Digital change is priceless

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It won’t have escaped readers’ notice that technology is likely to have a big role to play in the NHS’s 10-year plan. Comments from the Prime Minister and Jeremy Hunt suggest that technology will be a driver for some of the desired outcomes of increased funding. There is some sense to this. Digitising the NHS could lead to more accurate and quicker diagnosis, new care interventions and more closely integrated patient pathways, all of which provide better-quality care.

The challenge is how to achieve this vision. In the past, the NHS has been dogged by poor implementation of technology; the spectre of the National Programme for IT, which has become synonymous with big public IT failures, still hangs over the NHS. Things are changing, however, and in our new report – Digital change in health and social care – we argue that it is time for the NHS to step out of the shadow of past implementation failures.

The report shows how local areas are forging ahead with their own large-scale digital transformation. Unlike past national initiatives, local health and care organisations are charting their own course through digital change. They are doing so by using a team approach, with clinicians, suppliers and transformation managers working together to find a common vision for what modernised services should look like, and then designing and build new pathways supported by technology.

Our case sites aren’t perfect examples of how to undertake digital change. There’s no instruction booklet for doing this. Our case sites don’t read like an Argos catalogue of whizzy technologies, either. There’s a mix of digital maturities. Our research has been about understanding digital journeys in all their messy glory; how they had to make trade-offs between what was technically ‘best’ for what was practically workable. 

Our case study sites have done things I wouldn’t recommend –  which worked. And they’ve also done things that are purely common sense – which didn’t. Some of them had inauspicious starts. Fortunately, none have seen inauspicious endings. They’ve planned for how and when resources are needed, but their plans are flexible. Managers cannot see the future; so plans need to be able to change.

Our case studies, despite being about technology, are full of very human conversations and very human errors. Not one of our sites would describe itself as having done an ‘IT project’. The technology supports wider clinical transformation because it’s better patient care that gets staff excited.

Our case studies are full of the complexity of human relationships: building trust and losing trust, persuading and dissuading people, but above all not placing technology between people, but using it as a way of bringing staff closer together and closer to the patient. Information governance, as dreaded as it is, provides an excellent test for relationships and trust in a local area. Big, cross-organisational technology projects act as great tests of local collaboration. In doing so, they can flag up where relationships are strong or where they need improving for future integration plans.

These lessons are all being learnt locally and manifest themselves differently in each of our case study sites. And this is the conundrum for politicians and policy-makers looking for technology to be at the centre of the NHS plan. Technology has the potential to deliver, but is not a lever that can be pulled nationally. Decisions about how digital change happens, and on whose terms, need to be taken as close to patients as possible. 

Technology could be seen as an easy way to spend large amounts of money – especially where other ways to spend the money, such as recruiting more staff, are beleaguered by their own challenges. This would be the wrong path. While technology has its price, our report shows that digital change is not something that can be bought. NHS organisations can only move at the speed of local relationships.

The authors will be discussing the report, Digital change in health and social care, at the upcoming Digital health and care congress 2018 in July.


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