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If we don't digitise NHS, we are condemning people to die, says NHS England’s operational director

NHS England’s national director for operations, Matthew Swindells, calls for a complete overhaul of the way the NHS delivers care, claiming the current model “is not viable”

The NHS must change the way it works, and digitising the health service is the only way to sustain it, according to NHS England’s national director for operations, Matthew Swindells. 

Speaking at the NHS Expo in Manchester today (5 September), Swindells said extra funding alone would not be enough to solve the current and future pressures faced by the health service if it continued to run as it currently stands.

Earlier this year, prime minister Theresa May announced that the current £114bn funding would be gradually increased over the next five years, with an average of 3.4% growth per year. Swindells said that was a “fantastic settlement, but not enough money for us to work the way we’ve always done”.  

Swindells, who has previously criticised the NHS for failing to get the basics right when it comes to IT, said that trying to move forward with the current model of care was “not a viable model”.

“We can’t afford it. We couldn’t staff it even if we could afford it, and anyway, it’s wrong,” he said. “If we don’t digitise our health service, we are condemning people to die.” 

Swindells added that although the NHS was struggling and required a complete transformation to survive, a lot of work was being done to save it. 

Local health and care records

Earlier this year, NHS England chose five regions that would become Local Health and Care Record Exemplars (LHCREs).

Bids for the national investment in shared health records were due at the end of April 2018. The LHCREs selected will receive up to £7.5m in national investment over two years, which they must individually match. 

Swindells said the chosen sites had been working on integrated health and care records for many years, and would “build the technology” that will let care providers – whether in the community, GP surgery, hospitals or social care – create an integrated care record that the patient controls, choosing who gets access to it.  

“When we do that, and bring that together over the next two or three years, we will create the most linked health system app in the world,” he said.

“But of course it only makes sense if you’re also digitising how the data is captured as well, because it’s not that useful for sharing faxes. So we have to do the hard lifting at the provider end – we need to connect the patients so they see what’s in it for them, and then we need to create this integrated platform.”

Getting data right

A big part of digitising the NHS is getting the data right. NHS England is also working on a programme called “single source of truth” to bring together data from commissioners and providers into a single dataset, allowing the government to look at performance and productivity across the country. This information would then be given back to the country and the NHS.

Swindells said it would be “one data source” everyone can use, that’s fed automatically from health records and other sources, and curated to provide visibility and expert knowledge.

NHS England is also working with the research community to create a series of digital innovation hubs that will take in data from local health and care records to help the country transform the way research is done.

Swindells said it would give researchers the ability to study big data and look for variations, particularly with access to real-time health and care records, including “the ability to say what happens to somebody’s blood pressure in the first three hours after they have a drug administered, which you can’t see by looking at a discharge summary”.

Through bringing together different bits of the health record such as the GP view, the community view and the hospital view, anonymising it and make it available for research, the NHS is building "the shell around our local health and care records, which is where we will deploy population health management algorithms", Swindells said. 

He added that NHS England was due to go through a debate with HM Treasury, to convince it that “this is how you create an affordable NHS for the long run”.

Last year, the Life sciences industrial strategy report called for the government to create digital innovation hubs that would hold “comprehensive and secure data in primary, secondary and tertiary care, as well as social care and community data, for a population of between three and five million people”. 

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The best recent exemplar for NHS digital services was the West Midlands and North East England ambulance services. A completely joined up Electronic Patient Records system that saved lives and huge costs for the NHS. The EPR linked into hospitals, GPs and the NHS spine for patient records. The service was provided over a number of years by a private company that worked ceaselessly with the NHS to improve the service and build out functionality. These ambulance services were the only ones in the country to provide a proven and safe service to patients. The private company (Safe Patient Systems Ltd) went bust earlier this year as the NHS failed to work effectively with their partner. The loss is not just patient safety but also of a highly talented company that could have set the agenda for NHS digitisation. 
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