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The latest attempt at digitally transforming the NHS has the potential to “be different”, but only if the government tackles challenges around workforce digital skills and legacy IT and ensures staff and public support, according to the Health and Social Care Committee.
A report by the committee on the progress of digital transformation in the NHS highlighted the many previous unsuccessful attempts at digitisation, and said there is still “substantial variation” between NHS organisations.
According to the report, some organisations lack “even the most basic, functioning IT equipment”, which remains one of the key barriers to digital transformation in the NHS.
Software company Liquidlogic told the committee that many NHS organisations “are still kitted out with old, poor-quality PCs and laptops”.
“They run old versions of Microsoft Windows,” it said. “It can take over 15 minutes just for a PC to turn on, before people can start logging-on to their clinical system. Wi-Fi provision is often inadequate.”
The government published its plan for digital health and social care in June 2022, which promised more personalised healthcare and faster access to it.
The committee believes this latest attempt could succeed, as it has clear intentions and funding to address “factors that have frustrated progress in the past”. However, the report added that the government will only be successful if it responds “robustly” to challenges such as workforce skills and the challenges of building an inclusive digital health service.
The NHS has a checkered history when it comes to NHS IT. First, there was the disastrous National Programme for IT in the NHS (NPfIT), then the Care.data programme, which damaged public trust. However, in 2013, the then health secretary, Jeremy Hunt promised a paperless NHS by 2018, a target which was then moved to 2020, before a review found it to be unrealistic and recommended the target was moved to 2023.
Then, in 2019, the NHS published its NHS Long Term Plan, which set out a goal for all healthcare providers to have reached a “core level” of digitisation by 2024, including electronic patient records, and by March 2025, all NHS trusts would have electronic records.
Much of the digital funding has been directed towards “exemplar” trusts, those which already have a decent level of digital maturity. However, now the plan for digital has allocated £2bn multi-year funding to Integrated Care Systems (ICSs) to support trusts most in need, the report said.
One of the key success stories often used is the NHS App. The roll-out of the NHS App first began in January 2019, and it was hailed as the digital front door to the NHS. During the Covid-19 pandemic, use of the app spiked significantly, as it was used for various services including online consultations and Covid vaccination status.
While more than 30 million people have now downloaded the app, the benefits of using it, compared with non-digital services, “are not clear to many existing users”, according to the committee’s report.
“Witnesses agreed that the current integration of the app with NHS services is limited, and suggested that this limits usage,” the report said.
“For example, the Lift Council pointed out that just 8% of GP appointments are booked via the app, while Pharmacy2u noted a lack of integration with the pharmacy sector that inhibited the app’s use for managing prescriptions.”
It added that while the app could potentially support a wider shift towards digital channels in the future, “its current functionality is limited and the benefits of using it are not always clear”.
NHS England is currently in the process of replacing the NHS App with a new, native app, which will be present on the phone and integrate with its architecture, rather than run as a web-based version, which it hopes will support additional services and functionality.
“In the longer term, moving to a native app will help to enable the app’s capacity to make use of the data collected by the phone to provide personalised health advice and information,” it said.
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However, there is still no timeline for when this will happen, and the committee has called on the Department for Health and Social Care (DHSC) and NHS England to set out a plan for communicating the app changes.
Another issue is the use of third-party apps. The report said that while digital transformation can offer people choice and control over their healthcare, experiences with digital healthcare “depends in large part on whether they use an appropriate product”.
Previously, there have been several iterations of an NHS apps library – a list of approved third-party apps, hosted by NHS Digital. The first NHS apps library launched in 2013, however, it came under fire in September 2015, after a study, co-authored by researchers from Imperial College London, revealed several NHS-approved apps were leaking data about their users. The library closed shortly after, before a second version of it appeared in 2017. However, that was also closed after being decommissioned in 2021.
“The department and NHS England lack a systematic, consistent way of assessing and demonstrating whether a third-party health app reaches the necessary quality standards, and we heard that a majority of health apps currently available fail on aspects including clinical efficacy, security and cost,” the report said.
“This is unacceptable: using an unsuitable health product can affect people’s health, and might make people less likely to opt for digital channels in future. The department and NHS England should work together to introduce a more comprehensive accreditation scheme for third-party healthcare apps, in addition to the current approach of recommending specific apps on some nhs.uk webpages.”
According to the report, DHSC also plans to integrate third-party apps into the NHS app, but there is no timeline in place for this. The committee said it should be easy for people to check whether an app they use for healthcare purposes is recommended by the NHS.
“This scheme should be supported by publicity and communications that both promote the benefits of digital healthcare and explain the risks of using unaccredited apps, providing a clear steer on why using an accredited product matters and where to find them.”
One of the key barriers to digital transformation has been the lack of digital skills. In the Digital, Data and Technology (DDaT) sector, it’s often difficult to recruit, as the private sector often offers higher wages and better conditions.
The committee has therefore called on the DHSC to apply to implement the DDaT Pay Framework for NHS England, which would mean they could add pay measures such as bonuses to attract staff.
According to the DHSC, it is planning on a workforce strategy which “will provide a framework for bridging the skills gap and making the NHS an attractive place to work”.
It added: “This was initially due to be published in March 2023 but has subsequently been delayed. At the time of writing, it had not been published.”
However, digital skills does not only relate to the DDaT workforce. The rest of the NHS workforce also needs to understand the technology they are being asked to use if it is to be successful. However, the committee noted that the government’s plan for digital does “not contain any specific commitments to upskilling the wider workforce beyond DDaT specialists”.
“Investment in the NHS’s specialist digital workforce needs to be matched by investment in the wider workforce’s digital skills,” the report said. “It is important that digital is understood as a thread that runs throughout healthcare, not as a specialist skill set that is only relevant to some staff and occupations. Without staff engagement in the entire process of introducing digital initiatives, digital transformation risks being perceived as an unwelcome, time-consuming imposition on an already overstretched workforce.”
Social care is also suffering from a digital skills gap, which the report said could hinder digital transformation if it remains unaddressed.