NHSX: same but different
At the recent NHS EXPO, NHSX re-iterated its five key missions - reducing the burden for staff, giving citizens the tools to access services directly, safe and digital access to clinical information, improving patient safety and increasing productivity.
These missions make absolute sense and are strongly supported across health and care. At the same time, these are not new and arguably reflect existing expectations from the public and care professionals. The key challenge then for NHSX and digital leaders is how we learn from past mistakes and make sure the same problems don’t stand in the way of future digital progress. This requires an incremental approach to delivery but also much stronger working with operational and transformational colleagues to provide pragmatic solutions rather than 'jam tomorrow'.
This means providing digital services iteratively – starting with something simple, getting early wins and buy-in from care professionals and citizens. A good example of this approach is the work at Nuffield Health, where a new digital service was introduced every six weeks covering booking appointments, finding services, accessing records and creating a digital front door for citizens.
This requires a change in the methodology, using 'target experience' techniques which bring different user perspectives together and allows thinking to be tested continually by using minimum viable products. All these initiatives need to be underpinned by work to ensure digital services are safe and that sharing of a citizen’s information is decided by the citizen and is not just assumed.
At the same time, we need to support and enable our transformation colleagues in changing how care can be provided - both in the 'shift to the left' and at the interface of health and care. To do this, digital solutions don’t need to be overly technically complex. One example of this is the Argenti initiative, which uses technology (from low level telecare to Amazon Echo) to enable people to live independently within their homes. These provide prompts, medication reminders, control domestic appliances in their homes and call alerts for assistance. In areas that have used these technologies, such as Hampshire County Council, 98 per cent of citizens say they would recommend the service and the initiative has provided net savings of over £9.8 million in the first five years.
We also should be looking to use digital services to support our operational colleagues and to make the lives of care professionals easier and to help them do their job more effectively. This doesn’t necessarily mean complex tools that take years to implement. Digital tools for workforce planning whether in primary care, hospitals or at an integrated care level can use the data captured in clinical systems and/or activity-based data and use this to forward plan for the skills needed and also allocate resources in a more responsive way. Smart scheduling in hospitals can, for example, improve theatre productivity by enhancing clinical triage processes and dynamically allocating slots to patients where their needs match. This saving over 135 hours per month. Within hospitals and using outpatient departments as an example, these digital tools have led to over 5,000 additional patient appointments becoming available in one year, a reduction in DNAs of over 24 per cent and First to Follow Up by 13 per cent.
Robotic Process Automation (RPA) can support operational teams such as outpatient booking teams. Time spent on cumbersome repetitive tasks can be reduced that releases staff to focus on high-value patient facing tasks such as co-ordinating their care. Administrative tasks such as transferring patient details or referral letters from an external system to an internal system are rules-based and repetitive and so perfect for RPA. In one hospital automating just five administrative processes for a centralised outpatient booking team released 880 hours of staff time per month.
We should also be making more of the existing investments. For those with Microsoft licences, we’ve already seen the use of collaboration tools such as Office 365 enabling care professionals to safely and securely run multi-disciplinary teams and share clinical documents. This is leading to significant increases in productivity and savings of six weeks per annum.
The move to cloud also provides real benefits in service efficiency and security but organisations must be clear about their processes for the transition and how they can do this in an incremental manner. It will be important to avoid the pitfalls in other sectors where they have dived into cloud services and ended up paying more.
Clearly one of the most important requirements of healthcare providers is access and sharing of data. That means there is a need to complement strategic initiatives such as the Local Health and Care Records and gain early data insight that can then be applied and to also support less mature areas to also progress. Existing technologies can be used to create cloud-based data labs, define and test information governance in real-time with hypothesises tested, and improvements made. Several ICSs are already looking at these approaches to support primary care networks in identifying repeat attenders at GP practices and for hospital to address repeat attendances at A&E.
All these efforts will need to embed a security by design approach at provider level and across an Integrated Care System. This means they need a clear understanding of their operational readiness and the processes they need to follow, and where individual and collective responsibility lies, as well as the technology safeguards needed. NHS Digital provides Cyber Operational Readiness Support as one of the services to help the sector manage their cyber vulnerabilities and we would strongly encourage all organisations in taking up this suite of services.
By delivering incrementally, looking for pragmatic solutions that can directly support operational and transformation staff, we can ensure that the NHS X missions play an effective role in delivering the ambitions in the Long-Term Plan.