The novel coronavirus has caused huge disruption in a very short space of time. The UK population has been instructed to "stay at home", the NHS has been reorganised to meet peak demand, and health tech has been moving at a speed that was hard to contemplate six weeks ago.
Back then, visitors to Digital Health Rewired were discussing the potential for remote working and whether the crisis would encourage GPs to try video consultations. Since then, NHS Digital has deployed Microsoft Teams to everyone with an NHSmail address, GPs have moved as much as 90% of their work online, outpatient departments have followed suit, and virtual visits have become the norm.
Meanwhile, health tech firms have been scrambling to create or modify solutions to help the NHS identify Covid-19 patients, support those with symptoms in and out of hospital, and track the progress of the epidemic.
"The vendor community is coming out of this looking great," Andy Kinnear, the former director of digital transformation at South, Central and West Commissioning Support unit told the Highland Marketing advisory board.
He had more mixed feelings about the NHS response. "It is great to see people working so hard and so much good stuff going on," he said, "but we could have pushed on further, faster, earlier - and then we would have been in a better place when this hit."
Change agents - leadership, money, vendor offersWhat has changed to enable the NHS to move now? There has been some strong leadership from the NHS’ central bodies, and a flattening of procurement and decision-making structures; Teams was just rolled out in four days, NHS 111 services are being procured nationally, GP triage and consultation procurements have been run in hours.
There is more money around. Chancellor Rishi Sunak promised the NHS "whatever it costs" to get through the crisis. Just as importantly, NHS England / Improvement has suspended the contracting mechanisms that could make redesigning a service and pricing up its digital elements tortuous - and told organisations to get on with it.
Some of the information governance blocks on sharing information and using commercial communications tools have simply been suspended. And many vendors have been making their software adjustments or services available free.
The challenge is sustainabilityStill, there are challenges. The NHS central bodies have stepped-up and stepped-in, but Andy Kinnear pointed out that this was putting a lot of pressure on a few individuals that cannot be sustained. Local organisations are making rapid procurement decisions, but some of them will be bad decisions.
It's unclear whether the NHS internal market will return, but it's certain that, at some point, the NHS Data Guardian and the Information Commissioner's Office will take a keener interest in some of the data sharing that is going on. And there will be a financial reckoning.
"I see lots of companies offering products and services for free and I also see software companies offering additional licences for the short-term," said board chair Jeremy Nettle. "That's a great response to the 'call to action', but there will need to be some interesting negotiations to be done on the back of this."
Data architectures and cyber security are missingAlso, while the implementation of health tech and the shift to digital working has been impressive, it has not been uniform. There are gaps; and one of the big ones seems to be the collection and use of data.
At Digital Health Rewired, NHS Digital chief executive Sarah Wilkinson said her agency was developing a new algorithm to detect patients with Covid-19 and scripts to direct NHS 111 callers to the right service. Jeremy Nettle argued that this kind of thinking should have been more in evidence before the outbreak, to reduce underlying demand on hospitals.
And James Norman, healthcare CIO, EMEA, at Dell EMC, argued that more e-care apps are still needed, for example to help non-Covid-19 patients who are being advised to avoid hospital or finding it harder to access services than normal.
Andrena Logue from Experiential HealthTech argued that the technology the NHS is deploying now should put it in a better position to develop data driven services in the future, because it will be capturing more information for analysis to inform apps.
But Andy Kinnear pointed out that this would only happen if the NHS gets the data architecture right. And, for the moment, strategic thinking on data architecture has gone out of the window.
Similarly, systems are being deployed with little thought for interoperability, or even cyber security. Entrepreneur Ravi Kumar said the NHS really needed to stop and think about the last point. "We need some sort of defence force to monitor what is going on," he said, "because if the network went down - who knows what would happen?"
The acute sector is still missingOther gaps are shared care records, which appear to be on hold for the moment, and the acute sector. Trusts have been extending their electronic patient records to new services, including the Nightingale Hospitals, and working with suppliers to configure their EPRs to support COVID-19 patients.
But there hasn't been much new thinking on how technology can help hospitals through the crisis or discussion of how enterprise IT can be extended to the quarter or more of trusts that still lack and EPR.
Andrena Logue suggested there might be an opportunity to create a lightweight offer for these organisations that would deliver many of the functions of an EPR, without the procurement and deployment effort. Andy Kinnear agreed, but pointed out "there is a reason that these organisations are so far behind everybody else, and that's [lack of] leadership, and funding, and capacity to deploy, and capacity to drive change."
To address these issues, he argued there needed to be a shift back to delivering IT at a regional level. This would be in-line with international developments and with the new, more directional role being taken by NHS England / Improvement.
The big challenge, again, may be money. The digital aspirant programme, announced just before the outbreak, works out at roughly £1 million to each of 23 hospitals; nothing like enough.
"Spending on IT has got to rise," Ravi Kumar argued. "If we want to sustain this, we need to have a conversation, soon, with the Treasury and the Cabinet Office. How the technology is then delivered is secondary. It has to start with the money."
No going backIn the areas that have adopted new, digital ways of working, there is no going back. Both clinicians and patients are seeing the benefits of remote working, and commissioners and trusts are looking to build on that to drive service redesign in the future.
To build on that, the board suggested that a "lessons learned" exercise would be useful and that digital maturity models should be revisited to include new ways of working at a health-economy level. Because national action during the crisis may have closed down some aspects of the health tech market, they also suggested that firms should be actively introduced to each other to maintain innovation.
NHS IT has changed in response to terrible circumstances, but Jeremy Nettle thought it was in for an exciting time. "Will people say 'We did this in the COVID time, but we're not going to do that now' or will they say 'We did it in the COVID time, so there is absolutely no reason that we cannot do it now'," he wondered. "I think it will be the latter."
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