Government expects NHS IT overhaul will unleash innovation

Compliance to open standards will be one of the key components of the intended overhaul of technology in NHS England, with modular contract structures and a sandbox regulatory environment as additional ingredients to tackling fragmentation across the system and stimulating innovation, according to Hadley Beeman, chief technology adviser at the Department for Health and Social Care (DHSC).

Introducing “nationally agreed open standards with locally led delivery” is part of the agenda of the NHSX, a central unit launched in February to lead on digital strategy in the health service in England.

This means that public healthcare organisations building or buying systems will need to meet certain levels of interoperability, security and data integrity and interoperability, Beeman told delegates at the Digital Health Rewired event on 26 March 2019.

“Lives are at risk because our systems can’t talk to each other, so we will rigorously enforce interoperability standards at the point of purchase,” she said, adding that if suppliers don’t meet the standards that will be introduced, they won’t be selling to the NHS.

When health secretary Matt Hancock set out his vision for IT at the NHS, there was a clear focus on open standards and interoperability.

While NHSX will agree and mandate a set of common technical standards for use across the system, Beeman said it will prescribe “the bare minimum” and that it isn’t interested in intervening too much in the interactions between NHS organisations and suppliers. Micromanagement, she said, is a bottleneck to innovation.

“We will set a minimum level of standards, consistent with ensuring system-wide quality and interoperability. Within that context, we will let local NHS teams buy whatever they want from whoever they want,” Beeman said.

“We don’t care who builds the plug as long as it fits the socket,” she added. She also implied there will be changes in the actual procurement framework and that if suppliers undergo an entire process to sell into one NHS trust, they shouldn’t have to repeat it all to sell to another.

Ensuring continuous systems upgrades is another priority in the government’s new approach to healthcare IT. That, according to Beeman, will mean modular contract structures and “decoupling IT stacks” to allow trusts to swap and upgrade services as they evolve and get cheaper, without rebuilding the plumbing.

“For commissioning organisations, the end goal is that it should be as easy to switch GP IT providers as it to switch bank accounts,” she added.

Equally, Beeman stressed that the new way of handling third-party IT suppliers can no longer accommodate “a big multi-month review process every time the developers want to fix a typo or patch a bug”.

NHSX will also be looking to adopt the regulatory sandbox model that is commonplace in financial technology (fintech), she said. “There is real value to getting a new product or service in front of a live user group and subject to proper safeguards, seeing how they respond in real-time,” she added.

The new regulatory approach for NHS IT will have to allow for “iteration and failing fast”, Beeman said, adding that in return for that speed, if apps are falling short on privacy they will be removed just as quickly.

The NHS led public sector IT spending in 2018, with a procurement of Microsoft Windows 10 licenses being the largest chunk of a total of £1.3bn worth of new IT contracts across government, concentrated in 10 large suppliers. Experts argue more work is needed to diversify the government’s IT supplier landscape and allow smaller tech firms in the public sector supplier chain.

In her speech, Beeman implied the new procurement model to be introduced under the NHSX brings good news to healthtech firms. With the new strategy, the government expects that it will be “as easy to build for the NHS as it is to build on Open Street Map, or on Transport for London’s APIs [application programming interfaces]”.

Healthtech suppliers will have a place in the design and development of the common standards, alongside patients, clinicians, the civil society and the NHS tech workforce. The new code of conduct for artificial intelligence and data-driven healthtech cited by the DHSC tech adviser is a recent deliverable of the co-creation approach.