2020 vision: digital efficiency and innovation in the NHS

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Every year our Digital Health and Care Congress brings together a diverse group of people, united by an interest in digital health, to share and discuss the ways that digital products and services are changing and improving health systems. This year's congress was sold out yet again, demonstrating the huge interest in this area.

Among the many fascinating talks and discussions, I want to highlight a couple of important announcements that are very relevant as the NHS races to meet two prominent policy commitments by 2020: to achieve an unprecedented £22 billion of productivity savings, and to make all patient records digital and accessible in real time across all settings for patients and staff.

First, the top-down view. At the National Information Board’s leadership meeting, held at the Fund at the same time as the congress, there was a notable new focus on the contribution that better use of information and technology can make to the £22 billion productivity challenge. For the first time, chair Tim Kelsey shared the board's estimate of that contribution, saying that digital efficiency and innovation could make around a third of the savings required (up to £8.3 billion in total). This eye-catching figure is supposed to come from the role technology is expected to play in enabling many of the ambitious reforms and new models of care outlined in the NHS five year forward view.

The credibility of this top-down estimate will be tested in the coming months, as the board works to join it up with any savings realised from work on the ground. In future, expect to see a lot more emphasis on how technology can save money as well as improve the quality of care for patients, an assumption that has been questioned in the past.

Tim Kelsey also trumpeted the progress that the NHS has already made in some areas. For example, nearly all GPs (97 per cent) now offer patients online appointment booking, repeat prescriptions and access to summaries of their records. That's up from just 3 per cent a year ago. But while the technical capabilities are now in place, they are not always easy to use. The challenge is to make these channels as routine to use as others, like phoning or dropping in to a GP surgery. GPs and their suppliers would do well to learn and spread lessons from design-thinking to improve the ways these systems operate and fit into patients' lives – seeking and harnessing user feedback to continuously improve the experience, making it easy to use. The same will be true for the many new uses of technology and data due to be introduced before 2020 for both staff and patients.

The second announcement I want to consider comes from the local level, but it could have system-wide impact too. Rob Kenyon and Tony Shannon shared the achievements to date of the Leeds Care Record – a single patient record shared by multiple NHS organisations, GPs and the local council in Leeds.

They invited other areas to join their ‘Ripple’ programme to work together to understand how an NHS with a single record can be achieved across the system, not just in Leeds. Ripple will develop and document a set of open tools, systems architecture, the governance and the ways people can use it. The team plans to make this all open source, publishing it freely and allowing its reuse; a gift to the rest of the NHS and its patients.

So what are the benefits of using an open-source model? One benefit is that anyone can use or adapt the code for their particular application without having to buy it and without being locked in to an individual software supplier. Open source is most commonly used to develop software but can apply to the design and production processes for any product or service. You are benefiting from this approach right now, as the server sending you this blog runs on open-source software. Open source is a model that has struggled to gain traction in the NHS; its advocates blame ‘vendor lock in’ to proprietary platforms, its critics claim it lacks a viable business model without ownership. But now that could change. The Leeds team’s ambition is that the NHS benefits from an approach that helps new innovators to build on the work of others, instead of starting from scratch or buying into proprietary platforms.

Though it’s early days, the Leeds Care Record is an example of innovation from within the NHS. And this is the sort of innovation that needs to be spread, sharing the lessons and tools for replicating it; something Leeds hope to achieve with its new community. Along with strategy and standards set from above by the National Information Board, this is the kind of change from within needed to meet the challenges for 2020.



Comment date
01 July 2015
Tim Kelsey may want to mislead the public by saying " nearly all GPs (97 per cent) now offer patients online appointment booking, repeat prescriptions and access to summaries of their records" but the article below says "and/or", which seems much more likely to me. Can you check your facts and correct your article, and perhaps mention this error to Tim Kelsey?

Mervyn Fernandez

Internet Consultant,
Comment date
27 June 2015
"make all patient records digital and accessible in real time across all settings for patients and staff." This is dangerous. Technically easy but in an age of cyber warfare this is a minefield. If this approach is set in stone then you need to employ a team of hackers to undermine everything you do - you'll soon loose the will to live!!

Harry Longman

Chief Executive,
GP Access Ltd
Comment date
25 June 2015
97% of GPs offering online booking of appointments is all very well, but how does it save time for GPs? This is what we need to do to make those savings.
The problem is that around 60% of patients in front of a GP don't need to be there, ie they could have been dealt with remotely and in much less time, making a real difference to efficiency.
To do that needs the ability to seek help online, and receive it quickly, which may be an appointment but may not be in most cases. 97% switching to that online channel would be truly game changing for the NHS.

David Physick

Global Business Development,
Comment date
25 June 2015
Where does a truly effective learning and development program fit in to the £22bn "productivity challenge"? Firstly, turn that on its head. It's not that just more needs to be done, i.e. being more efficient, but that more needs to be done right first time, every time, i.e. being more effective. That old saw from the 1980s Quality movement remains as true today as it was 30 years' ago.

However, in times of focus on productivity and getting more down, an often first casualty is training - we can't afford that or we can't afford to let you have the time to go on that course.

The development of virtual reality environments on various platforms allow powerful training interventions to occur without the need for anyone to travel. A whole range of skills and behaviours can be taught synchronously to groups and asynchronously to individuals. The advent of VR headsets and "wearables" will allow still more to be done.

As in the £22bn challenge itself, the critical issue is that the learning and development is pedagogically effective. That is people acquire new knowledge, assimilate it and subsequently apply it to improve the patient experience. Training that is not so effective squanders money.

And, how is training, learning and development managed by NHS leaders. Again, are old principles exercised in terms of identifying a need, determining the best learning solution, explaining why it is being made available and what is expected as a result of doing that training and then tracking that something positive has materialised in performance.

Here is an example of an experiment undertaken with Brian Smith during his tenure of Head of Technology Enhanced Learning at Edge Hill University. Brian is now at Cogent Skills, an organisation committed to developing skills development in the UK science sector, including health - see https://www.youtube.com/watch?v=QboHO80tddQ In terms of creating multi-discipline training events covering different parts of NHS and Social Care, this initiative at Horry Georgetown Technical College in South Carolina demonstrates what can be accomplished over time through virtual engagement - https://www.youtube.com/watch?v=kMks-mZNivs

As in most things, it is the marriage of proven principles from the past with modern technology that will deliver the optimal outcome.

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