Successful modernisation of the NHS depends largely on its ability to digitise its operations. It can be done, but training and education will be key. By Ara Darzi
Professor Ted Baker, the CQC’s new chief inspector of hospitals, recently declared that the NHS was “not fit for the 21st century”. He was criticising unsafe practices in A&E departments and an outdated model of care that still drives a wedge between medical and social provision.
But a key factor in the NHS’s inability to modernise is its persistent failure to join the digital revolution.
A decade or more after banks, airlines and supermarkets introduced electronic transactions, hospital patients still receive notice of their next appointment by post, a process that is slow, laborious, error-prone – and costly. Some NHS trusts are spending £1million a year on postage alone.
Pressing the right buttons
We know digitising the NHS can be done. The primary care programme has been a huge success. More than 98 per cent of GP surgeries have electronic medical records, and patients are now able to access their records, make appointments and order prescriptions online.
Digitising the hospital sector has proved a bigger challenge. Yet we know this can be done, too. The US has made much greater progress than we have, despite lacking our national system.
One area where we have had success is in the digitisation of imaging. In place of the old, heavy, inflexible films, we can now upload an image, zoom in and out, change the penetration, measure the size of the tumour and share it, all at the touch of a button. The functionality, and consequently the care we provide to our patients, has improved enormously.
Just installing computers won’t work. We need a major effort to place well-qualified staff with advanced informatics training in every trust.
So what must we do? The report by the American clinician – informatician, Professor Bob Wachter, “Making IT work: Harnessing the power of health information technology to improve care in England,” published in September 2016, pointed the way forward.
“Just installing computers” did not work, Prof Wachter observed. We need “a major effort” to place well-qualified staff with advanced informatics training in every trust. “It is not just about the technology, it is about the people too,” he said.
To meet this challenge, the Institute of Global Health Innovation has been commissioned by NHS England to establish the first NHS Digital Academy, to train aspiring digital leaders from across the NHS. Details will be revealed at the Sowerby eHealth Symposium in London next week (12 OCT) and applications will open in November. The 12 month, part-time courses will be delivered mainly online, but with a residential component and workplace project.
The academy, headed by Rachel Dunscombe, Director of Digital for Salford Royal Group, will train 300 Chief Clinical Information Officers (CCIOs), Chief Information Officers (CIOs) and aspirant digital leaders from health and social care organisations across the country over the first three years.
Currently, these roles remain ill-defined, dependent on local context and filled by aspiring digital health leaders who may have been granted half a day a week to pursue their interest.
We aim to develop a self-sustaining community of digital leaders in authoritative positions across health and social care
That is not the way to drive change. Informatics must develop from its current status as a part-time, non-vocational activity to a fully professional pathway with training, standards and accreditation.
We aim to develop a self-sustaining community of digital leaders in authoritative positions across health and social care, with the skills and the autonomy to make strategic decisions and manage transformational change.
Participants will cover issues including leadership and management, public attitudes to the sharing of data, inter-operability of health systems, responding to user needs and artificial intelligence.
The training will be delivered by a consortium, led by IGHI with the University of Edinburgh, Harvard Medical School and Imperial College Healthcare NHS Trust (ICHNT). Together we provide expertise in blended learning, health informatics, leadership development and transformation programmes.
Looking further afield
In the US, respected universities and healthcare organisations have increased the number of informatics fellowships by over 50 per cent since 2009, expanded their health informatics capability, and substantially increased the number of senior leadership positions in informatics and digital transformation. We need to better that.
Participants will be encouraged to showcase their work on an international stage at the World Innovation Summit for Health (WISH), held biannually in Doha, Qatar, organised by Qatar Foundation in conjunction with the IGHI. Alumni will receive ongoing support, forging strong connections with an elite network of digital leaders.
The last attempt to digitise the NHS hospital sector – the National Programme for Information Technology (NPfIT), launched in 2002 – was shut down in 2011, having mostly failed to achieve its goals. The programme was criticised for being too centralised, for not engaging with trusts and with healthcare professionals, and for trying to accomplish too much too quickly.
The lesson of that failure is that clinical credibility is essential. Clinical informatics leaders must have front line patient experience, they must have the vision to see what digitisation can offer and they must be capable of carrying colleagues with them. Leadership in informatics must now be given the same priority as in other branches of medicine.
The Sowerby eSymposium will be held at BMA House, Tavistock Square, London WC1H 9JP, from 08.45 to 13.30