The NHS technology lag cannot go on

In a response to our new briefing, Jonathan Serjeant, co-founder of Brighton and Hove Integrated Care Service (BICS), argues that the NHS needs to take a proactive approach to implementing new technologies, before it gets left behind.

Blog post

Published: 08/04/2016

Managing our money via an app, keeping in touch with family around the world on Facebook, or using a smartphone to buy cinema tickets are things we take for granted in 2016. So why are we finding it so difficult to make technologies work in public services – especially in health and social care? The Secretary of State for Health recently committed to a paperless NHS, but in the meantime, fax is still a commonly used channel and letters, rather than email and text, are the Luddite default means through which hospitals communicate with patients.

Health care, and its intrinsically important cousin, social care, are laggards in the uptake of modern technologies. The Nuffield Trust’s report on digital requirements for new primary care models rightly identifies the key barriers as professional and patient resistance to change. However, more important – in my view – is the lack of interoperability between systems to facilitate coordinated care.

There are five clinical software providers for primary care across England, yet none of them talk to each other, which makes it impossible for practices to share information with each other. 

Different clinical software systems within general practice don’t work together, and this is compounded by the multitude of systems in use in secondary and community care. There are five clinical software providers for primary care across England, yet none of them talk to each other, which makes it impossible for practices to share information with each other. Smart work has been done in the United States and we have much to learn from it; a collaborative eco-system of providers here could address this.

Aligned clinical systems would enable more effective data gathering. Without a clear snapshot of our health economies, it’s almost impossible to know exactly what a clear end point is in commissioning terms and, importantly, where we should put our (limited) cash into technology uptake.

This month, I start a journey with NHS Collaborate. This work, commissioned by NHS England, will put both people and technology at its heart. As part of the programme we are spending time with the East and North Hertfordshire CCG Vanguard, who provide a good example of how organisations can use social intelligence as a starting point for health. Working with a data analytics organisation that shares a focus on patient outcome with its commissioner, ‘care’ has become the operative driver in the locality.

The boundaries between health and social care are blurring, and an emerging real-time view of the local health economy will inform a decision as to where, for example, telehealth services to support diabetes patients would be most effectively commissioned. More importantly, though, this kind of intelligent data will also help to identify the interventions that will prevent diabetes from occurring in the first place.

Indeed, we need to commit to a new focus on health creation rather than illness management. This is a core agenda for the new NHS Alliance, which seeks to share the understanding that health creation goes beyond public health issues like obesity, into understanding and addressing their root causes. Making this happen requires a low-tech rather than a high-tech approach – the involvement of real people may be more important – but new technologies will inevitably be important for targeting the right people in the population and understanding the impact.

The internet and online resources like Patients Like Me are creating a whole new dynamic, allowing patients to talk to each other through intelligent, people-informed environments.

Our other significant challenge lies in overcoming professional and patient resistance to change. There is a clear imperative to undo the traditional paternalistic ‘do to me’ professional–patient relationship to one that is ‘discuss with me’. The internet and online resources like Patients Like Me are creating a whole new dynamic, allowing patients to talk to each other through intelligent, people-informed environments. It would be churlish for us as health professionals to ignore these; there is much to be gained by engaging with them.

Beyond this, we are seeing new apps like openPASS emerge, which provide a window for health professionals and families into a person’s social care record. These are whole-system breakthrough technologies that have the potential to dramatically change our current, closed and disconnected environment, and transform the vital and fast-growing sectors that look after the vulnerable and older people.

Ultimately, we have to be brave enough to let go of the old, and be proactive in attracting a new cohort of talented, passionate and committed health professionals who are growing up in an internet-driven age: from hospital doctors and GPs, practice nurses and managers to pharmacists and optometrists, there is much to learn and embrace.

Their patients will be people just like them, using all kinds of apps to shape their lives, and who are understandably puzzled that the NHS isn’t keeping up. If primary care is to manage the complex challenges ahead, it must move at pace and scale to adopt new technologies. Science that interrelates with life, society and the environment is what will make a difference – as long as we allow it to do so.

The views presented in this blog are those of the authors and do not necessarily represent the views of the Nuffield Trust or our partners.

All product and company names mentioned throughout this blog are the trademarks, service marks or trading names of their respective owners, and do not represent endorsements.

Suggested citation

Serjeant J (2011) ‘The NHS technology lag cannot go on’. Nuffield Trust comment, 8 April 2016. https://www.nuffieldtrust.org.uk/news-item/the-nhs-technology-lag-cannot-go-on

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