The year 2019 brought some high-profile developments for technology to the National Health Service, the most important of which was the introduction of NHSX, a central unit that brings together leadership in digital, data and technology to support technology vision in the NHS and its Long-Term Plan.
A brainchild of health and social care secretary Matt Hancock, NHSX underpins plans to overhaul technology in the NHS by launching a digital unit with a similar remit to the Government Digital Service when it was first created in 2011.
The digital unit has the task of setting national standards and policies, working with other NHS organisations to support digital transformation, developing common technologies and services, and overhauling procurement practices. It also lead on cyber security, digital skills, and evaluating innovative technologies.
There were also noteworthy stories in areas such as the advancement of digital prescriptions in the UK and developments around social care, GP practices and screening services, where technology plays a significant role.
Here are Computer Weekly’s top 10 NHS stories of 2019.
Reporting to Hancock, the executive chosen to lead the NHSX as chief executive was Matthew Gould, formerly director-general for digital and media policy at the Department for Culture, Media and Sport.
Further back, he was director of cyber security at the Cabinet Office, director of the EU referendum unit, and British ambassador to Israel for five years.
In an interview with Computer Weekly soon after taking on the new job, Gould outlined his vision for the health service and the challenges ahead.
NHSX started operating in 1 July 2019 and ended that week with the announcement of two senior appointments for its leadership team.
Key appointments were deputy chief executive Simon Eccles and acting chief technology officer Hadley Beeman, who had previously been chief technology adviser at the Department for Health and Social Care.
Making systems talk to each other is a mantra at NHSX, and this was outlined by Gould as one of his key priorities.
Deputy CEO Simon Eccles also reinforced the importance of interoperability, in addition to keeping the centre thin, a discourse aligned with the overarching theme set out by the CEO for the new organisation.
Acting CTO Hadley Beeman also stated the need for interoperability across the health system as one of her key messages, as well as compliance to open standards by suppliers.
Soon after taking over as NHSX CEO, Matthew Gould said he was unconvinced that the health service should be making further enhancements to its flagship mobile tool, the NHS App.
He wanted to keep the app “thin”, allowing an envisioned ecosystem of innovators to build on existing features and create tailored apps to cater for different patient needs.
“I don’t want us to make the NHS App all-singing and all-dancing,” said Gould in a first blog post since his new job was confirmed in April 2019. “In fact, I’m not sure we should add many more features than it already has.”
NHSX stressed the need for ethical frameworks and guidance around patient data access as new data hubs were launched to focus on research into diseases such as cancer, Crohn’s disease and asthma.
One of the key parts of the discourse at the launch was that the hubs should ensure data was kept safe and secure, with public involvement in how the data is used.
“It is right that we manage access to any NHS information very carefully. It is time for the NHS to actively own and drive this agenda,” said NHSX chief digital officer Tara Donnelly.
The government was urged to prioritise joining up IT systems to unlock the potential of emergent technologies in a manifesto published by the Royal College of GPs.
The All systems GP manifesto estimated that up to 80% of GP practices could be using outdated systems that are incompatible with the digital ambitions set out by the government. It also called for an IT overhaul at GP practices, with digitally enabled, connected premises with interoperable systems, as well as access to a single electronic patient records platform.
The same day, Hancock announced the roll-out of fibre optic broadband across all hospitals and GP practices as part of pledges made in the NHS Long Term Plan to improve the range and access of digital healthcare services.
A major report into social care in a context of automation urged NHSX to create a data strategy for social care as part of the basic foundations needed to support reform plans.
The report by responsible technology think-tank Doteveryone called for the data issues in care to be addressed, as well as building tech skills for better care. It also said a better culture must be in place to empower people to use technology according to their needs.
“The failings of our current system are too heartbreakingly apparent. Technology, used responsibly, can be part of a solution,” said Martha Lane Fox, executive chair and founder of Doteveryone.
With a collective funding gap of more than £3bn for 2019/20, local authorities across the UK have sought assistive technologies ranging from collaborative robots to voice assistants as an attempt to enhance service delivery and reduce pressure in resources with automation.
A long-awaited adult social care green paper was supposed to have been delivered in the summer of 2017, but has been delayed at least six times over the past 18 months.
The NHS expects to achieve £300m in savings by 2021 following the national roll-out of the Electronic Prescription Service (EPS).
The fourth and final stage of the implementation started on 18 November as part of a wider overhaul of prescriptions in England. The last phase of the programme followed a pilot that successfully dispensed 329,000 prescriptions and involved 60 GP practices and 3,100 pharmacies.
Implementation will continue into 2020 with other system suppliers, while Clinical Commissioning Groups will manage the roll-out in their own areas with support from NHS Digital and the NHS Business Services Authority.
NHSX published its first State of the nation report in October 2019, which covered the breadth of development ongoing in artificial intelligence (AI) in healthcare.
Resulting from investigations carried out by the health service digital unit into how AI is being developed in the NHS, the report found that diagnosis and screening are the most common uses of AI.
The governance of AI was investigated in detail in the report, which proposed a new framework that emphasised ethical and legal considerations. Implications around the data that feeds AI systems was discussed in the report, as well as the topic of training people in the development, deployment and use of AI.
Also in 2019, the NHS said it would provide funds to reward use of AI and machine learning in the health service. According to NHS England, examples of where AI and machine learning trials have demonstrated the potential to increase efficiency included two million breast screenings carried out in the UK each year, in which each result is reviewed by two clinicians.
A much-awaited review by Mike Richards, former chief inspector of hospitals at the Care Quality Commission and the first NHS cancer director, investigated the IT infrastructure supporting breast, cervical, bowel and other screening services – and found a number of issues.
Launched in October 2019, the report called for the urgent replacement of breast and cervical screening, but also found issues in the platforms supporting other types of programme. A Public Accounts Committee report had previously found that screening IT in general had been unfit for purpose since 2011.
In August 2019, NHSX started to work on improvements to the delivery of screening services. Under a partnership with NHS Digital and Public Health England, NHSX launched a discovery exercise to understand the challenges that patients and health professionals experience, cervical screening being a priority of the programme.