{"id":7726,"date":"2023-12-22T11:28:25","date_gmt":"2023-12-22T10:28:25","guid":{"rendered":"https:\/\/www.gpsj.co.uk\/?p=7726"},"modified":"2023-12-22T11:28:25","modified_gmt":"2023-12-22T10:28:25","slug":"want-to-improve-nhs-productivity-start-by-addressing-its-legacy-it","status":"publish","type":"post","link":"https:\/\/www.gpsj.co.uk\/?p=7726","title":{"rendered":"Want to improve NHS productivity? Start by addressing its legacy IT"},"content":{"rendered":"\n

The state of NHS infrastructure and legacy systems has started to attract attention from organisations worried about falling productivity. The Highland Marketing advisory board asked what it will take to fix the issues, against a backdrop of more funding being diverted from digital to \u201cthe frontline.\u201d <\/strong> <\/p>\n\n\n\n

The NHS is heading for a significant financial squeeze, with its already tight 2021 Budget settlement<\/a> eroded by inflation and the bill for a year of strikes \u2013 which has come in at around \u00a31 billion.  <\/p>\n\n\n\n

With an appeal for help falling on deaf ears at the Treasury<\/a>, the Department of Health and Social Care and NHS England diverted around \u00a3800 million to the frontline ahead of the Autumn Statement, including \u00a3350 million that had been earmarked for digital initiatives.   <\/p>\n\n\n\n

Old and inefficient <\/strong> <\/p>\n\n\n\n

This kind of intervention is not unusual. Over the past decade, the NHS has been asked to manage with below-trend growth in its revenue budgets, on the assumption that it will be able to deliver significant efficiency savings. There has been little or no capital funding, and frequent raids on \u2018ringfenced\u2019 funds for headline-grabbing programmes.  <\/p>\n\n\n\n

The result is a \u00a310.2 billion bill for backlog building maintenance: and what the National Audit Office described as \u201coutdated and inefficient\u201d IT infrastructure and \u201clegacy\u201d software. Which, the British Medical Association, think-tanks, and MPs have pointed out, is wildly inefficient.  <\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n

\u201cWe have never invested enough in physical capital,\u201d The Institute for Government argued recently<\/a>, so \u201cwe are employing more and more doctors and nurses and then wasting their time while they try to free up a bed\u2026 or spend hours trying to book a diagnostic test\u2026 or wait for an agonisingly slow computer to wake up.\u201d  <\/p>\n\n\n\n

Needed: a target operating model <\/strong> <\/p>\n\n\n\n

These issues must be contributing to the NHS\u2019 apparent lack of productivity, which is suddenly a hot topic for politicians and system leaders. \u201cWe have got 20% more people in the NHS than pre-Covid, but we haven\u2019t got 20% more productivity,\u201d industry expert David Hancock told a recent Highland Marketing advisory board discussion, \u201cand the reason is a lack of capital funding.  <\/p>\n\n\n\n

\u201cWe have just had \u00a3350,000 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 \u00a3200,000 [of the \u00a32.6 billion earmarked for \u201cinnovative digital technology\u201d in the 2021 Budget]: and that won\u2019t buy much.\u201d  <\/p>\n\n\n\n

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. \u201cAt the moment, there is money for electronic patient records, but every clinician wants to know how they are going to be deployed,\u201d he said.  <\/p>\n\n\n\n

\u201cIs it going to be on iPads, or computers on wheels, or PCs at the ward station? That\u2019s because they\u2019re worried there won\u2019t be enough devices to go around. We should also have a basic limit on how old a piece of kit can get.  <\/p>\n\n\n\n

\u201cWe should have a stipulation that there is single sign-on where it\u2019s 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.\u201d  <\/p>\n\n\n\n

And clarity on \u2018who pays for what\u2019 <\/strong> <\/p>\n\n\n\n

Andy Kinnear, another former NHS CIO, said there should also be clarity on who should fund it. \u201cThere was a piece of work started by NHSX called who pays for what,\u201d he said.  <\/p>\n\n\n\n

\u201cIt tried to unpick the Treasury rules, the DHSC rules, the role of the integrated care systems, trust level spending and the role of auditors \u2013 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.\u201d  <\/p>\n\n\n\n

NHS England\u2019s recently appointed chief information officer, John Quinn, told this year\u2019s Healthcare Efficiency through Technology conference<\/a> that infrastructure is one of his priorities, not least because legacy systems are \u201cexpensive\u201d and a \u201csecurity risk.\u201d  <\/p>\n\n\n\n

However, he didn\u2019t sound like there\u2019s 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.  <\/p>\n\n\n\n

Shifting trust perceptions <\/strong> <\/p>\n\n\n\n

Andy Kinnear felt the first point needs to be addressed. \u201cTrusts tend to think of technology as optional, or linked to innovation, rather than essential,\u201d he said. \u201cThey would not see electricity as a nice thing to have, and they need to start thinking about technology in the same way. <\/p>\n\n\n\n

\u201cYou can\u2019t run a big, modern hospital without e-prescribing, or imaging. They\u2019re infrastructure, like bricks and mortar, and they need to be kept up the same way.\u201d  <\/p>\n\n\n\n

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.  <\/p>\n\n\n\n

However, he argued trusts will need guidance on how to make the shift \u2013 and to navigate complex spending rules. At the moment, he said some trusts \u201cfind themselves at odds\u201d with their auditors if they try and capitalise cloud computing and SaaS, while \u201cothers capitalise loads of stuff and don\u2019t get any push-back.\u201d  <\/p>\n\n\n\n

At the same time, he added, all trusts suffer from the \u201cdigital hokey-cokey\u201d<\/a> 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.  <\/p>\n\n\n\n

Rolling out legacy systems <\/strong> <\/p>\n\n\n\n

It\u2019s 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 \u00a3900 million to get some level of EPR into every trust in the country.  <\/p>\n\n\n\n

Yet, David Hancock pointed out, most EPRs being deployed now \u201care legacy systems\u201d. More than one of the most popular EPR choices were first developed in the 1990s and are neither mobile-first nor cloud-native.  <\/p>\n\n\n\n

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 development, to national maturity models that favour them, to \u201clow risk\u201d decision making by trusts, and a lack of clinical awareness of alternatives.  <\/p>\n\n\n\n

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.  <\/p>\n\n\n\n

Modern, UK-based alternatives are being developed, but for the moment they don\u2019t offer all the functionality of a big EPR, and only a handful of trusts are willing to back them. So, while there are cloud-based, 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.  <\/p>\n\n\n

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\"\"<\/figure>\n<\/div>\n\n\n

The big ask: a long-term, stable environment in which to plan <\/strong> <\/p>\n\n\n\n

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.  <\/p>\n\n\n\n

Responding to the Autumn Statement, shadow chancellor Rachel Reeves said<\/a>: \u201cIt says a lot that after thirteen years of Tory government, there are still nearly 12,000 NHS computers running on outdated software that is vulnerable to cyber-attacks\u201d and that ten-years after now-chancellor Jeremy Hunt \u201cpromised a paperless NHS by 2018\u201d there are still \u201c26 NHS trusts using 600 fax machines.\u201d  <\/p>\n\n\n\n

Despite this, advisory board chair Jeremy Nettle summed up by saying the NHS doesn\u2019t want more headline grabbing fixes \u2013 like shadow health secretary Wes Streeting\u2019s Fit for the Future fund to \u201cdouble\u201d the number of diagnostic imaging devices in use.  <\/p>\n\n\n\n

\u201cThere\u2019s a saying in business that IT infrastructure is like an iceberg,\u201d he said. \u201cYou see the software you are deploying, but it\u2019s going to account for only a third of the total cost of a project.  <\/p>\n\n\n\n

\u201cTwo-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. <\/p>\n\n\n\n

\u201cPredictable 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.\u201d  <\/p>\n","protected":false},"excerpt":{"rendered":"\n

The state of NHS infrastructure and legacy systems has started to attract attention from organisations worried about falling productivity. The Highland Marketing advisory board asked what it will take to fix the issues, against a backdrop of more funding being diverted from digital to \u201cthe frontline.\u201d  <\/p>\n

The NHS is heading for a significant financial <\/p>\n

Continue reading Want to improve NHS productivity? Start by addressing its legacy IT<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[1312,1,9],"tags":[25,417,26,264,1877,2167,143,3852,122,3851,416,422,1748,2257],"class_list":["post-7726","post","type-post","status-publish","format-standard","hentry","category-central-government","category-it-it-security","category-nhs-healthcare","tag-government-public-sector-journal","tag-government-journal","tag-gpsj","tag-gpsj-magazine","tag-highland-marketing","tag-highland-marketing-advisory-board","tag-it","tag-labour-party","tag-nhs","tag-nhs-infrastructure","tag-public-sector-journal","tag-public-sector-magazine","tag-secretary-of-state-for-health","tag-social-care","odd"],"yoast_head":"\nWant to improve NHS productivity? 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