Digital health care: our position

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Part of The King's Fund position

Digital technologies bring many opportunities to improve people’s health and experiences of services, but realising their potential will require investment and thoughtful implementation.

What we think

There is significant potential for the transformation of health care through better and widespread use of digital technologies. This includes a growing role for technology in supporting people to monitor and manage their own health and wellbeing. But the NHS has a poor track record when it comes to adopting digital technologies at scale.

In the past, major national IT programmes have been accompanied by significant investment, but a lack of user engagement and over-centralisation of decision-making mean they have not delivered change on the scale envisaged. Recent attempts to address this have been held back by insufficient investment due to wider financial pressures on the NHS. 

In the 2019 GP Patient survey, 15 per cent of people reported booking appointments online, 15 per cent reported ordering repeat prescriptions and only 4 per cent were accessing their medical records online.
Source: Ipsos MORI 2019

Patients’ experiences of digital access to NHS services are often clunky and fragmented, and uptake of digital options for ordering repeat prescriptions and booking appointments in primary care remains low despite the functionality being widely available. At the same time, there are indications that poor staff experience of IT systems can negatively impact on their working lives. This underlines the importance of understanding users’ needs and involving them in the design of new technologies.

Digital technologies are integral to many of the changes envisaged in the NHS long-term plan. Making a reality of these ambitions will require a stronger emphasis on engaging and upskilling the people who are expected to use digital technologies at all levels in the NHS, particularly clinicians. Additional funding and suitable digital infrastructure should be made available, including modern devices and network connections. 

It is important that health and care leaders have the knowledge and skills necessary to lead and oversee digital transformation. A whole-system approach to implementation is needed to ensure these changes support better joined-up care for patients and service users. This will require investment and support for all parts of the health and care system, including social care, to implement new technologies. 

It will also be important to take steps to prevent digital technologies entrenching or widening health inequalities. This means understanding and addressing the issue of digital exclusion and seeking to use technologies to address the health needs of groups hit hardest by inequalities.

Context

Digital technologies now play a key role in the economy and many people’s everyday lives. They have the potential to transform health care by changing the way people engage with services and professionals, improving the efficiency and coordination of care, and supporting people to manage their own health and wellbeing. This is already being illustrated through the growing use of self-care apps on smartphones, wearable sensors to monitor conditions or physical activity, online health information, digital access channels in primary care, and the development of electronic health records.

Digital technologies are not new to health care, and there has been a succession of national strategies to support their development and spread. These include the 1992 national IT strategy for the NHS and the National Programme for IT which ran from 2002–11. Despite being a multi-billion-pound programme of investment spanning almost a decade, it failed to achieve its main objectives of creating a single electronic health record system and connecting primary and secondary care IT systems. The programme has been criticised for not understanding users’ needs due to a lack of user engagement and overly centralised decision-making. 

Recent government targets for the NHS to ‘go paperless’ have been delayed, in part due to insufficient investment to deliver the required changes. Available investment has primarily been focused on a small number of ‘exemplars’ expected to lead the way for others. In contrast to the slow progress made in hospitals, efforts to digitise primary care have been much more successful with almost all GPs using electronic health records. However, despite the extensive roll-out of technology to give patients access to their GP records, public awareness and usage of this technology remains low. 

Digital technology is integral to many of the changes envisaged in the NHS long-term plan. This includes ambitions for increased care and support for people in their own homes using remote monitoring and digital tools, as well as a new right to digital primary care services from 2024. Technology is expected to facilitate service transformation, including the redesign of outpatient services and reorganisations of pathology and diagnostic imaging services and the plan reiterates the previously stated ambition for all secondary care providers to be ‘fully digitised’ by 2024. 

5.3 million adults in the UK do not use the internet.
Source: Lloyd’s Bank UK 2018

Policymaking around the use of digital technology in the NHS has been disjointed, with responsibilities split between NHS England, NHS Digital, the Department of Health and Social Care, and others. To address this, in early 2019 the Department of Health and Social Care announced that many of the teams from these organisations would join a new centralised ‘joint unit’ called NHSX to drive forward digital transformation. 

Digital technologies can have a disruptive influence on the planning and provision of care. The recent growth of digital primary care providers is one example of this, testing existing models of general practice and policies around patient registration and funding. This poses a major challenge to regulatory bodies and policy-makers, who need to be able to respond to developments at pace to ensure high quality care is maintained and to mitigate potential negative consequences on wider services. 

There is limited evidence about the impact of digital information systems on the working lives of NHS staff. However, concerning evidence is emerging from the United States indicating that poor experience of using technologies such as electronic health records can adversely affect staff wellbeing and contribute to burnout among clinicians. 

A further challenge in implementing new technologies is the issue of ‘digital exclusion’. Evidence suggests that digital exclusion is more likely to affect particular groups of the population, including older and disabled people. This means it is often people with the greatest health needs who are less likely to be able to engage with and benefit from digital services. Digital inclusion can be supported by efforts to build capabilities among individuals and communities to ensure that people of all ages and backgrounds can benefit from digital innovations in health care.

Key spokespeople on digital health care

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Matthew Honeyman

Researcher, policy

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David Maguire

Senior Analyst

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Siva Anandaciva

Chief Analyst