A very digital plan for the NHS

A very appy NHS

Not surprisingly, central to the plan’s focus on digital technology is the NHS’s all-singing, all-dancing app, which is currently being rolled out across England.

“The NHS App will create a standard online way for people to access the NHS,” said the plan. “The app will work seamlessly with other services at national and local levels and, where appropriate, be integrated into patient pathways.”

Patients using the app will access the NHS’s own ID verification platform, previously known as Citizen ID but now dubbed NHS Login, to verify who they are and to get “easy access to personalised content, digital tools and services”.

The app underpins a lot of the digital access work that is going on in the NHS. By 2020, every patient with a long-term condition will have access to their records through the Summary Care Record (SCR), which will be accessible via the app. The app will also offer triage services and direct people to appropriate care services.

“If needed, they will be able to be connected with their local services, get an appointment with an urgent treatment centre, out-of-hours services of a GP, or be prescribed medicine to be collected from their nearest pharmacy,” the plan said.

“Increasingly, automated systems and AI [artificial intelligence] will make these services smarter, but in-person services will always be there to do what computers can’t and provide personal contact for those who need or want it.”

By 2021/22, people will also have access to their care plan and communication from care professionals via the app.

Digital first

The plan signals a clear shift in the provision of NHS services, with a focus on prevention and a new era of self-service. “In 10 years’ time, we expect the existing model of care to look markedly different,” the plan said. “The NHS will offer a ‘digital first’ option for most, allowing for longer and richer face-to-face consultations with clinicians where patients want or need it.

“Primary care and outpatient services will have changed to a model of tiered escalation depending on need.”

NHS Digital CEO Sarah Wilkinson said the digital-first approach “will enable more patients to communicate with clinicians and therapists via live video channels, without the need to be physically present where this is not necessary”.

She added: “In parallel, we will enable much more sophisticated monitoring of health by a patient or their carer, in their home environment, with the data from those monitors available immediately to their clinicians and their whole care team.”

This new way of running the health service means it will not be enough to plug in a batch of digital systems on top – the change needs to be systemic, from the way the NHS works with suppliers, the way that patients interact with the service, and the way staff deliver care. It is clear this won’t happen overnight, which is probably why there is not a single mention of the NHS’s “paperless 2020” target in the plan.

From paperless to mainstream digital care

The NHS has long been gunning for a paperless NHS at the point of care, with integrated electronic records in place by 2020. But that target is becoming more and more unrealistic every day. The Wachter Review, published back in 2016, recommended pushing back the target to 2023, something which seemed to be accepted, despite the fact that the official line from the government was still “paperless 2020”.

However, the NHS Long Term Plan seems to have finally taken this into account.

Instead of mentioning “paperless”, the plan said that by 2024, “all providers, across acute, community and mental health settings, will be expected to advance to a core level of digitisation”.

This goes much further than putting in an electronic patient record (EPR) system that can integrate with other systems, but covers “clinical and operational processes across all settings, locations and departments and be based on robust, modern IT infrastructure services for hosting, storage, networks and cyber security”, the plan said.

“To support this, we will accelerate the roll-out of EPR systems and associated apps, including a spectrum of software as a service (SaaS)/cloud-based variants.”

Wilkinson said faster access to records by patients, clinicians and therapists increases safety and efficiency, but a key condition of this is the digitisation of all care providers, which is why the accelerated roll-out of EPRs is so vital.

“We will make life easier for clinicians by enabling them to capture rich and accurate records at the point and time of care,” said Wilkinson. “We will standardise, integrate and quality-assure records, using voice recognition, natural language and mapping and reconciliation systems.”

Other initiatives set out in the plan include ensuring that, by 2020, five areas deliver a fully integrated health and care record platform across both health and social care, followed by three further areas the following year. By 2024, all secondary care providers in England will be fully digitised.

Another key milestone is that by the summer of 2021, all NHS organisations will be 100% compliant with mandated cyber security standards. This comes after NHS Digital’s deputy CEO admitted in February 2018 that all 200 NHS trusts that had been assessed for cyber security resilience had failed their assessments. Since then, the health service has increased its cyber security training and focus.

Reforms to payment and clinical pathways

The Long Term Plan also involves a huge culture change, not just across the NHS, but in society itself. As part of the plan, the government will create primary care networks, consisting of GPs, pharmacists, district nurses and others, financed by a £4.5bn fund, launching what it calls “community-based healthcare”.

This will be supported through the ongoing training and development of multidisciplinary teams in primary and community hubs. “Community hospital hubs will play their full part in many of these integrated multidisciplinary teams,” the plan said.

From 2019, NHS 111 will start direct booking into GP practices across the country, as well as refer on to community pharmacies that support urgent care and promote patient self-care and self-management. Clinical commissioning groups (CCGs) will also develop pharmacy connection schemes for patients who do not need primary medical services.

The aim is to keep people at home longer and avoid unnecessary hospital admissions. However, a key success factor hinges on  proposals made in the government’s social care green paper, due out shortly, as integration with social care will become even more crucial in a digital age.

But not everyone believes the plan will succeed. Norman Lamb, former Liberal Democrat health minister and chair of the House of Commons Science and Technology Committee, said the plan is likely to be “fatally undermined by insufficient resources, a staffing crisis and a failure to address the disastrous situation with social care”.

Lamb added: “The government’s commitment to a new focus on prevention rings hollow when the very services which help prevent elderly people ending up in hospital are at breaking point and vital public health budgets are progressively cut back.”