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Interview: Matt Hancock, secretary of state for health and social care, on his NHS ‘tech vision’
Matt Hancock brings rare digital experience to running the NHS and social care systems, but can he overcome the legacy of past health service technology failures?
Matt Hancock’s reputation as a rare technology-literate politician has carried him through his ministerial career to date. As Cabinet Office minister, he was responsible for digital government strategy. As digital minister and subsequently secretary of state for digital, culture, media and sport (DCMS), he looked after digital economy policy.
Now, three months after his promotion to health and social care secretary, he is making IT a central part of the reforms he wants to introduce across the NHS, with the launch of his new “technology vision”.
For anyone who has followed the digital principles promoted by the Government Digital Service (GDS) over the past few years, the fundamentals of Hancock’s plan will contain much that is familiar. He is promising to create the “most advanced health and care system in the world” through modern technology architecture, open standards, and a focus on user needs, privacy and security, interoperability and inclusion.
The document that outlines his vision reads like something of a wishlist, but few would disagree with its aims – to use technology to make the NHS and social care system more efficient, and to support medical staff better through the use of modern digital tools.
“The time is ripe now to bring about this tech revolution in healthcare,” says Hancock in an exclusive interview with Computer Weekly. “ I have been really encouraged since I arrived here with my digital background just how much enthusiasm there is in parts of the system to get this right.
“For too many people, the scars of the failed projects of the past have led to a highly segregated set of local decisions. There is an increasing consensus of the direction of travel – the question is how to implement it. And this document is the first step on that road.”
A toxic legacy
For many in the NHS, those scars are still visible. The multibillion-pound failure of the NHS National Programme for IT, and controversies such as the aborted Care.data plan to share patient records, have left a toxic cloud over large, centrally driven digital initiatives.
Hancock believes the best solution is a combination of centrally mandated standards around interoperability, data, and the use of application programming interfaces (APIs), while preserving local decision-makers’ autonomy over specific technology and procurement decisions.
But he also expects those local decisions to improve.
“The technology vision is the standard that future technology will have to meet in order to be implemented in the NHS. The critical part is that it will save money in the medium term and it's abiding by the standards that will allow a system to run better,” he says.
“I’ve found that people are biting our hands off to have better technology, very enthusiastic about having standards of interoperability set for everybody to abide by, because everybody who works in the NHS can see how technology is improving lives outside of the NHS.
“I understand that history, of course I do, and I understand why it has led to a reluctance from some people in leadership positions who duck the challenge. But since the National Programme started 15 years ago, we have learned a huge amount as a society, and within the public sector, of how to deliver high-quality public sector digital services well.”
Hancock acknowledges that the state of NHS IT is mixed. Legacy systems and under-investment abound in many areas, and the gap between the best and the worst in healthcare can be significant. “I’d love to see everybody as good as the best now, but I’m not going to let that get in the way of progress,” he said.
“I want all parts of the NHS to improve their technology and I want a culture of continuous improvement and agile iterative development to take hold. But I’m not prepared to wait for the slowest to get going. Of course, they’ve got more catching up to do, but everybody can make progress now.”
With the NHS and social care under enormous financial pressure, IT leaders across the health sector will inevitably wonder where the money to deliver this vision will come from. Hancock points to the commitment made in his first speech in the job in July, to make £487m available for NHS technology projects and to replace paper-based systems.
But he says there will be no further funding associated with the technology vision and NHS organisations will have to use their existing IT budgets to deliver on the new plan.
“To get this right is more about standards than about money,” he says. “We will be mandating standards, and that mandation is the teeth to drive through the reform. Any money spent on technology is going to have to look to these standards.
“Ultimately, I see this as a cost saver once you get the standards in place, and it’s a cost driver only if you are implementing technology that doesn’t help you run a more effective and productive health system.”
“This is about the standards that future technology will have to meet in order to be implemented in the NHS. Of course, it takes budget to deliver on that. But those budgets exist. The critical part is that it will save money in the medium term and it is abiding by the standards that will allow a system to run better.”
“I want all parts of the NHS to improve their technology and I want a culture of continuous improvement and agile iterative development to take hold”
Matt Hancock, secretary of state for health and social care
One of the main criticisms of the £12bn National Programme was its failure to engage clinical staff in the technology overhaul. Aware of this, Hancock is keen to engage medical staff, but is also clear he wants to see a change in attitude and approach at a local level.
“We need to change the change culture in the NHS to an agile one from a reluctant one,” he says. “Clinicians have a mission to save lives and when the technology can save lives, they want to use it, but they need the underpinning architecture. It’s our responsibility to put that in place so that they can make that happen.
“Likewise, nurses choose to be nurses because they have a mission to make people’s lives better. Where technology can help to do that, they are very keen to adopt it, but the system has worked against that sort of adoption. In the board of every NHS trust in the country, I want that system to be changed and the culture to be changed, from the leadership positions all the way through the organisation, to be embracing new technology.”
One of the constants throughout Hancock’s ministerial career has been promoting the importance of data. In one of his early speeches as Cabinet Office minister, in June 2015, he called for a “data culture” across government. At DCMS, he poached responsibility for data policy from his previous department. But most observers of digital government would say that data is one of the areas where there has been least progress in that time.
Hancock acknowledges the complexity of the task to pull all the many data silos in government and the NHS together into something coherent, but believes his experience in his previous roles will help now.
“There is no doubt we have learned a huge amount about where data strategy worked well and where it hasn’t worked well,” he says. “I hope I’ve learned to understand better the role of different parts of the system.
“Our role at a departmental leadership level is to set standards and to give people the permission and encouragement to innovate and, to a degree, the funding that unlocks that. The role of an individual NHS trust is – within those parameters that we set out, within those guide-rails of the standards – to deliver the very best technology they can.
“The role of the leaders on the ground and clinicians in the NHS is to use the very best technology they can get their hands on. Sometimes in the past in the NHS, those roles have been muddled up.”
Read more about NHS IT
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Another common theme with which Hancock is familiar is the shortage of digital skills across the public sector. Whitehall’s digital teams have struggled to recruit top talent when the private sector – also desperate for such skills – can pay so much more. But Hancock hopes the opportunity to make a difference to the NHS will attract some of the best.
“We need more digital capability in the NHS,” he says. “We need more procurement capability to buy the right kit across the NHS. Working in the NHS is a mission-driven job – you are working to improve the lives of your fellow citizens.
“And so I would say come and join the revolution in the NHS – we are going to make it one of the most technologically advanced organisations in the world. It will be something you’ll never forget.”
But the challenge is never going to be as simple as that.
“I didn’t say it was going to be easy,” says Hancock. “Pay is always going to be important, but if you’ve got skills to offer and want to give something back to your country, then we have a need for those skills.”
With all the talk – and money spent – on NHS IT in past years, the social care system has often been left behind. Social care IT has historically been the responsibility of local authorities, where austerity cuts mean funding has been even more difficult to come by.
Arguably, the use of technology in social care is even more of a patchwork than in the NHS. Hancock is only the second secretary of state – after his predecessor, Jeremy Hunt – to take on both aspects of healthcare and try to drive better integration between the two.
“The link between health and social care is not nearly strong enough and I think can be tech-enabled,” he says.
“The daily need for people to leave hospital and find a social care package is an incredibly important task for keeping hospitals running effectively. There is a clear opportunity for adoption across the board of technology that allows those transfers to be done as efficiently as possible.
“That will have a direct impact on how long people have to wait to be seen in A&E. That is just one of many examples where we need to see the adoption of new technology, much of which already exists and needs to be taken right across the piece.”
Digital is Hancock’s comfort zone, but even with his experience, there will be an element of eye-rolling in parts of the health service about another new minister with another grand IT plan. But for the sake of the NHS – and all its patients – someone has to get the technology right eventually and, if nothing else, Hancock brings the zeal to try to make it happen on his watch.
“This is the next step along a long journey to world-class technology in the NHS,” he says.