with the aim of developing, trialing and evaluating AI products “most likely to meet the aims set out in the NHS Long Term Plan”. The AI Lab has also provided funding for several regulatory projects designed to create a “robust and streamlined regulatory system”.
There is also the AI Ethics Initiative, which has been set up to support research and practical interventions with the potential to strengthen ethical adoption of AI technologies in healthcare.
Other work in this area includes supporting the £21 million AI Diagnostic Fund; trialling AI diagnostic support tools for dermatology; implementing the AI Deployment Platform across two imaging networks; and supporting the roll-out of AI across stroke networks, with use of AI decisions support tools rising from five percent in 2019 to a reported 90 percent in August 2023.
Public engagement with digital
On this topic, the board shares that the #PoweredByNHS data campaign has “completed a successful pilot, showcasing the ways that secure use of data transforms research and leads to positive, real-world outcomes”; the figures indicate that one in 10 people in England have viewed at least one of the campaign videos all the way through.
Whilst there is “some evidence” in favour of public support for specific uses of data, such as direct care, NHSE emphasises that “continued dialogue with the public as we take forward specific data programmes and policy changes and programmes is key.”
The papers include a reminder that up to £2 million in funding has been allocated for the delivery of “large-scale deliberative public engagement over 2024 and 2025“.
NHS Spine
Finally, the board draws attention to NHS Spine, stating that it is now “running fully on the cloud” and has seen a 50 percent improvement in performance.
Looking ahead
Dr Diwakar’s report concludes by pointing out the “further opportunity to make the most of the investment into transformed community mental health services” posed by the formation of ICSs, and calls for the role of VCSE organisations to be strengthened as key partners.
He adds that NHSE expects to see “significant expansion in access to transformed models of care” in the final year of the NHS long-term plan, but that transformation must continue beyond 2024 in order to “continue to reduce the historical treatment gap” for adults with severe mental illness.
The board papers can be found in full here.
