Whether the NHS will cope or buckle around the impending winter of crisis is already under debate. Can digital transformation be one of the silver bullets for the future of the NHS? Without doubt, a better use of technology will help drive the best possible outcomes and services for patients. But why is digital transformation so essential, and what are the barriers?
Changing demographics, rising costs of delivering effective healthcare – both in terms of staffing and treatment – as well as tightening budgets, all mean it is essential for the NHS to progress with innovative digital transformation to avoid ‘cutting further into muscle’.
However, as with any digital transformation project, it’s not as simple as just investing in the technology to unlock efficiency gains and new ways of operating. Investment must be made in changing the culture within the NHS to support new ways of working with technology. Indeed, leadership is key in ensuring strong governance in driving such change.
Given the size and complexity of the NHS as a public service organisation, winning over key staff plays an important role in embracing change. For example, clinical staff who have ‘always done it this way’ can find it difficult to adapt, which can prove prohibitive in the progress of many digital transformation projects.
Structures are another inhibitor. Why, given current funding arrangements, would a 111 provider invest in order to keep patients out of A&E, for example? They would be taking on more cost, but the very significant benefits would accrue elsewhere. Or why would a local authority accelerate a discharge into their care (and cost) from A&E? These structural silos inhibit innovation and stop the wider health and care economy from really making exciting changes for the benefit of all.
That said, there has been some acceleration in the implementation of digital transformation across the NHS. There are some great local examples of organisations coming together to link their systems, and we are seeing Clinical Commissioning Groups (CCGs) now commissioning projects for the wider benefit of citizens in a region – in other words, not procuring in organisational silos.
The results? Putting past national programmes aside, some of the results are very positive. For example, East Midlands Ambulance Service (EMAS) has established a clinical hub within its Emergency Operations Centres with clinical staff trained using Advanced’s clinical decision support (CDS) software, Odyssey. This team includes nurses, paramedics and a mental health practitioner, all of whom perform Hear and Treat – a model of care which resolves 999 calls over the phone by providing advice to callers.
This Hear and Treat service, supported by a huge database of previous cases, means EMAS has the highest percentage of calls resolved by telephone – 18% against a national average of 10%. Even more remarkably, it has the lowest percentage of re-contacts within 24 hours – at just 1% against a national average of 8%. If this could be replicated across England, the NHS could save a further 474,000 unnecessary ambulance journeys – reducing ambulance costs, creating capacity in A&Es and, given most of us would rather not go to hospital, improving patient outcomes.
Another technology trial designed to reduce the strain is taking place in the West Midlands. They are using an app delivered by Sensely, based on Odyssey, which either gives self-care advice or suggests an appropriate next step to patients. It can arrange a call back from 111 or help make a GP appointment. Statistics show that, in over 40% of cases, the app gives appropriate self-care advice, potentially avoiding unnecessary GP visits or trips to A&E.
These projects are allowing for much better integrated care, bookings of GP appointments and, in some cases, the ability to prescribe – all taking pressure off stretched GP and A&E services, and potentially being much more convenient and safe for patients. But it’s clearly vital such pilots are rolled out at scale in other areas of the country with the same problems.
Although we can’t yet know whether these advancements in digital transformation in the NHS are enough to curb potential risks this winter, they are certainly part of the answer. Supported by technology, we need to make radical changes to maintain the ethos and standards of the NHS. It’s far too simplistic to see digital technology as the lone silver bullet for the future of the NHS but it can certainly can help transform the organisation and deliver better outcomes and services for patients.