The NHS Long Term Plan and NHSX
Richard Strong, Allscripts vice president and managing director EMEA, reflects on the NHS Long Term Plan and developments such as NHSX that give some indication of how its tech elements will be implemented. A lot is still unknown, but the direction of travel is positive, he argues.
The NHS Long Term Plan was published at the start of January. It’s a long document, and when it came out, the reaction I heard was that it was not really a plan, but a series of projects.
The plan covers everything from a commitment to return the NHS to financial balance, to proposals to reorganise the way it commissions and delivers services, and from multi-million pound projects to improve mental health, cancer services and primary care, to outline proposals for a “digital first” offer for patients.
Unusually for this type of document, there is also a chapter on technology. This recognises the need to complete the digitisation of hospitals and to create integrated health and care records at a regional level, so that health and care teams can work together more effectively.
Chapter five also talks about how to give patients access to those records and transactional services through the NHS App, and about generating the data that will be needed for population health management and precision medicine in the future.
So, chapter five, on its own, sets out a huge agenda: but it was encouraging to see the health service recognising that it needs a new service model for the 21st century, which it will not be possible to create without making full use of digital technology.
Ending reliance on outdated technologies
Since the plan was published, there have been some significant developments. England’s health and social care secretary, Matt Hancock, has issued a series of statements urging NHS organisations to remove outdated technology from their workflows.
Over the course of a few weekends, he has ‘banned’ fax machines and pagers, and has encouraged the NHS to stop sending letters and to start using email instead. Some of these ideas are not new: digital ‘tsar’, Tim Kelsey, called for “bonfire of the faxes” a few years ago.
There are also some subtleties around moving from snail mail to email, which isn’t part of the patient record and isn’t structured or coded. Rather than using email, I’d like to see the NHS publishing letters through a solution like Allscripts’ FollowMyHealth or HealthGrid, and for the letters to be created as part of the clinical workflow.
But it was good to see Matt Hancock following through on the fax ban and trying to inject some urgency into the health tech agenda.
NHSX created to shake-up the centre
The other significant development is the creation of NHSX. There seems to be a lot of uncertainty about how this will operate, however the appointment of Matthew Gould as CEO along with publication of more information on the remit of NHSX is encouraging.
The early signs are that NHSX will have a wide range of responsibilities. Everything from setting standards to driving the adoption of open systems and from sorting out procurement to improving training and uptake have been mentioned.
These are all areas in which action is needed but, again, there are some subtleties. To take just example, we are very committed to open standards and open systems at Allscripts, but to be effective standards need to be set in collaboration with industry and to be set globally. They also need to be adopted.
For example, the use of the NHS Number has been mandated for more than a decade, but it is still not used as the primary identifier for patients in all systems. If NHSX is able to engage with suppliers, adopt global standards, and drive take-up locally, it could make a real difference.
Right agenda, action needed
What we don’t know at the moment is what the market reaction to the NHS Long Term Plan is going to be. The plan talks about digitising hospitals by extending the global digital exemplar programme, and at Allscripts we welcome that.
Our partner, Salford Royal NHS Foundation Trust, has said its work on the GDE programme “is saving lives”, so we want other trusts to benefit from the approach. Even when an extension is announced, though, it is likely that many trusts will remain outside it.
That is why we have developed our ‘clinical wrap’ strategy to enable trusts to digitise without scrapping their existing systems. We are talking to a significant number of organisations about how it can help them; they are digesting the plan and what it means for their strategies.
Similarly, we are talking to some of the NHS new, integration and transformation bodies about dbMotion, and about how they can really get to grips with population health. A lot of the money that has been directed towards this agenda has gone on projects that already exist, and we’d like to see some bolder thinking.
There’s also an infrastructure piece to get in place. The good news is that the NHS Long Term Plan recognises that action is needed and that the outlines of an implementation approach are starting to emerge. I’m hopeful that this will give a real boost to the NHS digital agenda; and enable Allscripts to play a full role in that.