GPSJ WINTER 2023 2024 LATEST - Flipbook - Page 21
NHS & HEALTHCARE
or wait for an agonisingly slow
computer to wake up.”
Needed: a target operating
model
These issues must be contributing
to the NHS’ apparent lack of
productivity, which is suddenly
a hot topic for politicians and
system leaders. “We have got
20% more people in the NHS than
pre-Covid, but we haven’t got
20% more productivity,” industry
expert David Hancock told a recent
Highland Marketing advisory board
discussion, “and the reason is a lack
of capital funding.
“We have just had £350,000
taken out of IT. [Allowing for earlier
raids, the cost of the frontline
digitisation programme, and the
cost of the federated data platform]
that leaves us with about £200,000
[of the £2.6 billion earmarked for
“innovative digital technology” in the
2021 Budget]: and that won’t buy
much.”
Neil Perry, a consultant who
until recently was CIO at an NHS
trust, argued that the digital arm
of NHS England should go back
to basics and draw up a target
operating model for infrastructure.
“At the moment, there is money for
electronic patient records, but every
clinician wants to know how they are
going to be deployed,” he said.
“Is it going to be on iPads, or
computers on wheels, or PCs at the
ward station? That’s because they’re
worried there won’t be enough
devices to go around. We should
also have a basic limit on how old a
piece of kit can get.
“We should have a stipulation
that there is single sign-on where
it’s needed, because nobody has
an EPR that does everything. We
need some leadership to say what
good looks like on infrastructure,
and a target operating model, so
everybody can work towards it.”
And clarity on ‘who pays for
what’
Andy Kinnear, another former NHS
CIO, said there should also be clarity
on who should fund it. “There was
a piece of work started by NHSX
called who pays for what,” he said.
“It tried to unpick the Treasury
rules, the DHSC rules, the role
of the integrated care systems,
trust level spending and the role of
auditors – all the things that make
this such a difficult environment in
which to deliver a significant level of
infrastructure investment. We need
something like that again, so we can
move forward.”
NHS England’s recently appointed
chief information officer, John Quinn,
told this year’s Healthcare Efficiency
through Technology conference that
infrastructure is one of his priorities,
not least because legacy systems
are “expensive” and a “security risk.”
However, he didn’t sound like
there’s a big plan in the offing.
Instead, he urged trusts to increase
their spending on IT to the level
seen in other service industries; and
to adopt new delivery models, such
as cloud computing or software as
a service.
Shifting trust perceptions
Andy Kinnear felt the first point
needs to be addressed. “Trusts tend
to think of technology as optional,
or linked to innovation, rather than
essential,” he said. “They would
not see electricity as a nice thing to
have, and they need to start thinking
about technology in the same way.
“You can’t run a big, modern
hospital without e-prescribing, or
imaging. They’re infrastructure, like
bricks and mortar, and they need to
be kept up the same way.”
James Norman, a former NHS
CIO who now works for Pure
Storage, backed the second point,
arguing that when trusts do invest
in their infrastructure, they can
default to replicating what they have,
instead of replacing it with more
sustainable computing.
However, he argued trusts will
need guidance on how to make
the shift – and to navigate complex
spending rules. At the moment, he
said some trusts “find themselves
at odds” with their auditors if they
try and capitalise cloud computing
and SaaS, while “others capitalise
loads of stuff and don’t get any
push-back.”
At the same time, he added,
all trusts suffer from the “digital
hokey-cokey” in which the centre
announces and re-announces
funds, only to issue them so late
that they have to scramble to spend
the cash in a few weeks at the end
of the financial year.
development, to national maturity
models that favour them, to “low
risk” decision making by trusts,
and a lack of clinical awareness of
alternatives.
But they pose practical problems,
of which the most discussed is
their lack of interoperability, which
impedes the drive for integrated,
data driven care, and drives
extra spending on workarounds
like shared care records or the
federated data platform.
Modern, UK-based alternatives
are being developed, but for the
moment they don’t offer all the
functionality of a big EPR, and only
a handful of trusts are willing to back
them. So, while there are cloudbased, modular, and pay-as-you-go
systems in the NHS, they tend to be
found in well-defined and relatively
small areas: running the back office;
handling patient communications;
rolling-out virtual care.
The big ask: a long-term, stable
environment in which to plan
The UK must have a general
election by the end of January
2025, and could have one as early
as next spring. The Labour Party
has started to use the state of NHS
IT as a polling issue.
Responding to the Autumn
Statement, shadow chancellor
Rachel Reeves said: “It says a
lot that after thirteen years of Tory
government, there are still nearly
12,000 NHS computers running on
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outdated software that is vulnerable
to cyber-attacks” and that ten-years
after now-chancellor Jeremy Hunt
“promised a paperless NHS by
2018” there are still “26 NHS trusts
using 600 fax machines.”
Despite this, advisory board
chair Jeremy Nettle summed up
by saying the NHS doesn’t want
more headline grabbing fixes – like
shadow health secretary Wes
Streeting’s Fit for the Future fund to
“double” the number of diagnostic
imaging devices in use.
“There’s a saying in business that
IT infrastructure is like an iceberg,”
he said. “You see the software
you are deploying, but it’s going to
account for only a third of the total
cost of a project.
“Two-thirds of the total funding
will need to go on managing the
infrastructure that supports these
digital interfaces. And to make
that level of investment, you need
predictability.
“Predictable strategy, predictable
capital spending, because without
that, nobody can plan, including the
suppliers that we want to develop
these systems, and bring innovation
to the table.”
Rolling out legacy systems
It’s not just a lack of consistent
policy, strategy or money that
has left the NHS facing legacy
challenges. NHS England is running
a significant IT programme at the
moment: frontline digitisation, which
is spending £900 million to get
some level of EPR into every trust
in the country.
Yet, David Hancock pointed
out, most EPRs being deployed
now “are legacy systems”. More
than one of the most popular EPR
choices were first developed in the
1990s and are neither mobile-first
nor cloud-native.
The big EPRs have persisted
for reasons ranging from the need
for their suppliers to get a return
on the very significant cost of their
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