A Three-Point Plan for Digital Delivery

Sam Shah has seen health tech policy up-close and worries that little progress has been made over the past five-years. However, he has a plan for any health and social care secretary who'd like to solve problems instead of issuing sound bites.

Sam Shah has a very diverse portfolio: spanning clinical work, academic leadership, legal advice, and health tech advisory roles that see him travelling from the UK to the Middle East and back.

Shah has developed this diverse range of interests since he left NHS England and then NHSX, where he was director of digital development. So, he has excellent insight into the progress the NHS is making on digital - and he doesn't think it's great.

Lots of noise, very little action

"I do not think health tech has moved forward for the past five years," he says. "There has been a lot of talk, a lot of initiatives, but very little activity. There have been five changes of leadership at NHS England on digital in the past five years, and a lack of transparency about what they have been doing.

"The digital maturity assessment [that was supposed to underpin the frontline digitisation programme to implement and expand electronic patient records] has never been published in full.

"NHS England says 90% of trusts have an EPR, but […] that statement is meaningless unless you have a definition, or can say how things have changed over time, or whether these tools are being used, or what difference they have made.

"The cost isn't clear because it's subject to constant reassignment. And even though the last Budget made another announcement on funding, there is no programme, no proper senior responsible officers, to spend it."

In fact, he argues, Wales, Scotland and Northern Ireland have all made a lot more progress for a lot less noise by creating teams with clear digital responsibilities, allocating them a budget, and letting them run "small, useful" programmes in collaboration with their healthcare systems.

A three-point plan for progress

The UK is almost certain to go to the polls for a general election this year and it’s almost certain that Labour or some version of it will be voted in. Shah knows exactly what he would like shadow health and social care secretary Wes Streeting, who likes to talk about "reform" and apps, to do.

"He should establish a strategy, aligned with the system - which means industry partners as well as people working in healthcare," he says. "He should pick three things to do well, and find the budget to do them, but delegate it so people don’t have to keep going back to the centre."

And what three items would be on Shah's wish list? "Number one would be to make it easier for clinicians to collaborate with other clinicians," he says. "Not just referrals, or sending people from GP surgeries to hospitals, but the co-ordination of care across the system, or what we used to call 'any to any'."

This would not just smooth care pathways, he adds, but Amazonify healthcare. Just as people can use apps to track their parcels and modify their deliveries, they'd be able to see where they are in the healthcare system and make choices accordingly. Health is complex but decent platforms would make things a little easier.

"The second item on my wish list is to sort out the data environment," Shah continues. "That doesn't mean putting in one EPR, but making data fluid, so we can sort out data for our planning and our public health and our research colleagues.

"And the third thing would be to sort out the front end: whether that’s the frontend for clinicians or for patients." Shah says this means modern, mobile technology that makes it easy to do basic tasks, like putting together a patient list, or viewing a series of appointments on a calendar.

Not lots of apps. "Clinicians are getting app fatigue from being told to download this and login to that," he says, "and we don’t want to start giving our patients app fatigue as well. They are much more likely to want one login and one place to see everything, end to end as far as the NHS is concerned."

Sort out today's problems, then see what AI can do

Interestingly, Shah's wish list doesn't include AI, even though it seems to be compulsory for Streeting and other politicians to claim that it will solve all the NHS’ problems. “AI is interesting,” he says, “and everybody is interested in generative AI in particular, but we need to get the basics right.

"We need to solve today's problems and then start layering in AI, when it's mature enough, and we know which of tomorrow’s problems it’s going to help us with."

Instead, he has costed his wish list - he reckons it would cost around £4.7 billion over the first three years of a five-year programme. After that, there might need to be some "top ups" - although he argues his wish list would deliver efficiency savings.

For example, a transparent and efficient referral system would reduce the need for referral administration and cut the number of GP appointments that are made by patients desperate to find out what has happened to their test or trip to outpatients.

Better data could help public health and its partners in local government to get back to addressing some of the inequalities, determinants of health, and lifestyle choices that drive demand at a fundamental level. And some nifty administrative tech could deliver significant efficiencies.

"I see in my own practice that people are in pain, so they ring a call centre for an urgent appointment but it's made at a centre they cannot get to, at a time they can’t make, so they don’t turn up," he says. "It really should be possible to stop that happening."

Soundbites and spin doctors

Still, Shah is not exactly confident any of this will happen. Having seen some politicians at close hand, he feels they’re looking for soundbites to deliver to their electorate.

"They don't want practical or costly. And this is practical and costly," he sighs." Those of us who have been in the system: we can say the right thing and not worry about it being the popular thing. But most politicians aren’t in that position."

This might be an argument for following the lead of Wales and, to some extent, Scotland, and creating an arms-length body to plan and deliver NHS IT. Or, perhaps, to re-create one, as the NHS in England has tried a similar idea before, with the NHS Information Authority, and then NHS Digital, and NHSX.

Shah feels the idea has merit - but the fate of these bodies shows there are pitfalls. "There is no doubt that NHS England has got too big and there is an argument for breaking it up again," he says. "But you should only do it if you can find the right model, and the right leaders.

"It can't be like NHSX, where the friend of a politician was parachuted in, and created a circus before he went off to the zoo [NHSX boss Matthew Gould eventually departed for the Zoological Society of London].

"You need a good operator, who understands the NHS, but knows how to run a major programme and handle a big budget. If you can’t find one, you shouldn’t bother."

Finding causes for optimism

And if Streeting did come knocking, would he be tempted to go back? Shah laughs. "Only if he liked my plan and could accept a dose of reality," he says. And only if the right team was appointed, and promised the space to build, implement and deliver products.

Still, he says, there are reasons for optimism about health tech. "I think there is a commitment to improve access to healthcare for society, and I think it is recognised that inequalities have widened and there is a need to address them" he says.

"So, there is an opportunity for digital, which is to bring data together to help clinicians to do the job, and to help planners make better public health decisions. And, of course, to be more transparent with the public. I think digital and data can get into quite an interesting space, and there is an opportunity to do it."

Biography

Professor Sam Shah  works in digital health across the College of Medicine and Dentistry with Ulster University and is visiting faculty at UCL and UCLan. Sam works clinically in primary care and is an NHS consultant at the Royal Wolverhampton NHS Trust. Sam was previously chief medical strategy officer for online healthcare provider Numan. He works with a number of organisations in health tech, supporting development of ecosystems. He has a particular interest in health tech regulation, public health and behaviour change.

Most Popular Now

AI can Help Improve Emergency Room Admis…

Generative artificial intelligence (AI), such as GPT-4, can help predict whether an emergency room patient needs to be admitted to the hospital even with only minimal training on a limited...

Philips ePatch and AI Analytics Platform…

Royal Philips (NYSE: PHG, AEX: PHIA), a global leader in health technology, announced the successful nationwide rollout of its ambulatory cardiac monitoring service in Spain using its unique wearable ePatch...

Comprehensive Bibliographic Dataset Adva…

A groundbreaking study published in Health Data Science, a Science Partner Journal, introduces a curated bibliographic dataset that aims to revolutionize the landscape of Health Artificial Intelligence (AI) research. Led...

AI Health Coach Lowers Blood Pressure an…

A new study in JMIR Cardio, published by JMIR Publications, shows that a fully digital, artificial intelligence (AI)-driven lifestyle coaching program can effectively reduce blood pressure (BP) in adults with...

Will Generative AI Change the Way Univer…

Since the launch of ChatGPT 3 in November 2022, we've been abuzz with talk of artificial intelligence: is it an unprecedented opportunity, or will it rob everyone of jobs and...

New Deep Learning Model is 'Game Ch…

Research led by the University of Plymouth has shown that a new deep learning AI model can identify what happens and when during embryonic development, from video. Published in the Journal...

Huge NHS Cloud Deals Mean Tough Question…

Opinion Article by Chris Scarisbrick, Deputy Managing Director, Sectra. The largest public cloud projects to ever take place within the NHS are beginning. Regional procurements for public cloud hosted diagnostic imaging...

AI Tech should Augment Physician Decisio…

The use of artificial intelligence (AI) in clinical health care has the potential to transform health care delivery but it should not replace physician decision-making, says the American College of...

A Three-Point Plan for Digital Delivery

Sam Shah has seen health tech policy up-close and worries that little progress has been made over the past five-years. However, he has a plan for any health and social...

Facial Thermal Imaging + AI Accurately P…

A combination of facial thermal imaging and artificial intelligence (AI) can accurately predict the presence of coronary artery disease, finds research published in the open access journal BMJ Health &...

New AI Algorithm Detects Rare Epileptic …

More than 3.4 million people in the US and 65 million people worldwide have epilepsy, a neurological disorder that affects the nervous system and causes seizures. One in 26 people...

Siemens Healthineers Debuts New Cardiolo…

Siemens Healthineers announces new cardiology applications with artificial intelligence for the Acuson Sequoia ultrasound system, as well as a new 4D transesophageal (TEE) transducer for cardiology exams. These cardiology applications...