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Defining our digital heath destiny – shaping an ecosystem, or being shaped by dysfunction?


For health and social care to benefit from digital technologies there needs to be a vibrant ecosystem with innovations that are problem-led and rapid to implement, while using the best evidence-based technology. The evolution of the ecosystem is far from this ideal and risks being shaped by dysfunction.

The design, development, implementation and use of digital technologies in health and care can be considered to be an ecosystem made up of provider organisations, staff, patients, carers, innovators, regulators, researchers, charities and suppliers. It’s a complex ecosystem with many interacting parts, each one with different incentives and aspirations that can make them pull in slightly different directions. If the ecosystem is healthy, it should create a number of benefits for all parts of the system.

In a complex system there is more than one way to solve a problem and many different technologies that could be used.

'In a complex system there is more than one way to solve a problem and many different technologies that could be used.'

This spectrum of solutions is at the same time overwhelming and an important benefit for a system that has lots of variation in terms of its patients, staff, capabilities and capacity. The ecosystem should enable multiple innovations to be used and thrive, depending on the applicability of the solution and preference of the user. Technology suppliers should therefore compete by providing technologies that are problem-led solutions addressing the challenges and aspirations of providers and patients. Providers would benefit by having multiple sources of innovation addressing different areas of need and available at good value through suppliers that are easily able to compete for business. And new suppliers would benefit from being able to compete with incumbent suppliers through the use of innovative approaches. This would need providers to be able to easily compare and interchange tools.

The NHS is often considered to be a single purchaser, but suppliers experience it as a fragmented collection of individual organisations that can be difficult to navigate. As a single purchaser, the NHS should be able to provide direction to the ecosystem by driving innovation, setting the technology functionality agenda and using scale to unlock improvements in cost and reliability. Within a healthy ecosystem, this would mean a single purchaser behaving with intent to actively accelerate the development and maturity of groups of innovations that meet the needs of patients and staff. This would create new opportunities for suppliers to provide solutions while providers benefit from affordable innovations. In an ideal case as a single purchaser the best solutions should spread with reduced delays and procurement demands to benefit staff and/or patients nationally, scaling by person not organisation.

Finally, UK businesses in a healthy ecosystem should be able to use a dynamic relationship with the NHS to co-create innovative solutions that meet the needs of patients and/or staff. Rapid development of innovative solutions with testing and evaluation in the NHS could form a stepping stone to international markets. Further growth of the suppliers to the NHS has the potential to drive down costs, drive further technological improvements and increase the resilience of new suppliers

In combination, these should enable the NHS to inform and use the best quality science, technology and evidence to provide high quality and equitable care. But in reality the ecosystem seems far from healthy. There are well documented challenges to scale, innovators and entrepreneurs struggle to engage with staff under significant workload, and our legacy infrastructure – which has high levels of variation across the country – compounds difficulties implementing technology.

'The NHS and social care need to be able to use the best quality and value technologies to improve patient care and staff experience.'

The NHS and social care need to be able to use the best quality and value technologies to improve patient care and staff experience. Suppliers need to be supported to innovate and create solutions that help overcome challenges and meet aspirations of the health and care system. These are not mutually exclusive; it’s imperative to bring these both together to create a healthy ecosystem where innovative evidence-based digital technologies to improve health and care services for patients and staff can thrive nationally and globally.

The Medical Technology strategy set out some of these aspirations but they need to be across all digital technologies in health and social care. this needs focused effort to research the dynamics and incentives of the current ecosystem, how it differs from the aspiration and the policy changes needed. With this information we can start to bridge from the reality of now to the world with a thriving ecosystem which is sorely needed.

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