When I started my career as a radiographer some 20 years ago, I was in awe of the NHS. Its brand and its sheer size was and still is like no other organisation anywhere in the world. But it did not take long to learn that this national institution does not fully harness its potential reach, power and influence as a provider or as a customer.
Our national health service is most certainly envied and admired across the globe. It is something we should be immensely proud of. However, even today, the NHS does things in a fragmented and disconnected way, restricting its ability to connect services for patients and limiting its strength as a consumer of technology.
Much more could be done to maximise the impact of its magnitude and in turn deliver greater benefits to hospitals, staff and patients. Any business of this size would have the greatest buying power on the planet, with the ability to wield tremendous economies of scale and command markets.
The NHS does have the potential to be the most powerful technology customer in the world. But it needs the mechanisms to support this, and that means taking a different approach to IT strategy and IT infrastructure.
The National Programme for IT was in part a success but it failed to deliver the ability to share information seamlessly across a region, let alone the country.
However, the idea of an NHS that utilises common infrastructure at a national level, may make technology far more affordable for hospitals and allow them to get the tools they need.
Cultural buy in is certainly already there. The majority of NHS staff understand the benefits of sharing information and have a desire to engage in cross enterprise working, a practice that can support in-sourcing and sharing of resources across the health service. Equally, healthcare professionals want data to flow and to follow the patient, so that a clinician can make an informed decision with right information when the patient is sat in front of them. The NHS certainly does not lack vision.
What it does lack is a single strategy to support that vision. Whilst some hospitals leap ahead in their technology deployments and digital maturity, others cannot afford to pay for expensive infrastructure that enables cross organisational, or even cross departmental working.
The cost of deploying infrastructure at a local level to support collaborative working can be prohibitively expensive. Culture is often blamed for the NHS not having achieved joined-up and integrated practices, yet the affordability of technology is undoubtedly a major barrier.
Consumer technologies like Google are only run at such a low cost per user because of the global scale on which they operate. The volume makes them affordable. No single user organisation would entertain hosting a technology like this. The same should apply for hospitals which could benefit from aggregated cost reductions if the technology they use was instead centrally hosted for any number of trusts to draw on.
The NHS needs a technology infrastructure that allows it to plug specialist tools into a backbone capable of sharing information across a wider audience. Hosted solutions, cloud solutions and pay as you go models that can be scaled to a national level are a way forward for the NHS. IT infrastructure must deliver the best it possibly can to different people across the enterprise at the lowest possible price. This does not mean that specialists need to sacrifice their specialist applications, rather the infrastructure layer needs to be commoditised and standardised.
The infrastructure must also respond to the fact that there is an enterprise across which patients will flow, as must their data. This will enable the NHS to become more patient centric. Right now in the health service, even demographic information does not follow patients, who have to fill out their names and addresses on paper forms so many times. This must change and hospitals need technology that is affordable to make that happen.
The National Information Board talks about becoming tight on standards, whilst still allowing local decisions, in its new framework for action on providing personalised healthcare by 2020, a document that emphasises the need to give professionals and carers access to all the data, information and knowledge they need. All of this can and must happen.
We need to move away from a disparate, dysfunctional approach to IT. We have a national health service to be proud of, but there is nothing national about the IT strategy that underpins it. The NHS now has the opportunity to address this and to move from being a fragmented NHS to one NHS.