Brexit will continue to cause short-term upset in UK politics, but it is long-term trends that will shape the NHS and the health tech market in 2019 and beyond. Highland Marketing and its advisors look ahead to the policy, tech and security themes for the coming year.

Lyn Whitfield, director of content strategy, Highland Marketing

It wasn’t easy to write predictions for 2019 in December 2018. In the middle of the year, the government had found a “birthday present” for the NHS of “an extra £20 billion a year by 2023-4”; but we still lacked crucial details, such as how inflation or pay will be handled, or how the money will be distributed.

The long-term plan that was supposed to determine future priorities had not been published; and there was no sign of the social care green paper. Which was hardly surprising when ongoing turmoil over Brexit made it difficult to predict who would be in Number 10, the Treasury, or Richmond House at the end of the week.

Brexit could have a terrible impact on the NHS. But assuming public health information continues to flow, EU staff are persuaded to stay, and health and social care secretary Matt Hancock finds enough fridges to keep the pharmacies open, it is long-term trends, not day to day politics, that will shape the NHS and health tech in the coming year.

The demand pressures on health and care caused by an ageing population and rising inequality are not going to let up. The £20 billion won’t go far toward addressing them, when the acute sector is £1 billion in deficit and the Treasury seems determined to get hospitals hitting key targets again.

Traditionally, the NHS’ response when change is needed but apparently blocked is a reorganisation, and the outline of one is becoming clear. NHS England, NHS Improvement and Public Health England have effectively announced a new regional structure.

NHS England chief executive Simon Stevens has insisted that the push for accountable care organisations (currently integrated care services) is “the only game in town.” And his deputy, Matthew Swindells, has said one clinical commissioning group per ICS should be plenty.

Hancock has shown no interest in disrupting this direction of travel since he replaced Jeremy Hunt; and it is anyway in line with reforms being pursued by health systems worldwide. So, a change in personnel or government is unlikely to derail it (although the organisational acronyms may change again).

On the tech front, this should create space for the further development of regional care records and predictive analytics. The big question is whether it will finally force change in England’s hospital-focused model of care; and if it does, how the tech component of that will be addressed.

Digital laggard trusts have a huge job of work to do, while leaders are starting to face legacy issues. There is growing agreement over what Hancock calls “interoperable data standards”, and this should help to link-up existing systems.

But with the global exemplar programme mostly pushing single-supplier EPRs and the secretary of state pushing public-cloud located, internet-first applications, someone will need to broker an agreement about what the future looks like. And then find a way to deliver it. Now, why does that sound familiar?

Mark Venables, CEO, Highland Marketing

It’s tempting to say that in 2019, winter will be cold, spring will be wet, summer will be very hot, and autumn will start getting cold again. Because it’s hard to see how 2019 will differ significantly from 2018.

The challenges facing the NHS and social care remain the same, and it sometimes feels as if the people working in them are so bogged down in the day to day that they don’t have the time to scope out, never mind adopt, the transformational change that everybody can see is needed.

Health tech companies still need to communicate their messages, though, so the right stakeholders hear them as often as possible and are ready to act on them when they have the headspace and resources. Selling to the NHS is a long-haul, and the key to success is to have a drip-feed of the right marketing, PR and sales content.

If it’s hard to see much change in the NHS and social care, there are changes on the technology front that are likely to have an impact in 2019. The idea that every hospital should have its own IT department, running its own server room, and sorting out its own network and devices is being questioned.

The idea that everything is just going to shift to the public cloud is unrealistic. But I would expect to see the wider uptake of hybrid models in 2019, with more major suppliers hosting their own systems, and more applications becoming cloud based.

That should free up chief information officers to focus on strategy and free up people in their departments to focus on more interesting things. Again, the role of PR and marketing in all this is to make sure companies have their messages in front of key influencers, and to show them the art of the possible, and how that will support them.

That’s particularly important because the health tech market is such a crowded space. It is a paradox that while health and care is a hard and cash strapped environment, there are a lot of companies looking to sell into it. In 2019, as in other years, it is companies that put the effort into understanding the market and shaping its thinking that will stand out.   

James Norman, healthcare CIO – EMEA at DellEMC, and Highland Marketing advisory group member

I think there are going to be a few key initiatives that will continue through 2019 and some innovations that take off in a niche way. The key initiatives are interoperability platforms and data analytics, by which I mean machine learning, deep learning and, to a lesser extent, AI. What the papers call the “rise of the bots”. 

Interoperability platforms will be built through a combination of cloud and hybrid on-premise environments. There is a push from the centre to use public cloud, but a large percentage  of the applications in use in the NHS will not run in a cloud environment; whilst long term storage ofdata in the cloud can be prohibitively expensive, because of the cost of retrieving it when needed.

Nevertheless, people are starting to accept that cloud is going to be part of the story; and some of the big providers have just made it easier to move data to and from their clouds: Microsoft Azure and AWS have announced systems that will make it easier to consume cloud services.

This should enable people to take advantage of the flexibility of cloud, while maintaining the security that comes with managing patient data on premises, and the cost benefits of archiving data on disk or tape.

At the same time, people are starting to understand that different cloud environments are good for different things; and in 2019 I think we will start to see the spread of what we call multi-cloud, with people managing data between different providers.

The exciting part of all this is that once you have built your interoperability platform, or your collaboration and research platform, you can start using the data differently. Until relatively recently, people either had to build their own analytics platforms or, if they wanted to go down the AI route, they had to work with companies like Google DeepMind or IBM Watson.

Now, there are new entrants writing applications for healthcare that organisations can plug and play; and we are starting to see trusts adopting them for simple things, like audit, readmission planning or drug dose checking, because they save time and improve efficiency.

Around the world, we are also seeing pockets of interest in using machine learning to identify disease and treatment trends, to risk stratify populations, change clinical decisions in real time, or even tell patients that they might be better going to a GP practice with open appointments than staying in A&E.

We will see a slow rise of this in the NHS in 2019; and it is the direction of travel for the LHCREs, especially now the research agenda is being brought in. My niche innovations, finally, are augmented and virtual reality. There is a lot of investment going into this area; and they’re definitely going to be featuring in future predictions with pockets of clinicians trying them out in 2019.

Dr Saif Abed, founding partner and director of cybersecurity at AbedGraham, a Highland Marketing partner

When it comes to making predictions, there’s the risk of making outlandish or wildly ambitious claims about what the future could look like. The technology sector is particularly guilty of this; there will undoubtedly be claims the 2019 will be the year of technology x, y or z or, even more cliché, the year of disruption.

The world of cybersecurity is no stranger to this. However, there are some inescapable facts that – as much as being predictions – are warnings to heed.

  1. The cyberattacks won’t stop
    In fact, the volume of attacks targeting the NHS will go up. It’s simple maths. We continue to digitise NHS organisations with more applications and devices that are network connections; so there are more things to try and break or take control of.
  2. The cloud brings new risks
    Transitioning to more cloud-hosted services in 2019 is going to yield productivity, workflow and security benefits for the average trust. That doesn’t mean it’s risk free. It simply means there will be new types of vulnerabilities that we have to be aware of and contending with. Attackers will be keeping a keen eye on this.
  3. Interoperability and contagion
    Interoperability is the name of the game for 2019. We need major healthcare IT suppliers to work together to support regional workflows. However, if insecure networks and systems are connecting with each other then they introduce risks to one another that mean a single attack could compromise an entire region.
  4. The Internet of Insecure Things
    IoT devices are now everywhere. That includes medical devices and more of them is going to be another upward trend. Unfortunately, many of these devices are woefully insecure. We will see more IoT attacks hitting the headlines in 2019 that will hamper everything from hospital facilities to patients’ medical devices.
  5. Insecure start-ups
    My final prediction is the only one I think isn’t guaranteed for the coming year, although I do think that it is ultimately inevitable. In 2019, a major digital health start-up in the UK will suffer a major cybersecurity event that either takes down its services or leads to a patient data breach. Start-ups are notorious for paying little attention to security and regulatory standards and that’s no different in healthcare.

So those are my predictions for 2019. They might sound like doom and gloom; but in reality most of these are perfectly manageable if we work together to tackle them head on.

Andy Kinnear, director of digital transformation, NHS South, Central and West Clinical Commissioning Group, chair, health and care executive, BCS, The Chartered Institute for IT, and Highland Marketing advisory group member

I think 2019 will be remembered for three things. The first is the start of real consumerisation in the health and care space. We are going to see the launch of the NHS App, a big expansion of the NHS Apps Library, and an explosion of personal health record platforms of one form or another. This agenda has been bubbling under for a while, but this year I think that it will surface and be really exciting.

The second thing is a huge change in digital leadership. I think we will see boards start to take their responsibilities seriously and give a lot more time to the digital agenda. That’s because [health and social care secretary] Matt Hancock has signalled that we need the system to engage, but also because we are seeing a lot more interest in putting digital into the NHS operational model than we have done in the past.

Again, it is something we have been talking about for a while: but I think we will go from rhetoric to action this year. The other side of that is that we will continue to see investment in the calibre of digital leaders in the system. With the growth of FEDIP [The Federation for Informatics Professionals, part of the BCS], the success of the Faculty of Clinical Informatics, and the first cohort coming out of the NHS Digital Academy, there are influencers ready to change things.

It we want to increase professionalism in the IT space, I think we need to target leaders, because they bring their teams with them. I think we will see that in 2019. I think we are on the road to professional accreditation and that’s a good thing. I often say I want the people who do my job to be properly trained and accredited, instead of falling into it by chance.

The third thing is interoperability. It feels like 2018 was foundational, with the consolidation of the Professional Record Standards Body and INTEROPen, and the establishment of the local health and care record exemplar programme. So, I think that in 2019 we will see active spending on building interoperable health and care and the creation of regional platforms to support data flows. If that happens, and the NHS sorts out its regional and transformation structures, I think we will be in for a bright future.

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