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NHS challenges require alignment of tech and redesign, says Swindells

NHS England’s national director for operations and information, Matthew Swindells, calls on the NHS to use technology to alleviate pressures on the health service and enable app developers to create an ecosystem of self-care apps

The NHS will not be able to meet its current challenges unless it uses technology and information alongside redesigning services, according to NHS England’s national director for operations and information, Matthew Swindells.

Swindells called for a move away from using technology as an administrative tool and deploying it as an enabler of better healthcare and improved patient pathways.

“Large numbers of people who need support from the NHS are receiving it in a more acute venue than they need, but everything is full, so if you don’t move all of the pieces, you can’t move any of the pieces,” he said. “It feels like the sort of thing technology was invented to help with.”

Swindells said technology could be used to create the space needed for people who actually need face-to-face care by using online services, phone appointments and apps.

“I would much rather go online and answer online the questions that the NHS 111 call centre person is going to answer,” he said, “and if I know the conclusion of that is I need to speak to a clinician, I will happily go to speak to the clinician on the phone.

“Using technology can get people to the right location. If I spoke to a doctor on 111 and the conclusion was I needed a prescription, it would be really great if 111 could send that prescription to the pharmacist. The point of technology intervention in the pathway is to help create a shift.”

Swindells said the NHS needs to move away from the “current madness” of disparate data – where NHS Digital says there is a 3.4% increase in A&E admissions, a hospital says it has a 16% increase in A&E admissions and clinical commissioning groups (CCGs) say something completely different – to a place where there is a single source of truth.

“It’s such a waste of our time,” he said. “We have to get to a single source of truth. We have to get to one set of trustworthy data that we are all using. The number of people who are not getting hip operations because we sit around and argue about whether we have got the referring GP right is outrageous.

“We need to get it right first time, we need to share that data and we need to move to a point where we are focused on an accountable system that is delivering care for the population, not a system that is accountable to the balance sheet.” 

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Swindells said there is no point looking to future technologies, such as artificial intelligence and connected algorithms, while the basics are not in place. 

“Quite frankly, those conversations at the moment are just pipe dreams,” he said. “If we don’t get the underlying technology right and start linking data and sharing data, we don’t get the data quality right and then your predictive algorithms are worth nothing if you base it on crap data.”

Swindells, who joined NHS England last year, has previously urged the NHS to create an ecosystem of innovation that gives patients the tools to take responsibility for their own health. 

Earlier this year, NHS England announced that the revamped NHS.UK website, which aims to become the “trusted route into personalised digital care”, is due to go live in September. 

The library will comprise three tiers of apps: NHS-approved apps with a published evidence base assessed by Nice (National Institute for Health and Care Excellence) and demonstrating that they can “help a person manage and improve their health”; NHS-connected apps that have been “tested and approved for connections to NHS systems” , which means information from NHS systems can be downloaded into the app; and standard “health apps which will be a directory of other health applications which you may choose to use”.

Swindells added: “We need to get to a point where the content within NHS.UK is open and available to the app developers, because I strongly believe that if we want people to adopt technology to manage their care, we are not going to do it by writing one perfect app in Leeds. It will come from creating an ecosystem whereby developers can create for the niche that they need. We need to make that possible.”

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