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NHS Digital Transformation: 'Past Mistakes Must Be Addressed'

The House of Commons Health and Social Care Committee (HSCC) has published its latest report on 'Digital transformation in the NHS', the conclusions of an inquiry launched in May 2022. It declared that the Government "must address past mistakes" if it is to realise its ambitions for a modern digital health service.

In February this year, the Committee rated the Government's progress in digitising the NHS as 'inadequate'.

This week, the Committee explained that digital transformation encompassed digitising services and processes that had traditionally been delivered physically, as well as greater use of innovative approaches that are enabled by advances in technology. Such a transformation was "vital for the long-term sustainability of the health service", according to the Department of Health and Social Care (DHSC).

It wanted to see expanded use of the NHS app, digital patient records accessible and shared across the NHS, and interoperability of data storage systems. 

Concerns About the NHS App

The report noted that DHSC and NHS England (NHSE) intended to develop the NHS app as the 'front door' to NHS services, in the belief that this could alleviate pressure in the wider system, delivering priorities such as reducing care backlogs and improving access to primary care. 

"Success in achieving this will depend on whether it can present a compelling case for using the app, such as when it was used to host the COVID pass in 2021," the report noted. It described the so-called 'vaccine passport' as "a unique incentive to download the NHS app", despite its divisive nature when used then to enforce pandemic restrictions .

MPs also raised concerns about future plans to enable third-party apps to be integrated with the NHS app. They described the lack of systematic and consistent assessments of necessary quality standards as "unacceptable", and said there was evidence of "a majority" failing on clinical efficacy, security, or cost, with the risk that patients could lose confidence in them.

They warned that the DHSC and NHSE "must clearly demonstrate the [NHS] app's continued value" or risk a drop in the number of sign-ups, which risked frustrating their goals.

Risks of Digital Exclusion

The Committee also warned of the risks of exclusion from services for people unable or unwilling to use digital services. Figures from Age UK showed that a third of people over 65 do not use smartphones, for example. There were 1.7 million people in England without internet access and 10 million adults in the UK who lacked "even the most basic digital skills". Various witnesses said that maintaining non-digital arrangements for this group was "essential".

"People should not find themselves unable to access the NHS because of wider challenges around access to technology, connectivity and digital skills", MPs said. The Nuffield Trust, and others, had emphasised the importance of maintaining physical alternatives to digital services. 

Chair of the HSCC Steve Brine, Conservative MP for Winchester, said: "The long-term sustainability of the health service depends on getting this right, but there will be people who decide that digital services are not for them, and we are clear that they should not find themselves excluded by future developments."

Previous Digitisation Attempts 'Thwarted'

While maintaining that digital tech offered numerous benefits to patients, ranging from increased convenience to access to cutting-edge treatments and diagnostics, the Committee stressed that Ministers must "address mistakes of the past".

A 2020 report by the National Audit Office had concluded that previous attempts had been "expensive and largely unsuccessful". The Committee said: "Previous attempts at digital transformation have been thwarted by out-of-date 'legacy' IT systems and hardware unable to handle the demands of a modern digital health service." 

Progress had been "slow and uneven", leading to substantial variation between organisations, and parts of the health service still lacked even the most basic, functioning IT equipment. Many NHS organisations continued to use old, poor-quality PCs and laptops running a multitude of different programmes and operating systems and in some cases unable to support needed software and hardware.

Old-fashioned pagers persisted in the NHS until they were banned in 2019, hot on the heels of fax machines, which were scrapped in the NHS only in 2018 - when most other organisations stopped using them in the early 2000s.

Mr Brine said there were "major challenges to overcome". He gave an example of one case where it took over 15 minutes for staff to turn on a PC and log in to their clinical system, because the kit was so outdated.

A lack of skilled digital professionals was a further barrier, the report said, leading inevitably to a call for more money for additional pay and bonuses to recruit specialist data, digital, and technology specialists. Mr Brine said that the NHS needed to offer higher salaries to compete with the private sector.

The report's other key recommendations to the DHSC and NHSE were:

  • Clearly set out the benefits of technology, including the NHS app, and address risks and patient concerns
  • Set out a timetable for introducing a new 'native' NHS app, with a plan for communicating the benefits and features offered to users of the current 'portal' version
  • Ensure that non-digital channels remain available
  • Ensure that the wider workforce, including clinicians and frontline staff, had the "time, headspace, and training to allow them to fully engage with digital transformation".