Will NHS.UK be the next GOV.UK?

When Jon Rouse presented his part of the plans to improve digital services for the health and care sector at the National Information Board meeting in June he focused on just one thing:

Our number one priority is that we create a single portal. All services [will] start and end with that single portal. Services are developed against consistent standards, with a consistent look and offer, and can be all accessed through that single portal with customers coming in through multiple channels. I haven’t got time to talk about the rest.

In other words, NHS.UK – currently NHS Choices – will be the place we go, not just for information about health and local services, but to book appointments, manage repeat prescriptions and (eventually) access health records and care plans. 

It’s an ambitious plan, to be sure, but it’s also the only plan. We live in a world where we can bank and shop online, claim carer’s allowance and renew our passports with ease, whether we are using a smartphone, tablet or PC. Countless transactions involving important, sensitive data are carried out every day but the NHS is still predominantly paper-based, and where it does provide digital services these are of variable quality.

It’s no longer enough just to have a website. Your website needs to work across multiple devices and browsers, it must be tested by real people to make sure they can actually use it, it has to be secure and reliable, and it needs continuous investment to keep it that way. 

Currently, only a quarter of NHS acute trust websites are designed to work on mobile devices, even though smartphones are the most important device for internet access. Similarly, 97 per cent of the population may now be able to book GP appointments or access medical records online but if their experience was anything like mine they will have to request a username by phone or post and pick up the confirmation letter in person, the appointment form won’t work on their smartphone and they’ll find that the practice’s computer system has gone down.

It’s no surprise that this is the case; hospitals and GP practices are not digital specialists, nor should they be – their primary concern is to provide high-quality care to their local populations. NHS digital teams up and down the country lack the resources to deliver quality digital services. Giving them all hundreds of thousands of pounds to build or procure digital services is not sustainable. Handing this responsibility for digital services to a central body with the necessary expertise and resources could be. 

The situation was similar in central government. Until recently, there were thousands of central government websites run by dozens of different teams. Few provided anything more than basic information and PDFs to download, and where they did offer more advanced tools these were of variable quality. 

The picture now is quite different. Since the Government Digital Service (GDS) was set up in 2011 more than 1,800 separate websites have been closed and hundreds of departments, agencies and public bodies moved over to GOV.UK. Eight hundred digital services, from renewing patents to booking prison visits, are now processing 1.73 billion transactions a year. All services are now required to meet strict standards for user research, evidence-based design and ongoing improvement. By scrutinising digital and IT spend across government, moving websites to GOV.UK and transforming online services, GDS is improving the quality of services and saving money at the same time: £1.7 billion savings from digital and technology related activities in 2014/15. This model is so successful it’s being copied by other governments across the world, from New Zealand to the USA.

It’s important to note that GOV.UK is not universally popular. Critics will argue that regular users of the ‘old’ government websites hate it, that specialist users have been ignored and only the needs of the general user considered. If NHS.UK is to succeed it will need to work for staff as well as for the patient.

The challenge facing NHS.UK is also more complex. For example, building the new online system for selling motor vehicles was essentially a self-contained DVLA project. For NHS.UK to be able to handle appointment bookings and cancellations it will need to integrate with hundreds of NHS trusts, thousands of GP practices and the myriad back-office systems that implies. You could even argue that the NHS.UK vision is a challenge to the independence of NHS foundation trusts and GP practices, not to mention private and voluntary sector providers of NHS services.

On top of this, the NHS is understandably wary of large-scale technology and data projects. The failures of Connecting for Health and care.data, among others, have instilled a reluctance to digital transformation.

Yet transform it must. Good-quality digital services, from booking appointments to accessing your personal health record, will improve the patient experience and provide efficiency savings, and right now NHS.UK looks like the best way to achieve this.

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#544467 James
Downland Practice

97% coverage by GPs in just a few years... Why? Because there has not been some central attempt to make one huge it solution. GP systems have lead the way in health because there has been a healthy market. Oh and given you will be able to access your notes soon it is quite correct that you should go through strict identification procedures

#544468 David Buck
Senior Fellow
The King's Fund

I for one stick my hand up as a GOV.UK naysayer. It's a truly appalling resource for policy and research, we've gone backwards in terms of being able to study and hold govt to account over time in that respect. However, clearly it's working in lots of ways, as you point out re citizen transactions. Thanks for insightful post.

#544469 jameshiggott
Digital Communications Manager
The King's Fund
James, The speed at which online bookings, etc have been rolled out is impressive. I'd be interested see figures around take-up and patient satisfaction with the systems. Re third-paty suppliers though, I don't know what the NHS.UK IT architecture is going to look like but my guess is that it will allow third-party systems from this healthy market to continue to play a part, as long as they meet certain standards around quality, data structure, accessibility and usability, design, etc.
#544478 Nick Booth

integrating with third part systems needn't be that tricky. Creating a set of core standards for booking services and asking suppliers to gp's to fit into that would be a sensible way to go.

This is complicated but GDS has picked a huge amount of skill on how to prioritise - starting with the most used/important, fix that, move. It will of course go wrong if this is framed as a pre-specced single it solution for all ends which has to be finished before it's launched

#544479 Nanda Kar
Maritime Medical Consultancy,Calcutta

NHS has all the data of about 97% of the population of UK , no other strong competitor , it will be too big to handle ,so dictator will step in, whatever the way they choose.

#544480 James Higgott
Digital Communications Manager
The King's Fund

Nick - I completely agree. I know it's a bit of a digital buzzword, but this calls for an agile approach. This programme will need to break the overall project down into achievable chunks and adapt as new information arises while keeping the big vision central to everything they do. If they try to plan everything in advance the landscape will have changed by the time they finish their big spec document. To their credit, this seems to be how they're doing it.

#544481 Robert

all talk and the actions taken are sticking plasters on a massive wound.

#544484 Ben Colman
Information services manager
Salford City Council

I wonder how or whether social care would fit in a single NHS portal. Social services are dealing with a smaller, less connected population than the NHS, yet they are the more intensive users of NHS services.

#544552 Kat Hall

In fact just 15 live "transactional" services are up and running not 800. And most of those are just a refresh of what pre-dated GDS. The National Audit Office has found that no cost savings have yet been made through a channel shift to digital. The £1.7bn savings figure mentioned is mostly all through spend controls and the cost savings associated with shutting down websites.

#544554 Marsha Miles
Marsha Miles Consultancy

As someone working within the integration arena, I would be interested to know what is being planned about ensuring health and community services delivered by the third sector, private organisations are included.

#547854 Dr Mills
Health Expert

Thanks for sharing! Its a challenge on both sides to keep the NHS public or private. Health community services and health organisations should give advice on such matters.

#548028 Dr Claire

We all remember when they said the NHS was to be privatised, but due to the amount of protest at number 10 downing street. This issue still remains debatable.

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