A cash-strapped NHS has exhausted all the obvious means of finding efficiencies and saving money. If it really is to transform patient care in austere times, proper service redesign is the only answer. Michael Thick, VP Clinical Strategy and Governance, McKesson UK, in this ‘opinion piece’ examines how the innovative use of technology is a crucial part of the solution – but the clock is ticking.
If the NHS is to meet efficiency targets in the coming years, it has to embrace IT appropriately. Department of Health figures show that the health service made £5.8 billion in efficiency savings in 2011/12, with a reduction in ‘wasteful’ IT spending making a key contribution. But, if the health service wants to transform services and create more effective and efficient care pathways, back office savings will not be enough. The NHS has exhausted all of the standard levers for efficiency – none of the obvious cuts and financial manipulations remain at its disposal. As such, an increasing number of hospitals find themselves on the ‘at risk’ list as the realities of economic failure bite. The only way that savings can now be made is by proper service redesign. The NHS is crying out for innovation, and looking for health organisations to behave in new and different ways. To progress, parts of the NHS must move away from cost cutting and focus instead on quality and productivity. Both nationally and locally, the health service must redouble efforts to implement change at the patient level and drive innovations that can make a real difference. And undoubtedly, if the health service is to meet its QIPP targets, innovative use of technology is going to have to play a major part.
Evidence increasingly indicates that technology can do much more than save money. Used properly, it can help drive better, faster and safer care, and put the patient at the centre to improve health outcomes. The challenge for local clinicians across the NHS is to conduct a fundamental review of individual care pathways, and to develop locally-tailored services that are more responsive to patients’ needs. And, once this has been done, find the technology that fits the purpose. Forcing ‘solutions’ into the hands of users will only fail.
The Power of Information
The Government’s recent blueprint for the use of technology within the NHS provides a mechanism for greater local autonomy and decision-making when implementing IT systems. Rather than expecting every organisation to use the same technology, The Power of Information advocates an approach that connects and joins up local systems, ‘unleashing innovation at a local level.’ Although this has largely been interpreted as a move away from a centralised approach to IT, this is not wholly true. The National Programme for IT may have been consigned to the scrapheap, but the new strategy will still be led from the centre. The approach, however, has moved from being a product-based method of implementation to a standards-based one. Choosing a system may now be a local decision, but the central power will lie in determining and mandating national standards that ensure information can move freely, safely and securely around the system.
The national reform programme places a great emphasis on the integration of services. As a consequence, local leaders are working hard to establish how they can gain improvements in quality by ensuring there are no longer large gaps between primary, secondary and social care. With demand on the system increasing, maintaining intelligent control of referral management will be vital. Optimising technology to help join up care is therefore a major priority. Developing good informatics and sharing data across organisational boundaries will be essential if the promise of integrated care is to be realised.
The multiplicity of services
The move towards local IT decision-making within a framework of national standards is certainly the right strategy for the NHS. The approach should help local clinicians and commissioners unlock innovation to design new services and integrated care pathways that are responsive to patient needs, using technology as a great enabler. But although the new-found autonomy is giving local health organisations greater freedom to choose systems that best suit their needs, adapting to the new approach is not without its challenges. Around the country, many providers are introducing their own small systems to support innovative, localised service redesign, but GPs are struggling to come to terms with having to use a multitude of different systems driven by the shift from secondary to primary care. They are increasingly being required to use different applications that, generally, provide similar services – and are becoming anxious for a more uniform approach to be established.
This is something that will require national leadership. The Information Directorate at the Department of Health, along with the NHS Commissioning Board (NHS CB), will need to take a closer look at some of the new technologies that are being introduced, and support examples of best practice so that innovation is diffused across the system. The NHS CB has yet to address the concept that there is a multiplicity of potential applications out there that could be unified – and they could play a significant part in that unification by supporting and, where appropriate, funding them.
A good example of this is the Royal Marsden’s Coordinate my Care service, which has now been commissioned by NHS London to extend across all 31 London PCTs. Coordinate my Care is an electronic end-of-life care register that is fully integrated with community and social care providers. The system brings together various aspects of care – such as chronic disease management, emergency referrals or special patient notes – that might ordinarily be managed via separate, individual electronic systems, and instead supports them through a single, centralised application. NHS London has worked hard to ensure that its GPs are being provided with a uniform platform that supports multiple tasks – in the process, driving a more efficient and effective delivery of care for patients.
Be bold
ThePower of Information outlined a belief that local innovation and market development will drive progress for healthcare delivery in the UK, facilitated by sharing and showcasing technologies and solutions that are already in use in some health and social care services. But as pressure on the NHS continues to mount, threatening the long-term delivery of services in hospitals across the country, the clock is ticking. The wider health service cannot afford to wait for the NHS Commissioning Board to introduce a framework for national IT standards, or to issue guidance on the issue of multiplicity. The time to innovate is now.
Local health organisations must be bold and take some important decisions ahead of CCGs forming. They must not shy away from funding innovation. If they do, good initiatives risk being endangered, and patient services will almost certainly suffer.
Undoubtedly, technology can play a key role in the delivery of care where quality is higher, mistakes are fewer and costs are lower. The most effective solutions will be those that have been designed to suit innovative pathways of care as they emerge. In a clinically-led, patient-centric health service, technology can help drive improvements in quality, increase patient safety and enhance patient outcomes. And in the spirit of the Nicholson Challenge, it can help the NHS become more efficient in the process. It needs to – before it’s too late.
