Wachter watch: where next for the NHS’s digital strategy?

Back to school and back to another round of new NHS initiatives and announcements. At the NHS Health and Care Innovation Expo on Wednesday, the focus was very much on digital technology and what it can do for the NHS.

The ‘Digital Doctor’ Bob Wachter launched his review of hospital IT. This was followed by Secretary of State Jeremy Hunt returning to a theme he has regularly championed since he challenged the NHS to ‘go paperless' back in 2013.

So, what are the big changes? Many of the announcements made by Jeremy Hunt focused on developments for patients: announcing new progress on the plans for national website NHS.UK; plans to take the NHS 111 triage service online for the first time; and to adopt the GOV.UK Verify service used for transactions elsewhere in the UK government by September 2017. This last one is a particularly important development which should standardise the process to activate patient accounts without the need for them to visit a GP surgery in person, as many still require. The team developing NHS.UK is currently recruiting and £400 million has been earmarked for online services over this parliament, though there is precious little detail yet on how any of the £4.2 billion digital funding announced earlier this year is being spent. Expect to see more big announcements as NHS.UK starts turning on the features planned.

A second attempt at an NHS app library is now planned, launching with apps for specific medical conditions in March. This will presumably be informed by the work that has been done under the banner of the National Information Board (NIB) – a coalition of national bodies including NHS England, NHS Digital, NICE and many stakeholders – to develop a new, staged model for ‘endorsement’ of apps, based on evidence of their effectiveness. One of the biggest problems faced in realising the benefits of health-related apps is how to assure patients and clinicians of their value. The NIB model seeks to balance the burden of proof for app developers with the need to avoid stifling innovation.

Is there anything new here? Well, sort of. Jeremy Hunt specifically said that the data people generate with their own devices (think Fitbits and smart phones) will be linked to NHS records. He referenced an NHS competition for apps and said they would ‘link into people’s health records’. If he is referring to data that users/patients generate themselves, then this was mooted in the 2014 digital strategy, but it would be the first firm commitment made to enable the flow of this kind of personal health data. It’s not part of the current plans taking the NHS up to 2020.

We've written about some potential applications before. But it’s very early days for understanding how to make use of personally-generated data in the health system, and the mechanics of how this will work are yet to be explained. The GP Connect programme to provide technology for apps to interface with patient records only promises basic read-only functionality from January 2017; so this will be a speculative bet, but one many people hope will pay off in a big way.

One of the most significant changes came with Wachter’s recommendation to relax the timetable for the Paperless 2020 initiative. It injected a welcome dose of realism into the debate. The plans to be paperless at the point of care imply big changes, but are matched with little funding. They are also challenging to deliver at a time of relentless operational pressures. The targets would require widespread roll-out of new digital systems in most acute hospitals, and further rapid progress on digitising and standardising the information that flows between GPs, hospitals and other parts of the system. The idea that local areas could achieve all this by 2020 is ambitious to begin with. The idea they could all do it in the face of the huge financial and operational pressures is veering towards the fanciful.

Instead, Wachter recommends taking the time to get digitisation in acute care right, something he thinks remains inevitable and desirable. He recommends relaxing the deadline for most hospitals (2023 is his more realistic 'end of the game') and taking an unashamedly elitist approach to distributing much of the funding supposedly set aside for supporting digitisation before 2020. Only just over 30 of the most digitally-sophisticated hospitals (still behind by international standards) will be asked to accelerate their development in the near-term and become ’global exemplars’ in exchange for matched funding. The very best will get £10 million and be paired with leading international digital hospitals.

Jeremy Hunt appeared to welcome Wachter’s review, and announced the first 12 hospitals who will be exemplars, an approach consistent with other efforts to transform care. So we can now add digital exemplars to vanguards, pioneers, test beds and STPs. The world of innovation in the NHS is becoming increasingly busy. Meanwhile, the day job still needs to be done and roadmaps for digital transformation submitted in June already look out of date.

We will be publishing a briefing about the digital health agenda later in September, which along with an early reaction to Wachter, will seek to make sense of the commitments made on digital and the progress made towards them so far.

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#548238 Kadiyali Srivatsa

Its interesting Mr Hunt has now decided to offer NHH111 via apps. I have been probably the first doctor to share information about my tool MAYA in 2004. The nurses hated my concept and idea but it works. Patients love the apps. Now I must warn NHS to be careful because it takes years to develop tools but takes few minutes to steel the idea. My book is probably the cheapest way to help patients and you don't need $400 million to use my tolls that is available FREE to download. Its crazy but true, these politicians are addicted to waste tax payers money

#548239 Kadiyali Srivatsa
7i Med Ltd (UK)

By the way, I forgot to mention that I am already introducing internet things and frugal innovations to help doctors diagnose illness using smartphone and so prevent wasted appointments. By the way, if junior doctors are on strike, you can ask a doctor living in other country too

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