Digital Innovation in the NHS: Exploring the New Ten Year Plan with Hatim Abdulhussein
Notes on a discussion. Transcribed manually. Personal musings interjected.
Source: https://open.spotify.com/episode/4DD5BGApi3lWy1gRIiCjxU?si=8a5Y53iCQsax5Cme36Cq6g
Dr Victoria Betton is the author of Towards a Digital Ecology - NHS Digital Adoption Through the COVID-19 Looking Glass
Hatim Abdulhussein is a practicing GP, CEO of Health Innovation Kent Surrey Sussex, and Honorary Professor of Innovation and AI at the University of Surrey.
Health innovation Networks
Section titled āHealth innovation NetworksāHealth innovation networks (HINs) find, test, implement, and scale innovations to solve challenges in the NHS. and support economic growth in their region. bring the right people together to drive change there are 15 across the country.
VB: āitās important that HINs are adjacent to the system not deep with in itā - shades of Creative Bureaucracy dynamic stability.
The 10 year plan
Section titled āThe 10 year planāThe 10 year plan - itās ambitious - It talks about 3 big shifts.
- from analogue to digital
- from acute to community (not so much GP, but actually into the community)
- from sickness to prevention
each of these shits requires digital tech to enable them.
The 10 yr plan is achievable. it sets the right tone. some big changes
- the nhs app (front door)
- single patient record (how data is stored)
VB: A critical response to it is that itās just aspirations, not a plan (e.g no implementation detail, no money). to realise the ambition what do we need?
How do you transform HR or training journeys using techā¦ etcā¦ things weāve been talking about for ages. iās good to have them written down. we know that top down doesnāt always work, so perhaps it itās good that there isnāt an implementation section. the ingredients are there, but itās gonna need careful going through and clear engagementā¦
what should be done once nationally, and what should be done regionally, what locally and what for providers?
VB: do it once, but too big, and not taking people with you has been a problem.
National should set policy and strategyā¦frameworks/pricing mechanism/procurement policy then allow a region to explore, and support a rollout at scale. figure out who are the right champions to push forward on the next thing that is not the current priority.
Align ambition with tech with what we are trying to solve e.g. neighbourhood health implementationā¦ what will help? single patient record and nhs app are gonna help there. worth scaling.
if productivity is a priority, what tools will help? if waiting lists are priority? what digital services are gonna help that. set that at a national level and regional. create the ingredients and share them.
VB: the regional level is trickyā¦integrated care systems are being severly reduced. HIN remain, but more responsibility is falling to providers. do HIN have to step up? those networks share info more.
why cant we scale innovation from one region to the next?! we have to fix thats.
ICBs is interesting areaā¦ they have core digital staffā¦ but there focus will be pulled elsewhere. you might not need a digital transformation team in each.
providers: some are more mature than others. some are still implementing electronic health care record now.
grass routes testing is more prevalent. how do we do it safely and encourage it.
HIN are there to support orgs to recognise innovation in the pipeline that can work and support the 10 year plan.
āsouth london HIN does it well! they have lots of digital transformation work - end to end from horizon scanning to co-development to test and evaluatingā
VB: how do you keep the fundamentals in place while having an eye to the futureā¦ fixing the engine while running.
- 10 year plan asks providers to reinvest 3% of their budgets on innovations.
- is that realisticā¦ will they do it. so much has to be in place culturally within a provider org to invest internally in innovation
well this is inline with industryā¦ a well functioning company would have this. and its good that the plan has suggested this. you need an element of freedom with what you do with that 3%ā¦ not proscribedā¦ but we should be able to see what happens to that investment.
multi-year spend is critical. it is hard to land things with in a single year.
- looking for funding
- hard to build team
freedom to orgs to be able to use multi-year funding to unlock change.
- weāre gonna see resident doc strikes (takes headspace away from frontline)
- multi year funding lets you ride out the storms
- age
- increasing sickness and rising demands
- shortage in healthcare staff
VB: startups - be wary of funding that comes at the year end.. it was thrown over the wall with no commitment to see it through.
VB: Equity and digital inclusion
real mix of affluent towns and those that lack access to services. understanding the population is critical. we have to work towards tech advances. but not everyone can join in, so we must not increase inequity.
digital inclusion frameworks. design services thinking about what they look like with digital access and without digital access.
AI triage. ipad in reception to let people use. and ensure that people can bypass the digital tools if anything about there circumstance prevents them using it.
inclusion needs change over time.
VB: thinking about suppliers - what tools do we have to encourage equityā¦ how do we do our procurement. social value. how do we send the right signals
digital health london or national innovation accelerator
- ahead of the game
- they ask about equity and sustainability as key areas for people to be successful to get on those programs
Where we havenāt perfected it yet is defining the value of social value in procurement processes! we need to make sure thats a key part of decision making. not just looking for financial value. looking for providers that have gone above an beyond to design something inclusive that takes into account population needs.
The values of the NHS have not changed much since inception. if we embody them and work with tech that lives those valuesā¦ it will mititgate some risk
VB: we need to get the incentives and the levers going right through the process. HINs are reshaping where they face, but more established procurement patterns and bigger companies there is work to do.
What does success with the 10 year plan look like?
Section titled āWhat does success with the 10 year plan look like?āVB: futureā¦ the 10 year plan has been implemented (laughs) what would you like to see?
Single patient record
Section titled āSingle patient recordāoracle cerna based platform i can see letters from other orgs
- first time i could see a real clear report on how the london ambulance service had done and how they came to there decision
- to understand what each others are doing.
ability to understand what each other are doing and talk to each other and let patients input into their care record could be game changing.
electronic health care records - shows clinitians are overburndend by the reporting requirementsā¦ if i can talk to a system ācan you do this referral for me based on the consultation i just had and these are the things iād like to highlight.ā
VB: what risks
sustainability and spend. we need to procure so we get the best over reasonable timeframes and not get locked in to providers. historically we have been locked in. we cant be nieve buyers of tech. especially when things are changing fast.
NHS is so complex. how do we bring everyone along. we have failed in the past. how do we avoid that mistake again. we must engage. we must co-design.
VB: that takes some resource! i rarely see them executed well!
VB: whats your boldest bet on the 10 year plan?
the acute to community shiftā¦ more so than analog -> digital, sickness -> preventionā¦ other 2 shifts will come if we get the acute to community shift right. a shift closer out of hospitals, closer to there homes, closer to there devices. If you move care closer to peoples homes. you will make a massive difference. most people do not want to go to hospital. most people go to GPs to avoid going to hospitalā¦ the reason why people go to A&E sometimes innapropriately is becuase they dont have access to a service elsewhere.
if we can fundamentally change how services fit around people and communities, powered by tech, we will have achieved a very differnt health service than we live in now and one ready for future societal changes.