By James Norman

The NHS must do more to support frontline staff and work with innovative IT suppliers if it is to embed the change required at scale to safeguard its future, argues seasoned health IT veteran and Highland Marketing industry advisor James Norman.

Technology has transformed huge swathes of modern life, but the change that has gripped the high street is slow in reaching the hospital. The NHS needs to make a significant shift in approach if it is to realise the potential for IT to create better, more efficient care.

One issue is that technology is not seen as an enabler, with budgets often at risk and leadership absent from the board. How often do we hear of how funds for IT projects that could save money in the long run have had to be sacrificed to address short-term financial pressures?

Various initiatives show that there are masses of innovative ideas coming from the frontline, and technology is often key. But without the necessary support from central government, such as backfilling the roles of nursing staff to give them time to spread these ideas and  good practice, such projects will struggle to deliver change outside the local environment.

Spreading good practice is essential
Central government needs to look at ways to incentivise innovative projects, through targeted funding that supports frontline staff with ideas that can have a wider impact. What is required is ring-fenced funding and guidance to support projects that capture good ideas and provide the support that will help the spread and adoption of good practice.

The Beacon projects were an example of this. These involved health organisations in three areas of the country and looked to disseminate good practice drawing on the work of US health provider Kaiser Permanente across health economies and their work to embed enhanced integrated care, and demonstrated a positive impact in three areas across the country. A 2010 Health Services Management Centre policy paper looking at these projects called for the integration of services to be delivered on a more ambitious scale.

Some of this activity evolved into integrated care pioneer sites. A recent report showed that, whilst some progress has been made at a local level, this initiative has been held back in part because “the wider health policy environment had become less supportive of transformation”.

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Integration is a central theme for the Five Year Forward View, so this lack of progress is a concern. Alongside this, the financial climate means that some organisations are becoming ever more cautious of investing in technology to drive change. IT budgets are sometimes seen as a reserve that can be dipped into when times get tough, and projects put on hold as immediate pressures come to bear.

Technology must drive transformation
Without concerted support for technology-enabled change, transformation of the scale required is unlikely to be achieved. Technology has traditionally been seen as an afterthought, rather than a fundamental part of transformation.

Such an approach can be seen in engagement with SMEs and other innovative suppliers, whereby they are brought in after the change has been decided and tasked with designing or changing a system to support that change.

SMEs and other innovators need to be involved early on in discussions, to help shape the strategy and thoughts as to how they can enable digital transformation at scale. If they are only brought in after the change has been decided, their input is limited and the opportunity to change the way services are provided to incorporate the capabilities that new technologies bring, will be severely hampered.

This can mean that clinical systems are developed that merely replicate existing processes, rather than realise the benefits that come from using technology to re-engineer the service. Electronic Patient Records that are implemented to replicate current, paper-based ways of working, are likely to fail to deliver the benefits that we know they can bring.

Central support is essential
Cultural and operational change will only come through support for spreading innovation across the NHS through investment in the ideas of frontline staff, so they can show how their ideas can work in different health economies. Promotion and mentoring are vital elements of this process, as is providing the headroom for innovation to flourish.

The Beacon sites tried to do this; the Department of Health’s former NHS Modernisation Agency sought to do the same. Now Academic Health Science Networks have a similar role, but lack the budget and teeth to enforce any change. They struggle to foster innovation at scale as they are trying to coordinate a number of small projects/pilots that are working independently of the wider environment.

Even the new NHS Improvement body looks like it may focus more on sustainability than transformation. The Wachter Review of health IT has a narrow remit, and just looking at digital technology in the acute care setting may not have the necessary impact to support change across the whole system approach that is required.

There are great ideas happening across the NHS, as anyone who follows pioneers such as Helen Bevan or Roy Lilley and his Academy of Fabulous NHS Stuff website will know. They are regular proponents of many good things that are happening in healthcare.

However the future NHS will struggle to be sustainable without a tangible commitment to technology-enabled transformation. Central support for those that can drive and deliver innovation at scale is essential, or else we risk missing the opportunity to use IT to deliver the world-class healthcare for which we are renowned.

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