NHS England has committed to making patient-facing digital services a requirement by 2020. The Personalised Health and Care 2020 framework is a set of requirements, proposals and case studies intended to ensure the delivery of digital health and care information over the next six years.
The strategy provides information on how the NHS will deliver change and make the best use of data and technology.
Nearly two years ago health secretary Jeremy Hunt stated his intentions for the NHS to go paperless by 2018 and, more recently, promising all NHS England patients would have online access to their medical records by April 2015.
The framework paper now makes this a requirement rather than an aspiration. It stated that all patient and care records will be digital, real-time and interoperable by 2020, with clinicians in primary, urgent and emergency care accessing paperless records by 2018.
The framework stated that, by March 2018, all individuals will be able to view their care records online. By 2020 they will be able to write in those records comments and preferences through routes including NHS Choices online.
“Initially, this will focus on data held by NHS providers (primary care, acute, community and mental health), but it will be extended to cover other care settings, taking account of local authorities' work with personal records,” said the report.
The National Information Board
A body called the National Information Board (NIB) created the Personalised Health and Care 2020 framework. The NIB incorporates the Department of Health (DoH), NHS England, the Local Government Association and various other agencies. It said it created the framework for action to “support frontline staff, patients and citizens to take better advantage of the digital opportunity”.
The NIB stated it will publish a roadmap later this financial year, which will provide greater detail over who will be responsible for transforming digital care. It said it plans to test the framework’s priorities with service users, care professionals and technology suppliers.
The NIB also plans to oversee a national experiment to give patients a personalised mobile care record. This will be conducted by encouraging parents of newborn babies to use a personal child health record, which will document immunisations and so on in a digital format, rather than in a physical book, as at present.
The NHS also plans to introduce a kitemarking system to accredit applications and digital services which are safe to use. The NIB hopes this will give users consumers and care professionals the confidence to use them.
Digital improvement to health management
The Personalised Health and Care 2020 framework points to the value of digital technologies to improve the management of health and access to care services.
“The transformation of our services and the transition to prevention and self-care requires a fundamental business change and cultural shift, one that ensures the responsibility for sharing information is understood by everyone throughout organisations and across communities,” it said.
One example of a service which uses digital technology to share information and improve health management is the Dean Street Express clinic in Soho, a walk-in service for sexual health screenings.
“Routine sexual health screening needs to be as quick and convenient as possible to encourage use among at-risk groups,” said the report. “Anyone who thinks they need a sexual health test can arrive at the service without an appointment, check in with a touchscreen and complete the self-taken tests themselves or blood tests with staff on site.”
Results are sent out in six hours in text messages, without the need for a follow-up call or appointment.
But the framework document stated the use of digital technologies remains low in practice.
“This demonstrates the system is not currently meeting the needs of those it serves, and that there is a paucity of current offers adding value," it said.
"To some extent, the health system faces particular digital challenges, as many of its users come from disadvantaged groups and the elderly. Nonetheless, the increased uptake of smartphones and extensive broadband access is overcoming barriers to inclusion.”
Speaking to Computer Weekly in September 2014, head of digital at the DoH Stephen Hale said the challenge is to drive up the confidence of leaders and staff in digital technology, so it doesn’t feel innovative – rather, digital platforms are just seen as the best approach.
“Digital is such a broad term - the more you think about it, the more it can help with everything,” he said. “Not just how you conduct public health campaigns, but how you provide better services.”
Integrating health and social care
The Personalised Health and Care 2020 framework suggests how data and technology can be used to increase integration across care services including hospital, community and home, clinical and social care.
Currently, there is little integration between health data held by the NHS, and social care data held by local authorities.
Hunt told the Tory conference last month that progress is being made on integrating health and social care systems.
“For the first time ever, it is happening – 150 local authority areas working together with their local NHS on their Better Care plans to pool commissioning, reduce emergency admissions and share medical records, all starting from next April,” he said.
The NHS is now split between different organisations in different parts of the UK, so Hunt’s announcements only apply to NHS England – not to Scotland, Wales or Northern Ireland, which are following their own plans.
The NHS has had a chequered history in its attempts to provide online medical records. The failed £12bn NHS National Programme for IT spent billions of pounds trying to establish electronic patient records in every GP practice and NHS trust, before it was scrapped in 2009.
The controversy surrounding the plans to expand patient care data collection came to a head in February 2014, when the NHS's failure to explain the benefits to the public forced it to put plans on hold for six months.