Why digital representation is needed for a sustainable NHS transformation

Digital representation on NHS boards is something which many IT leaders have campaigned for. Paul Richards, a non-executive director at Torbay and South Devon NHS Foundation Trust, explores how it could help with building sustainable transformation across the NHS

CREDIT: This is an edited version of an article that originally appeared on The BMJ

Since COVID-19 the NHS has been at a major pivot-point; it can’t afford to provide services in the way it has done before and the expectations of citizens and patients have shifted. This is due to the increasing cost in the technology of providing healthcare — not just in terms of digital IT systems, but also the cost of medical equipment, therapies and drug regimes. There is so much the NHS is now expected to provide; we need to find new ways of doing this.

Increasingly, from a Department of Health and Social Care, NHSE and NHS central perspective, there is a view that digital has a huge part to play in this. This necessitates that NHS trust boards must quickly come up to speed with what it means to be providing digital services, and what it takes in terms of investment, resources, people and money to have a platform shift in healthcare — away from buildings, and towards technology-based, digital platforms.

To aid in this, NHS Providers, Health Education England, NHSX and Public Digital have partnered up to deliver a digital boards programme, aiming to build board level understanding of the digital transformation agenda, it’s potential and implications; it is important to implement this from a holistic health system perspective, as well as on an individual, care facility-centric scale.

Effective and sustainable strategy

This training needs to happen at board level because, for a long time, innovation has been driven by research, clinicians and people with specialist interests. There have always been solutions available at this level but, in order to properly and effectively set sustainable strategy, decide on implementation and assess business cases for clinical technology, boards need to become digitally literate.

As part of my portfolio I am non-executive director at Torbay and South Devon, which is an integrated care organisation, operating within an ICS known as Devon STP. I think there is a huge opportunity here for better, more joined-up care across councils, health, social care and other care providers. This kind of synergy would mean that, suddenly, healthcare becomes the seamless service that citizens always expected – but never quite got; with a proper digital approach, the joins across and within providers should become seamless.

The ultimate aim of digital boards is to move towards delivering digital healthcare on a wider scale. To do this, first and foremost, all staff — especially senior staff — need to understand that they should be planning for digital-first. Hospitals are no longer at the centre of the way in which digital care is provided, and are increasingly becoming more of a component. Meanwhile, we are seeing health and wellbeing centres become more prevalent, and beginning to provide a wider range of services.

Working around patients

To add to this, the public are expecting more from the NHS so that they can get access to services around their working hours. Increasingly, people want to avoid having to go to hospital, or attend an appointment between nine and five – they want care in a time and way that suits them. People from all walks of life now expect that they won’t have to take a bus, leave home – and any potentially dependent relatives alone – to attend a non-emergency appointment.

In response to this demand we have seen exciting innovations from companies like Babylon – with their GP at Hand solution allowing appointments with a clinician at any time of the day or night – LIVI – with a similar service in partnership with Boots-  and other innovations that are just taking flight. There is a public expectation now that, just as we can book tickets, hotels, flights and other services online, access to hospital and healthcare services should be available online too.

The NHS has, however, had a chequered history in terms of the adoption of tech. This is mainly a result of the fact that boards, and the wider organisation, haven’t anticipated the amount of commitment they need to make in order to transform the way that they work. The transformation agenda is vital for this; you can’t just throw a system over the wall and expect it to work. A lot of preparation needs to take place, as well as proper and effective programme management. I think that the NHS needs to employ more professional programme management expertise,  with knowledge of systems integrations and services, which can ensure that the patient flow is seamless from being a citizen, through to being a patient, and back to being a citizen again.

This is also important for those with long term conditions, ensuring that the services delivered are causing the least possible interruption to their lives, and enabling them to get access to the correct wellness services and care plans they need to follow, through health, social care and other care providers.

Lessons learnt

There have been a number of lessons learnt as part of COVID-19 on this front; perhaps the most prevalent is that nothing will ever be the same again. COVID has been a major disruptor in enabling those in healthcare to think up and develop new ways of providing services, and there has certainly been a different approach towards information governance and gaining quick agreement on which information can be collected and shared – a concept that most NHS organisations have been struggling with for decades.

If nothing else, COVID has certainly meant that, at roughly five pm. each evening, the public have suddenly become very interested in NHS data and NHS information. Who’d have thought we’d all be sitting around looking at pie charts and graphs, considering whether or not this information is accurate, or if it has been collected properly, whilst considering the relative merits of the research and data being used.

There has been a wave of discussions on data; COVID-19 has actually taken the public to a new found level of literacy around information and data, and this has heightened expectations around digital and digital services – so, this is an excellent time to be considering how to address healthcare in a totally different way.

Shifting the agenda

I think it’s fabulous that NHS Providers, Health Education England and NHSX have launched digital boards as an initiative, and are providing support to the varying levels of expertise within NHS trust boards to enable this shift.

As with most things concerning the transformation agenda, there are those trusts that are not quite ready, and those that are incredibly advanced. More integration between health and social care needs to take place in order for this to happen – with the rise of STPS and ICSs – and it’s important that we all learn how to work with county councils, district councils and local authorities, as well as across the NHS and care sector.

At the heart of this, it needs to be understood that patient data, records and information belong to the patient, and we should never forget that. Boards must put in place the right levels of governance and security around its data and digital security.

It is important that boards are in constant touch with patient representative organisations, and the patients themselves, to make sure that we’re taking their needs into account, and acknowledging the growing expectation that individuals want to collect their own data around health and wellness.

Clinicians need to gain the confidence to utilise that data, use remote monitoring and testing devices in the home, and not waste NHS resources by repeating those tests in order that they are ‘official.’ It’s absolutely vital that we take patients and citizens along with us on this journey and that we ensure we are only using the data for agreed purposes, as explained to patients from the outset, so that they can have the confidence to be active participants in this new digital care system.