Tim Kelsey, National Director for Patients and Information, recently said that digital plans for the NHS could lead to savings of £10 billion by 2020 – a staggeringly large figure. The plans he’s talking about were published by the National Information Board (NIB) in Personalised Health and Care 2020 last November. The document contained precious little about how these plans would be implemented or the budget available (perhaps fair given they were released pre-election), so when the initial roadmaps were released, we hoped they would provide more information.
Part of the rationale behind the strategy is to provide an enabling environment for healthcare organisations to embrace technology. Simon Stevens, Chief Executive of NHS England, describes it as “direction without dictation”. This means that a lot of energy has been spent thinking about how to create the right conditions for the NHS to benefit from technology – through building public trust in IT; through establishing a culture of openness and transparency; and through enabling different technology systems to interact seamlessly.
Of course the plans do not only focus on creating the right environment. The NIB has big aspirations: primary, urgent and emergency care services will be paperless by 2018, and all other parts of the NHS will be paperless by 2020 – enforced through regulatory and commissioning requirements.
There will also be changes to the way patients interact with the NHS. Most notably, NHS Choices will be transformed into nhs.uk – an online portal for patients to register with a GP; book appointments and order prescriptions; access apps and digital tools; speak to their doctor online or via video link and view their full health record.
Will these changes lead to £10 billion worth of savings?
While the roadmaps provide a bit more detail about what NHS England will do in practice, they don’t provide any more information about how struggling Trusts might hope to make the transition to digital systems on the ground. The plans do show some awareness of this issue – proposing support for staff training and the creation of local digital roadmaps as well as on-going local stakeholder engagement. But at this stage it is unclear whether this will be enough. Perhaps the publication of more detailed plans in September 2015 will provide more reassurance for healthcare organisations in meeting these targets.
Getting organisational implementation right is essential to the realisation of efficiencies. An on-going Nuffield Trust project has found the evidence on efficiency savings through technology implementation in healthcare is somewhat equivocal. Much of this stems from the inability of healthcare organisations (primarily hospitals) to make the most of technology in practice.
Our work has revealed three important lessons for organisations in achieving efficiency gains:
1. Organisations need a transformation programme supported by technology, not a technology programme
Organisations are unlikely to see efficiencies if they don’t change the way they work in light of technology. This is not easy. In the first instance, technologies need to be able to adapt to existing ways of working without setting the existing system in stone. It means those using the technology on a regular basis need to regularly revise their processes and how the technology is used, weaving it into day-to-day routines. For example, work should not be duplicated such as keeping both paper and digital records. Where organisations fail to adapt, and attempt to “layer” technology on existing processes, “work-arounds” are more likely to be required such as medical scribes to enter data – thereby reducing efficiencies. This constant cycle of monitoring and improvement will require significant, on-going investment. Implementation of digital systems must not be seen as a one-off event.
2. Organisations need to invest before they save
Related to the above, organisations need to be aware that there is a period of learning when a new digital system is implemented. Process transformation will be required, which will need both individual staff members and organisations to learn new ways of working. This is likely to cost money – and where efficiencies are realised eventually, they are unlikely to be realised within the first few years of implementation. This must be factored in to any business case, and borne in mind when evaluating the system. Where Trusts are already at full stretch, it is unclear how they will be able to cope with this.
3. Organisations are likely to see the biggest savings from investing in analytical capacity
Analysing organisational data can help providers to become “learning organisations” – constantly improving processes and ultimately outcomes. Analytics can also enable organisations to move from reactive to proactive care – for example through offering the same screening or diagnostic intervention to entire patient cohorts simultaneously, which will drive efficiency savings.
Without considering these points, it is unlikely technology implementation (even if implemented at scale through interoperable systems) will lead to savings in the order of £10 billion.
In addition, while creating a single, online platform for patients to see their records, find advice and connect with a healthcare professional will be hugely beneficial for patients, there is some evidence which suggests consumer portals increase demand – which may offset efficiency savings for primary care, at least in the short-term.
Nevertheless, embracing technology is essential for the future of a modern, efficient and safe NHS.
We need to be realistic
If there was ever a time in which the NHS needed technology to deliver efficiency savings it is now. But the NHS is still in the foothills of becoming a digitally enabled service: a stage when IT can cost more than it saves; a stage which requires headspace and time to invest in the service transformation that IT can facilitate.
While the efforts of the NIB to help the NHS on this journey are to be welcomed, the estimates of potential savings appear unrealistic – particularly if organisations don’t make transformational change when implementing technological solutions.
Castle-Clarke S (2015) ‘Will technology save the NHS £10 billion?’. Nuffield Trust comment, 30 June 2015. https://www.nuffieldtrust.org.uk/news-item/will-technology-save-the-nhs-10-billion