By Steve Brain – Executive Director, Health & Care at Civica
The NHS has faced mounting problems driven by years of austerity, budget cuts and uncertainty around Brexit, leaving its resources stretched. The escalating pressure of the Coronavirus crisis has added an urgent crunch to these long-term concerns, potentially maxing out the organisation’s limited reserves. The necessary bureaucracy of such a large and complex organisation is a challenge in itself, and makes it difficult to deliver the innovation projects the service so desperately needs.
In his recent budget, Chancellor Rishi Sunak promised to give the NHS “whatever it needs” to tackle the coronavirus crisis, but even when the crisis ends, the long-term challenges facing the organisation will remain – and will be even more urgent.
Calling for innovation in the NHS has become a truism but it is still an urgent priority. Following extensive consultation, NHS England and NHS Improvement have recommended the introduction of a Health Service Bill, which could be the catalyst needed for significant reform. This introduces a new NHS ‘triple aim’ for better population health, better quality of patient care, and financially sustainable services. It also streamlines operations by merging NHS England and NHS Improvement to create a single leadership body, combining their respective responsibilities for performance, finance and care transformation.
The broader push for innovation was also evident in Matt Hancock’s recent vow to “double down on the tech agenda and bring the NHS into the 21st Century”. The tools for innovation are available, the desire is there, and all that is standing in our way is execution.
The fourth pillar; improving the health sector’s workforce experience
The triple aims put forward by the NHS are noteworthy, but putting the system on a sustainable footing requires an additional emphasis on workers’ experience. The NHS has long been the destination for the best and brightest from Britain and beyond, and these ambitious graduates do not want to arrive in a world of analogue, obsolete processes.
The knee-jerk reaction from many technophiles is to overhaul everything, but digital transformation for its own sake is not innovation. Commissioning perceived lengthy IT transformations which could cause disruption to operations for a potential improvement in the medium-term is not an option for an organisation that deals with life and death consequences on a daily basis.
Technology should not be seen as the answer to, ‘How can we carry out old processes better?’ but rather as a means to answer, ‘Why do we want to carry out old processes better?’. Digitising paper use, for example, is a useful first step to replace back end processes, while allowing more sweeping overhauls in the medium-term without creating disruption.
Prioritising workforce experience will enable the NHS to continue to attract top talent, while improving operational efficiency and eliminating bureaucratic bottlenecks.
Reducing siloes and improving the workforce experience
The size of the NHS, coupled with the sensitivity of the data it holds, has inevitably led to the creation of data siloes. These have historically prevented widespread analysis of data. In this era of data-driven, personalised insights, the NHS’s scale can become an advantage if we are able to truly unlock its data.
This is an operational problem at a local and national level. Locally, NHS trusts are hamstrung by legacy operations that often include storing and transporting vast quantities of paper, while nationally these same trusts will not share data to improve processes on a wider scale. Addressing this will require high-level intervention and a change in the incentives of senior management when it comes to data storage and sharing.
Obsolete technology such as fax machines are still used across the NHS, causing additional workload and preventing centralised data analysis. Rather than replacing these processes completely, the NHS needs to digitise them and encourage more efficient data transfer and storage. Open, interoperable systems are a way to save money on administration while enabling the use of advanced medical technology.
The board leading on innovation
The need for technological innovation has moved beyond operations to become a strategic concern. Any reforms comprehensive enough to drive the change our NHS needs will ultimately have to come from the board.
NHS organisations must first ensure a strong clinical leadership, bringing a Chief Clinical Information Officer (CCIO) onto the board, and making sure the digital transformation agenda is led from the top down. It is also important that this member does not shoulder the burden of the digital agenda entirely, rather this needs to be distributed across the entire Trust.
Too often procurement departments and organisations as a whole look to innovations to produce short-term, cash-releasing savings, rather than identifying where innovations can transform care pathways and lead to more efficient services. Transforming the NHS must be a long-term project that incorporates the organisation’s urgent operational needs, the privacy requirements of patients and the heritage and culture of this great British institution.