The government has published its independent investigation into the NHS in England, following health and social care secretary Wes Streeting’s order of a full independent investigation earlier in the summer with the aim of exposing the “extent of the issues” facing the NHS.
Professor Lord Darzi was selected to lead the report and has considered available data and intelligence in order to assess patient access, quality of healthcare provision and overall performance of the NHS. Here, HTN explore the findings and implications around digital and data.
The report outlines key findings including that the NHS “has been starved of capital”, with the capital budget repeatedly used to fill holes in day-to-day spending. Lord Darzi notes outdated buildings and impacted productivity as a result with “outdated scanners, too little automation, and parts of the NHS [that] are yet to enter the digital era”. Over the past 15 years, whilst other sectors have been “radically reshaped” by digital technologies, Lord Darzi states that the NHS is “in the foothills of digital transformation” and highlights the last decade in particular as a missed opportunity to prepare the NHS for the future by embracing technology and its ability to support a pivot from a ‘diagnose and treat’ model to one focused on prediction and prevention.
Also on funding, the report states that the health service as a whole, as well as individual trusts, lacks the authority to decide how NHS budget is divided, impacting on investment in digital technology and buildings.
Lord Darzi reflects that “important themes” have emerged from the report with regards to how the NHS can be repaired, which will require consideration alongside strategies to improve the nation’s health and reforms to social care. A “tilt towards technology” is one of these themes, with Lord Darzi stating that a major tilt is needed towards tech in order to unlock productivity. In particular, he notes high numbers of NHS staff working outside hospitals who “urgently need the benefits of digital systems”, and recognises the “enormous potential of AI to transform care and for life sciences breakthroughs to create new treatments”.
Focusing specifically on technology, Lord Darzi reflects that the NHS “continues to struggle to fully realise the benefits of information technology” and “always seems to add to the workload of clinicians rather than releasing more time to care”. Additionally, the richness of NHS data is “largely untapped” for clinical care, service planning and research, the NHS struggles with data-sharing, and digital maturity is reported to still be low across much of the NHS.
The report acknowledges significant investments such as the federated data platform and examples of start-ups committing to improving healthcare quality and efficiency, but comments that “too many of these remain subscale”.
Additionally, investment in IT focuses largely on acute hospitals rather than other providers, with technology platforms that have existed in the private sector for more than 15 years such as automated route planning “rarely found in the NHS”. Lord Darzi stresses that there are many technologies with the potential to support community care, but they are “largely absent”, and adds that with the shift in disease burden towards long-term conditions, there is a “greater need for information systems that work across different settings”.
In common with community services, the report adds, there has been underinvestment in technology with the potential to improve mental health community teams. Research indicates that productivity in this area has not dropped, but Lord Darzi comments that it was not “likely to be high to begin with, given the poor use of technology and the absence of sufficient management information to drive up performance”.
Additionally, Lord Darzi explores issues with patient flow from emergency departments due to a number of factors including capacity of the departments themselves; workforce and physical space; availability and speed of diagnostics; and availability of beds for admission. He emphasises that this is the result of intersection of high levels of demand, often caused by lack of investment in the community, as well as “chronic capital underinvestment in both facilities and technology” alongside operational planning and management issues.
On AI, the report suggests that we are “on the precipice of an artificial intelligence revolution that could transform care for patients” and highlights a submission from the Royal College of Radiologists indicating that 56 percent of NHS trusts are already using AI within radiology. In order to capture the benefits afforded by AI more widely, Lord Darzi repeats the need for a fundamental shift towards tech.
With regards to access to NHS services, Lord Darzi brings attention to the concept of the digital front door and comments that whilst the pandemic led to a rapid increase in registrations for the NHS App with nearly 80 percent of adults registered, less than 20 percent are reported to use it on a monthly basis. He states that the app is not delivering a ‘digital-first’ experience similar to that found in other aspects of daily life, noting that “just one percent of GP appointments are managed via the app” – however, he also notes the “huge potential”, calling on the App to improve both efficiency and patient experience.
Looking at changes in the population and strategic priorities for service change in the NHS, Lord Darzi notes that the fundamental driver of change in healthcare provision is change in the needs of the population, with a need to better plan interventions based on strong evidence; integrate care; and place more focus on community care. A challenge here is availability of resources to provide high-quality, multidisciplinary care, including modern facilities, digital infrastructure and supporting diagnostics as well as the right professionals with the right skills. The report calls for a shift in the distribution of resources towards community-based primary, community and mental health services, pointing to research from NHS Confederation which indicates that “on average, systems that invested more in community care saw 15 per cent lower nonelective admission rates and 10 per cent lower ambulance conveyance rates together with lower average activity for elective admissions and A&E attendances”. On access to community services, the report points out that proper assessment is hampered by lack of data, with information on the total waiting list size only available from 2022.
The report draws focus to the wide variations in performance by providers within the same settings, with “plenty of scope for improvement in many organisations”. Many of the productivity problems in the NHS are caused by interaction between different parts of the system, Lord Darzi reflects. Using congestion in acute hospitals as an example, he writes that the “only sustainable solution” here is to “build up the capacity, capability, infrastructure and technology base of care that is delivered in the community, including general practice, community services and mental health services”.
When it comes to resources and productivity of general practice in particular, Lord Darzi acknowledges the wide array of challenges in this space and comments that “some GP practices have embraced extraordinary innovations” in the face of this, including shifting towards a digital model, introducing “impressive” approaches to triage, and boosting responsiveness to patients. “I saw some remarkable examples of local innovations that were improving access and quality of care,” Lord Darzi writes, “while also relieving pressures on acute hospitals.”
On the role of digital around inequalities in health and care, the report highlights a survey of Faculty for Homeless and Inclusion Health members which found that health services are “very difficult for inclusion health patients to access”, with concerns raised around digital exclusion in particular.
Moving on to look at staff attitudes, the report highlights that many staff feel disempowered and disengaged; research for the investigation found that the top three words NHS staff used to describe their experiences were ‘challenging’, ‘tiring’ and ‘frustrating’. Again, chronic underinvestment is raised into processes and infrastructure. “While the evidence shows that health information technology improves care, the National Audit Office found that the NHS track record on digital transformation had been poor,” Lord Darzi writes. Focus groups undertaken for the purpose of the report found a “strong perception” among staff that IT creates an additional burden. This, alongside poor definition of operational processes, are believed to be “at the heart of the feelings of disempowerment and disengagement”.
Click here to access Lord Darzi’s report in full.
Other news from the government
At the start of the month HTN highlighted that The Department of Health and Social Care has selected Norfolk County Council, Medway Council and Lambeth Council as test sites for the digital NHS Health Check, with the platform to be trialled with a small number of patients in early 2025.
In July we reported how five new quantum research hubs are to be launched in the UK with an investment of £100 million, tasked with developing quantum technology for industries including healthcare.
