It’s a truism to say that technology is moving fast, yet so too is the thinking about how to harness its potential in health care.
So far 2019 we have seen the launch of the NHS Long Term Plan, the Topol review, details on NHSX, and the latest iteration of the code of conduct for data-driven health and care technology. While exciting, the pace risks there being inadequate time for thinking about the objectives, benefits and risks of new technology.
Urgent attention needs to be paid to operationalising service innovations (such as the NHS App, video consultations in primary care, mobile monitoring devices for people with diabetes and paperless systems), while also supporting the workforce to take up new ideas and practices. These are essential, but local and national system leaders need to ensure these steps are underpinned by a strategic framework that puts patients at its centre.
Four key areas warrant attention: purpose, clarity about the rules of the game with industry, obtaining fair value when sharing NHS data, and building analytics capability.
1. Be clear about the problems for which technology is the solution
Innovation is only a force for good if it tackles the problems being faced by patients and staff. The NHS needs to be clearer about what it sees as the most significant problems, and where it thinks technology might play a role in overcoming these.
Unless the NHS is clear about what it needs, there is a risk that developers and innovators will develop solutions that add marginal value – for example, more convenient health care for the worried well. Software developers and innovators need to be told what the NHS considers the biggest needs to be, to make sure that energy goes into the right places.
Some challenges to industry might be: can you develop approaches to improve care for the 14.2 million people in England living with multiple conditions, who often have poorer quality of life, difficulties with everyday activities and fragmented care? Can you develop approaches that improve, rather than worsen health inequalities, by addressing the needs of our most deprived communities or groups at risk of exclusion?
2. Be transparent about the rules of the game with industry
There is an explicit aim in the Long Term Plan to 'encourage a world leading health IT industry in England with a supportive environment for software developers and innovators.' It will be essential to be transparent about how the growing health tech industry will be regulated for quality and safety, and how decisions will be made about whether to purchase technologies or support their use within the NHS.
There are real risks here. When new technologies have been implemented in the NHS in the past, they have sometimes driven up costs without obvious health gains, at least in the short term. Algorithms could entrench or potentially increase health inequalities. Imagine that somebody is not referred to surgery because an algorithm identifies that, on the basis of their gender or race, that they are less likely to benefit, or if an ambulance doesn't arrive quickly because an algorithm has prioritised other neighbourhoods.
The Long Term Plan is light on how change will be evaluated, and the code of conduct for now requires only that suppliers consider what 'evidence generation plan should be put in place.' Although NICE is developing an evidence standards framework for digital health technologies, there is still more work to be done to ensure that new technology is having the effects that were intended.
3. Obtain fair value when sharing NHS data
The latest Life Sciences Sector deal, published in December, recognised that NHS data provide a 'unique global opportunity' to cultivate a health technology industry in the UK. Because it is a universal health care system, the NHS has particularly good data – this could power the next generation of technology, including artificial intelligence and new, personalised treatments.
These data need to be managed for the benefit of the NHS and its patients. A bigger conversation is needed with the public about data sharing, both to build public trust and also to empower individuals to contribute to decisions about how data about them are used.
As NHS organisations begin to enter into commercial arrangements with private companies, it will be vital to ensure these provide good value to the NHS. We need to avoid the situation where technology companies gain too cheap access to NHS data to develop their products, which they then sell without the NHS getting sufficient compensation for the contribution it has made.
4. Build analytics capability within health and care organisations
Amidst the excitement about new technology, it can be easy to forget that the NHS already uses data in a myriad of ways every day, for example to track the quality of care provided and manage scarce resources. The ability to do these tasks well can make a huge difference to the lives of patients and staff.
Unfortunately, we know that the NHS is underdeveloped when it comes to using data to support decision making. This means that, alongside exploring opportunities with the private sector, health and care organisations need to be investing in their own analytical capability.
For some examples of Health Foundation work to fund and champion data analytics in health and care, please take a look at the examples below.
Adam Steventon (@ASteventonTHF) is Director of Data Analytics at the Health Foundation.
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