Dr Elizabeth Murphy (senior research clinical psychologist) and Kate Kelly (gameChange peer support worker) at Greater Manchester Mental Health NHS Foundation Trust discuss the role of virtual reality in treating mental health.

The use of virtual reality (VR) technology in psychological therapy is not new – it has been used in specialist mental health clinics for more than 25 years.

However, until recently, this was always on a small scale, as VR was used alongside in-person therapy. With recent advances in technology, this is changing and it is now possible for a virtual therapist to be built in. This means that treatment does not necessarily need to be overseen by a specialist therapist.

At Greater Manchester Mental Health NHS Foundation Trust (GMMH), we are currently delivering gameChange VR therapy to people with psychosis through five mental health teams across Manchester. This rollout builds on the results of a randomised control trial (RCT),  published in the Lancet Psychiatry (Freeman et al, 2022), which involved 346 participants across nine NHS trusts, was delivered in collaboration with the University of Oxford and its spinout company, Oxford VR.

The RCT found that VR therapy could reduce symptoms of agoraphobia and distress in everyday situations compared with usual care alone. We are now investigating how the technology can be used as part of our routine clinical services.

Many people with psychosis suffer debilitating levels of agoraphobia, and it is common for everyday situations such as getting a bus or going to the shop to induce extreme stress and anxiety. As such, they often struggle to leave their homes.

Using the gameChange headsets, our service users can try out everyday situations through digital simulations from the comfort of their home. During the VR sessions, they’re guided by a virtual therapist who helps them practice being in everyday situations, such as at a café, a shop, or a doctor’s surgery. In this way, people who experience severe anxiety and distress at the thought of leaving the house are able to access therapy without having to leave the house and go into a clinic.

The therapy is based on Cognitive Behavioural Therapy (CBT) and works by reducing anxious thoughts and feelings that patients have about the simulated situations. As patients progress through the therapy, which is typically delivered over six sessions, they gradually encounter more complex tasks. Throughout the sessions, the virtual therapist prompts patients to practise noticing their thoughts, feelings and defences, replacing them with more positive beliefs and behaviours. Following the VR therapy, service users are then supported by a wide range of staff to apply this learning in real world situations. The result is that people who were previously paralysed by their fears and unable to leave their homes on their own, are able to take part in everyday activities that they had previously found unthinkable.

One of the key ingredients for success for technology like gameChange is involving people with lived experience throughout the development of the technology, through to the delivery of the therapy. With gameChange, the different scenarios within the headset were co-designed by a Lived Experience Advisory Panel, comprised of people with personal experience of psychosis. Similarly, peer support workers who have experienced psychosis themselves, work with people who are undergoing VR therapy to help them apply their learnings in the real world. Peer support workers offer a role model for recovery, and this combined with the virtual therapist, can help create meaningful change for people who may be unable to access in-person therapy.

VR offers tremendous promise and technology like gameChange has the potential to have huge benefits in the lives of service users experiencing extreme distress in managing everyday situations. By automating certain aspects of mental health treatment, VR could also help treat more patients more quickly, as well as provide greater choice for patients. While we’re still some way off technology like gameChange being available in mental health services as standard, we hope this is going to change soon, and that we will see VR therapy being more widely available across GMMH and beyond.

Feature by Highland Marketing

How are trusts and health tech suppliers going to find the people they need to develop, deploy and optimise critical clinical information systems in the future? Highland Marketing’s advisory board invited Paul Rice from Bradford Teaching Hospitals NHS Foundation Trust to outline how he has been thinking about the challenge.

The NHS is facing “the worst staffing crisis in its history” according to the Commons health and social care committee. An inquiry led by former health and social care secretary Jeremy Hunt concluded that the service could be short of as many as 50,000 nurses and 12,000 doctors.

Medical vacancies inevitably command news-site headlines. But it isn’t just doctors and nurses that the NHS needs. As digital, data and information technology systems play a bigger and bigger role in its operations, it also needs people who can build, maintain, and innovate with them.

That will mean recruiting, training, and promoting a new cadre of digital and data professionals. Yet the NHS is likely to face some tough challenges when it comes to doing this.

It is going to be looking for staff from a shrinking pool of young and working age people, as the UK’s natural population ages and demand for its services increase exponentially. And it’s going to be up against stiff competition from international companies with a strong local presence.

At the same time, the NHS will need to make sure that clinical professionals are engaged with new systems and that frontline staff have the digital skills they need to make the most of the innovation coming on stream.

NHS IT teams are big teams that require many skills

Paul Rice, the chief digital and information officer at Bradford Teaching Hospitals NHS Foundation Trust and Airedale NHS Foundation Trust, has been thinking about these challenges in the context of his own organisation and the West Yorkshire Association of Acute Trusts.

Specifically, he told the Highland Marketing advisory board, he has been thinking about how to put a team together to implement some big systems (a new electronic patient record for the West Yorkshire Association of Acute Trusts, and a laboratory information management system for the local pathology network).

“We need a whole range of talents to push and pull in the right order,” he said, indicating that these will range from a chief clinical information officer who can effectively engage clinicians, to a project management office to run the deployments.

Also, from people with the infrastructure and data skills to “keep the lights on” while generating clean information for analysis, to people who can analyse it, to legal and procurement professionals because “we spend a fortune on these systems, and we don’t tend to invest in the specialist expertise that we need to procure them.”

Once he’s got a team together, Rice said he wanted to “avoid the Grand Old Duke of York model” in which “we march everybody up to the top of the hill” for go-live and then let them “depart rapidly at the other side” because “to get the best out of these new tools we will continue to need significant input and expertise to continuously improve and optimise.”

Creating sustainable, meaningful careers  

Also, he said, these big projects should be an opportunity to start creating meaningful careers that will attract scarce people and support the local economy. “An EPR contract, a LIMS contract, will run for a decade,” he pointed out, “so we need to attract, develop and maintain a broad base of skilled people for the long haul.

“This offers the prospect of developing genuinely sustainable career pathways because, if you find yourself working in a corridor that covers Airedale, Bradford, and Calderdale for example, you should be able to build and use your skills for a very long time.

“I have been encouraging colleagues to think about creating a ‘Centre of Digital Excellence’, where we can recruit and retain, identify and retrain people on our doorstep.”

While a centre of excellence is still an ambition, Rice has been thinking about the organisations that would need to be involved. He told the advisory board that he has been talking to the universities and further education institutions on his patch and to vendors of consultancy services, accredited skills providers, and digital systems.

“It’s hard for some health tech suppliers to support [my trust] from London,” he pointed out. “I would love them to come and work with me in Bradford and to build a resource pool at home in the North. I’d also want to partner with established local businesses with proven capability like TPP who remain central to our ambitions, and they are just up the road.”

Think like an anchor institution

More broadly, Rice said he has been thinking about how digital and data can play a key role in supporting the NHS operate as an ‘anchor institution’. The idea of an anchor institution argues that the sustainability of a large, typically public-sector, institution is tied to the wellbeing and make-up of the population it serves. It can contribute through local employment and procurement.

“Bradford has one of the youngest populations in Europe,” Rice said. “There is just this incredible diversity and richness, and as an anchor institution we need to make sure that we can tap into that and make sure that our communities get opportunities to build good careers locally.

“That means taking seriously the idea that we need to uplift skills – core technical ones, programme management, improvement science, data analysis – with people operating with digital sensibilities at every level of the organisation. And it means getting diverse views in the room, to create those diverse opportunities.”

Education, vendors and trusts all have a part to play

Jeremy Nettle, the chair of the advisory board, asked how much engagement Rice was getting. For example, he asked, were local universities competing to provide the skilled staff that the NHS is going to need?

Rice said he was talking to them and that he hoped Bradford’s success in becoming the UK Capital of Culture in 2025 would increase its profile and appeal further.

Andy Kinnear, a consultant at Ethical Healthcare Consulting, who used to run an NHS commissioning support unit, said he had taken three things from the presentation. “The first is that we should learn something from Covid, and that is the importance of having a single goal,” he said.

“Being able to tell people that they are working on something worthwhile, like improving health in Bradford, should help to drive us forward. The second is the vendor piece. We definitely need to work with vendors so they can give back more to the system, while still making money.

“And the third is specialist skills. I think we need parity of esteem between digital/data skills and clinical or finance skills, because that will help to create career paths with salaries to match.”

Facing a problem? Solve it locally

Neil Perry, the CIO at Dartford and Gravesham NHS Foundation Trust, and James Norman, EMEA health and life sciences director at Pure Storage, were also interested in the development of roles at the top of NHS IT.

Perry noted that some organisations are developing a CAO – or chief analytics officer. While Norman noted that an increasing number of organisations are appointing CNIOs – chief nursing information officers – alongside the more established CCIOs – or chief clinical information officers.

Were these good ideas? Rice said that these roles were all vital and that it was critical to work in partnership with clinical colleagues to better understand workflows and pathways, audit requirements and research aspirations. If he had a concern about CCIOs and CNIOs it was that people take up these roles quite early in their careers, and there needs to be a real commitment to support progression and professional ambition.

But, in an ideal world, he’d have all of them: “A CCIO and a CNIO doing clinical engagement, a CIO, a CAO, and also a CTO doing transformation work. I’m looking to engineer some of that in Bradford and Airedale. My own ambitions are to assemble a team of all the talents to deliver the over-arching ambition of higher quality patient care and outcomes, working with patients and communities in a digitally enabled way.”

Digital nurse leader Anne Cooper concluded by asking Rice where other CIOs should start. In response to which, Rice suggested the most important thing is to start.

“So, the first thing is just to carve out some time to understand both the scale of the challenge and the pipeline on your doorstep. Because if Covid showed us anything, it showed us that local matters; and as anchor institutions we should be committed to solving this locally,” he said.

By Lyn Whitfield, Highland Marketing’s strategy and content director

Amid the Brexit turmoil, chancellor Sajid Javid delivered a mini budget with a headline £6.2 billion for the NHS. However, as this analysis from Highland Marketing explains, most of this money had been announced before, it only covers one year, and there is unfinished business on capital spending and money for health tech.

Amid increasing political turmoil over Brexit, there was some uncertainty about whether Sajid Javid’s ‘mini budget’ would go ahead on Wednesday, 4 September.

In the event, the chancellor did make a statement. He promised an “end to austerity”, more money for key public services, and a new economic policy for what he insisted would be a post-Brexit Britain.

As part of this, Sajid said the NHS would receive an additional £6 billion next year, with £2 billion for capital spending. Which sounded good, except that most of the money had been announced previously; and even if it hadn’t, this wouldn’t have been the budget the NHS wanted.

Javid’s announcement covered a single year, when former chancellor Philip Hammond had promised to unveil the results of a three-year comprehensive spending review, which would have been much more useful for planning across Whitehall.

This year’s slice of the birthday cake

The NHS is in a better position than some departments, because it has the NHS Long Term Plan to deliver and the NHS70 “birthday present” money to do that.

The “birthday present” is the “extra £20.5 billion a year for the NHS in England” that former prime minister Theresa May found for the health service when it marked its 70^th anniversary last June.

Next year’s instalment is the biggest component of the mini-budget’s £6.2 billion. However, this money only covers revenue spending; and, as the Nuffield Trust’s Sally Gainsbury has been pointing out, it won’t go that far.

First, as she wrote in a briefing ahead of last year’s Budget, the money is being “added to a system that is currently underwater” – facing unrelenting demand, falling behind on targets and barely managing to balance the books.

Second, the Treasury has quietly shifted a chunk of the money towards the end of the first five-years of the plan. As the official documents supporting the mini-budget make clear, the NHS will receive a real-terms increase of just 3.1% next year; well below the long-term trend of 4%.

This “backloading” also makes it harder for the health and care system to bring in some of the reforms and innovations, that are supposed to make it sustainable in the long-term.

Third, this money only covers “frontline” spending, and not public health, training, or capital. Or social care, which is facing a crisis that impacts on the NHS by pushing more people, particularly frail, old people into hospital, and making it hard to discharge them again.

Long-term capital plan needed

Back in June, the NHS Confederation urged the government to address “unfinished business” in these areas, of which capital of most interest to health tech, because so many NHS IT projects require capital funding.

With rotten timing, NHS Providers launched a campaign to get the government “to address the challenge of NHS capital funding in the forthcoming spending round” just as the three-year CSR was scrapped and the mini budget was announced.

The £2 billion that Javid ‘announced’ in the mini budget is, in fact, the £850 million for 20 hospital building and enhancement projects that Boris Johnson announced this summer, and the £1 billion that he said would be spent on basic maintenance.

Think-tanks have demonstrated that, one way or another, this is money that is already in the system, but NHS trusts have not been allowed to spend. Putting this point to one side, NHS Providers points out that £1.8 billion is “inadequate” when the NHS backlog maintenance bill has reached £6 billion.

More fundamentally, its campaign flags that no capital budget has been set for the NHS beyond this financial year. Also, that the mechanisms that are supposed to give trusts access to capital funding “do not work”.

This is something that many IT suppliers will recognise, given the long-delays that can be incurred by tech projects at every sign-off point.

NHS Providers was hoping to secure a multi-year capital funding settlement, enough money to bring spending on buildings, scanners and other tech “into line with comparable economies” and a more efficient and effective mechanism for spending the money.

The mini budget did not deliver this. Although NHS England chief executive and NHS Improvement leader Simon Stevens told the Expo 2019 conference in Manchester that he was optimistic that a long-term capital budget will be set, eventually.

Where has the tech fund gone?

The NHS should still be in a better position to address its technology agenda than some other areas that require capital, because the last CSR, concluded in 2016 when Jeremy Hunt was health secretary, put aside money for IT.

Hunt said £4.2 billion would be spent on NHS IT from 2017-18 to 2022-23 of which £1 billion to £1.8 billion was new money. A good chunk of this has been spent on national initiatives, such as the global digital exemplar and local health and care record exemplar projects, and on more recent priorities, such as cyber-security and Microsoft licensing.

However, after combing through NHS Digital’s accounts, the Health Service Journal’s tech correspondent, Ben Heather worked out in June that there was still around £700 million to spend this year and next. Unfortunately, by August, NHSX had confirmed that a substantial amount of this money is “up in the air”.

In his briefing, Heather explained that the NHS Long Term Plan Implementation Programme committed to spending £264 million on technology over the next two financial years. However, he also established that this money is coming from Hunt’s CSR pot; it is not additional cash and it’s all revenue.

There is no capital budget in place, and previous capital allocations may or may not be honoured. Heather noted that there is, in effect “a void of clear information about where money for NHS IT is going, and whether money already promised is still coming.”

Tech funding ‘chaos’? 

On the ground, this has been evident for some time. The extensions to the GDE programme that have been floated have not materialised and the LHCRE projects are making slow progress amid rumours that NHSX wants to change their approach.

Money is going to NHSX itself and to headline projects. Another chunk of the mini budget’s £6.2 billion was £250 million for an NHS AI Lab that was announced this summer. But there seems to be little or no money going in on the ground.

Heather noted that the £412 million from Hunt’s CSR settlement that his successor, Matt Hancock, said would go to sustainability and transformation partnerships in his first few weeks in office, has quietly been forgotten about. He also quoted “one senior NHS IT provider” willing to describe the current approach to NHS IT as “chaos”.

Certainly, the lack of details around recent announcements means that it is hard to judge whether they are a good use of resources. Or whether they are a better or worse use of resources than, say, maintaining national programmes that were up and running or funding local initiatives.

A missed opportunity?

On the financial front, though, the biggest issue facing the NHS is now social care. As he took power, Prime Minister Boris Johnson promised to address this; but the mini budget could only promise £1.5 billion for councils in lieu of long-term reform.

In his keynote to Expo, Stevens welcomed this money. However, £1 billion is coming from the NHS, via the Better Care Fund, and the rest will come from a 2% precept that councils may or may not choose to levy.

Health and social care secretary Matt Hancock told the Big Tent ideas festival that he had no timetable for the much-delayed social care green paper. But without this, it is hard to see how the NHS is going to deliver the long-term plan which technology is meant to be supporting.

With so much going on in Parliament, response to the NHS elements of the mini budget has been limited. For the Nuffield Trust, director of research and chief economist John Appleby noted that while Javid did find £150 million for training, the rest of the NHS budget was, in fact, “barely rising.”

As such, he argued, the mini budget was “a missed opportunity to reverse years of cuts.” Over at the King’s Fund, director of policy Sally Warren was more charitable. Given the constraints the Treasury and Whitehall were working against, she argued, “this is a decent outcome”.

However, she concluded that while the funding that is going in next year “stops the current problems getting worse, it doesn’t undo years of underinvestment.”

“We need a proper, multi-year settlement for all of health and social care to really have confidence that the sector as a whole can plan for and deliver a health and care system fit for the future,” she said. And that will need to include a long-term, funded, tech component.

Highland Marketing is an integrated strategy, communications, PR and marketing consultancy, supporting UK and international health tech organisations and the NHS.

Over 18 years, we have built a reputation for being the go-to agency for vendors and their customers; and now we are on G-Cloud 11. Find out more on our website: http://www.highland-marketing.com, follow us on Twitter @HighlandMarktng, or call us on: 0203 651 6818.

The health and social care secretary was widely expected to leave for a new job in Boris Johnson’s first cabinet reshuffle. But he’s back. Highland Marketing considers his first year in office, his possible new priorities, and where the latest round of politics leaves NHSX and the health tech agenda. 

Boris Johnson was elected leader of the Conservative Party on Tuesday and became prime minister on Wednesday. One of his first actions was to sack and then appoint a new cabinet; in which health and social care secretary Matt Hancock was one of the few survivors to stay in his old job.  

So, a year and two weeks after he took up the post, he finds himself back at the Department of Health and Social Care, facing more or less the same challenges as he faced last July.

Number 10 sets new priorities 

One reason for this is that, until now, Hancock has been following an agenda that was set by his predecessor, Jeremy Hunt. Working with NHS England chief executive Simon Stevens, Hunt secured a £20.5 billion a year “birthday present” for the NHS to mark NHS70, to kick-in by 2023-24.

Stevens then launched an NHS Long Term Plan to set out how the money would be spent on cancer, mental health, primary and child health services, and on pushing ahead with the Five Year Forward View’s agenda of population-level planning and integrated care delivery.

Think tanks have been warning there is “unfinished business” on health funding and urging the Treasury to address capital, public health and social care in the upcoming comprehensive spending review – assuming that this takes place this autumn.

But the long-term plan has moved forward. NHS England and NHS Improvement have all-but merged and are setting up a new regional structure. A long-term plan implementation framework has been issued that local areas must use to inform their own strategies by November.

A whole new organisation type, the primary care network, has come into being. More publicly, patient satisfaction and performance against key targets has continued to slip.

Hancock has had little input into or comment on any of this. Which made it interesting that, in his first speech as prime minister, Johnson chose to say: “it will be my job to make sure you can see a GP in less than three weeks” and that he would invest in “20 new hospital upgrades.”

Some political commentators have speculated that Johnson is anxious to be seen to be delivering on the promise made on the now-infamous Brexit Bus to spend £350 million a week on the NHS. But a Number 10 hospital building policy might bring the government into some conflict with an NHS England committed to integrated care, delivered closer to home.

The social care crisis: even more intractable than Brexit? 

Johnson also promised, in his first speech, to sort out social care, claiming that he has “a plan to fix the crisis once and for all.”  Which was well received by health and local government commentators, who have been warning for years that the situation is urgent, while seeing deadlines for a new green paper come and go.

Niall Dickson, the chief executive of the NHS Confederation, said tackling social care was “urgent” while the Local Government Association urged him to make funding it “an immediate domestic priority.” Hancock may now have to deliver that much-delayed green paper. But, even if he does, there is no way that the NHS or social care are going to be more immediate priorities than Brexit.

The NHS Brexit Alliance has been warning for two years that a hard or no-deal Brexit will have a significant impact on the operation of services in areas that could be gridlocked by customs queues, such as Kent, on staffing, research, regulation, and access to medicines and treatments.

In his list of “priorities for the new prime minister”, Dickson said that if it was impossible to secure an EU exit deal, the government must make sure that “patients will not be put at risk and that there is a transition period to make sure they are protected.” Perhaps thinking of Johnson’s assurance that he would deliver Brexit by 31 October “do or die”, he added that “nothing less is acceptable.”

Marking Hancock’s own scorecard 

Hancock’s own stated priorities, when he took office, were: staffing, prevention, and technology. Taking him at his word, public health has been his biggest failure to date. Longevity has stalled or is falling, and public health experts calling for an inquiry into this unprecedented situation have pointed to austerity and growing inequality as the causes.

Hancock came in for considerable criticism in the final days of the leadership campaign for attempting to pull a consultation on prevention that suggested expanding some of the ‘sin taxes’ that Johnson had come out against.

But public health experts argued that if even if had been launched with the normal press release and ministerial statement, it would have been a disappointment. David Buck, a senior fellow at the King’s Fund, described it as “falling short of the scale and ambition needed to address the big health challenges we faced as a society.”

Meanwhile, following last year’s injection of cash, the NHS Confederation’s annual survey this year discovered that staffing has become the number one concern of NHS managers, given that the health service now has 100,000 vacancies.

As long-term health correspondent Denis Campbell pointed out in the Guardian, when Hancock was widely expected to be leaving for the Treasury, the minister’s time in office has seen virtually no progress on this issue. There is an ‘interim’ NHS People Plan; which Campbell described “to use a phrase beloved of his new boss” as “a pile of piffle.”

Leaving a tech legacy 

Which leaves technology. This is the one area in which Hancock made a significant splash in his first year. One of his first actions as health and social care secretary was to publish a blog post criticising the state of the IT that he had seen during a night shift with a London trust and the London ambulance service.

He followed up with a tech vision that put a strong focus on cloud-first, internet-first services and interoperability between NHS systems driven by standards. And then he announced the creation of NHSX, a new unit to bring together policy and standards setting – and to overhaul just about every other aspect of health tech, from security to procurement.

NHSX officially started work at the start of July, with a chief executive, Matthew Gould, appointed from Hancock’s former department of Digital, Culture, Media and Sport, and a chief technology officer, Hadley Beeman, recruited from his own pool of advisors.

When it looked as if Hancock might be leaving for another department, members of the Highland Marketing advisory board expressed the hope that NHSX would be his legacy at health. Andy Kinnear, who described Hancock as “the most pro-digital secretary of state in my 29-year career” argued that while it is still too early to say whether NHSX will be successful, “all the signs are positive.”

“The reduced fragmentation of decision making, the focus on standards and the internet-first approach, not to mention the appointment of what Joe McDonald, the outgoing chair of the CCIO Network, has described as a ‘weapons grade civil servant to lead it, all point to change – a welcome change – of direction.”

NHSX retains its sponsor 

Ravi Kumar said: “Since it is early days for NHSX, one would hope that whoever takes over at the DHSC would allow it to take shape and to deliver on digital technology.” From this perspective at least, Hancock’s return is a good thing: he has his own team in place at NHSX and is unlikely to alter its focus.

However, the new unit will still need to get itself embedded into the NHS’ new structures and come up with a solid plan to not just deliver on Hancock’s agenda but deal with the National Programme legacy of installed systems and Hunt’s contribution in the form of the global digital exemplar and local health and care record exemplar programmes.

The advisory board has suggested that it would do well to baseline digital maturity at trusts and health economies, to give it a measure to work from. Whatever it does, NHSX will need to move quickly. Because there are plenty of signs that Johnson’s administration could be distracted by Brexit and short-lived.

An early election or even a second referendum possible stop-points. If Hancock leaves health in this kind of scenario, questions about NHSX’s future will be raised again.

A growing to-do list 

Meanwhile, Hancock’s second stint at the DHSC may see him spending less time on tech. His top priorities are likely to be steering the NHS through Brexit, addressing Number 10’s investment pledges, and sorting out social care (possibly). If he is in post for any length of time, he will also need to decide what to do about the long-term plan and (possibly) lobby the Treasury for support on capital, staffing and prevention.

As Campbell pointed out, he has a lot of ground to make up in these areas, and some bridges to build with NHS policy makers and managers, given his abrupt decision to abandon his department for a leadership run that ended in support for Johnson.

But the NHS Providers organisation, at least, was grateful to see some continuity. “Matt Hancock’s re-appointment provides important continuity for the NHS at a key time,” said deputy chief executive Saffron Cordery. “He has been quick to acknowledge many of the challenges the service faces, including the priorities he set when he first took on the job – workforce, technology and prevention.

“As implementation of the NHS Long Term Plan gets underway, his experience of the NHS and encouragement of innovation will be a great strength for the service as it seeks to transform services to meet 21^st century needs.”

Highland Marketing is an integrated strategy, communications, PR and marketing consultancy, supporting UK and international health tech organisations as well as the NHS, we are now on GCLOUD 11. Over 18 years, we have built a reputation for being the go-to agency for vendors and their customers. 

Find out more on our website: http://www.highland-marketing.com, follow us on Twitter @HighlandMarktng, or call us on: 0203 651 6818.

Health and social care secretary Matt Hancock is setting up an NHSX unit. It’s hardly the first attempt to set up a central body to sort out IT policy and approach. So will it fly, or founder on the launch pad? Lyn Whitfield, Highland Marketing’s strategy and content director, considers

When the Health Service Journal broke the news that Matt Hancock was pushing to create his own digital unit, labelled NHSX, the story was greeted with some scepticism.

Surely, said commenters below the line and on Twitter, even a secretary of state as interventionist as Hancock couldn’t think he could just “dabble with the NHS like a kid with a new train set.” Or call his new unit NHSX, with its overtones of Mars shot SpaceX (and, less happily, Elon Musk).

Yet, just a few weeks later, the Department of Health and Social Care has announced that a new unit is, indeed, being set up. And it’s still called NHSX.

What do we know?

The official press release says the unit is needed because the slow pace of change on NHS IT is down to the “responsibility for digital, tech and data” being “split across multiple agencies, teams and organisations.”

“NHSX will change this by bringing together all the levers of policy, implementation and change for the first time,” it says. However, some details have yet to be filled in.

Most obviously, it’s not clear what status the new unit will have; there is no mention of it being given the legal status of, say, a special health authority. Nor is it very clear how it will be resourced or staffed.

The press release says NHSX will have a chief executive who “will be accountable to the health secretary and chief executives of NHS England and NHS Improvement”.

But it looks as though its other staff will be drawn from Hancock’s own, digital team, and NHS England’s rather more established technology and digital patient leads; who will continue to be employed by their respective organisations.

In another complication, a lot of its work may need to be executed by third parties including NHS Digital, which the release says will report in to the new unit.

A question mark against NHS Digital

In the medium-term, the establishment of the new unit puts a question mark against the future of NHS Digital, which, on launch day, was putting a brave face on things.

In a quote on the gov.uk website, chief executive Sarah Wilkinson described NHSX as “an important and welcome initiative” and one to which “we are absolutely committed.”

However, in an email to staff quoted by digitalhealth.net, she acknowledged that she expects the unit to “define” NHS Digital’s future and it will have to justify its “privileged position as the prime digital, data and technology delivery partner for the NHS.”

As one chief information officer told Highland Marketing, this “didn’t exactly scream stable future”. On the other hand, he didn’t feel this was a bad thing, as “maybe they are long overdue an overhaul”.

Here we go, again?

That’s not an unusual reaction. But NHSX has been set up to do more than put a boot under NHS Digital.

The gov.uk release says its responsibilities will “include” everything from setting policy and standards and making “source code open by default”, to running its own projects (“agile” ones, naturally) while cracking adoption, reforming procurement, sorting out security, and developing training.

So, the bigger question – and the one NHS organisations and tech suppliers will be asking – is whether it can do all those things. Its chances will depend on several factors; starting with whether Hancock is right, and they all need to be done by one body.

Over the years, various models have been tried for overseeing and delivering technology. The 1998 Information for Health strategy left policy with the Department of Health and what was then the NHS Executive, but set up a single body – the NHS Information Authority – to build infrastructure and run model projects.

When this didn’t work, the 2002 Delivering 21st Century IT strategy led to the NHSIA being side-lined up in Leeds while the National Programme was set up in London under a ‘director general’, Richard Granger.

When NPfIT started to struggle, the different power-centres morphed into NHS Connecting for Health. In its later years, CfH ran alongside the data-focused NHS Information Centre. Until the 2012 Lansley reforms split policy, commissioning and delivery between the Department of Health, what had become NHS England, and what became NHS Digital.

While this certainly suggests that the NHS can’t decide where to ‘put technology, it doesn’t suggest that it is having one body, or many bodies, for policy, commissioning, delivery and data that make a strategy successful, or otherwise. Other factors, from technology to money to service buy-in, matter.

As if to prove the point, NHS IT has a co-ordinating body at the moment, the national information board. This looked set to become a powerful, national body on the NHSX model when it was controlled by NHS information director, Tim Kelsey.

But it has faded from view since Kelsey left for Australia, the ‘paperless’ agenda he promoted with former health secretary Jeremy Hunt has more or less dropped off the agenda, and NHS England has focused on the global digital exemplar and Empower the Patient programmes.

Ignoring the statutory niceties

Still, NHSX may be something much more straightforward: a land-grab to resolve a good old-fashioned power struggle between Hancock’s new team at the DHSC and the more established set-up at NHS England.

The CIO quoted above certainly saw the move in these terms. “Hancock doesn’t want a whole lot of national agencies running ‘digital’ when he wants to be in charge himself,” he said. This has raised eyebrows in policy circles.

In a thread on Twitter, Harry Aagaard Evans from the King’s Fund noted that “the creation of quangos in response to particular issues is not new” but “they are most often created from the integration or disintegration of existing ones” rather than by “siphoning off” staff and responsibilities from existing ones.

“And that’s significant, because it demonstrates that the independence of NHS England from the DHSC is only really at the pleasure of the secretary of state.” Hunt went along with that. Hancock “is by nature a disruptor.”

The up and the downside a bold innovation

Hancock has been widely welcomed as a breath of fresh air. His focus on interoperability and his impatience with companies that block it have gone down well in NHS IT circles and with suppliers that are on board with the approach.

His headline grabbing statements that trusts should just “axe the fax” or stop sending letters and start sending emails have cut through a lot of rather stale debate about NHS tech. So, the arrival of NHSX, as a startling policy innovation, explicitly designed to drop a bomb into the established world of NHS IT, could make it a radical force that will cut through existing policy entanglements.

Equally, it could severely limit its chances of doing that. Because the flip side of NHSX being created at the behest of the health and social care secretary is that it could be dependent on his patronage. And nobody really knows how long Hancock will be around.

Parking the issue of Brexit, which could still topple the government at almost any moment, he has risen through the ministerial and cabinet ranks by staying for only a few months in any jobs he has had.

Meanwhile, as Ben Heather demonstrated in an opinion piece on the Health Service Journal (£) there are signs that the status quo is quietly fighting back. “An early, proposed version of NHSX would have placed it firmly within the DHSC, with its own director general reporting to Matt Hancock,” he wrote.

But that’s not what happened. Meanwhile, all the organisations involved, which, as Heather notes, includes a bunch of organisations not mentioned in the press release with data or regulatory responsibilities, retain their statutory duties and reporting lines.

And, critically, their budgets. The government may have promised the NHS in England an additional £20.5 billion a year by 2023-24, but for the moment, the only significant sums of money available for NHS IT are tied up in NHS England, NHS Digital, the GDE programme, and sustainability and transformation partnerships – which have already been given the £714 million that Hunt got out of the Treasury for tech in the last spending round.

To do what?

The really big challenge facing NHSX, though, may not be getting things done, but working out what it is meant to be doing. The NHS has an IT strategy, Personalised Health and Care 2020, which was launched to support the Five Year Forward View.

At one point it had more than a dozen workstreams. But of these, only the Empower the Patient programme, which has just lost its leader Juliet Bauer to the private sector, is still visible. PHC2020 looks dead in the water.

The NHS Long Term Plan, which was issued in January to revitalise the Forward View, has a chapter on technology. This focuses on digitising hospitals by extending the GDE programme, creating local health and care records, population health management, and Empower the Patient’s NHS App and NHS Login.

Last year, Hancock launched his own tech vision, extoling the virtues of cloud first, internet first, and app-based technologies. This is at odds with the (mostly) single supplier approach of the GDE programme, and the platform with open APIs approach of the local health and care record exemplars.

Plus, as Roy Lilley pointed out at a recent health chat with Hancock, it’s not really a strategy. The tech vision, for instance, won’t tell trusts what to do once they have axed the fax, on a spectrum from ‘send e-faxes’ to ‘go through the pain of exchanging structured, coded documents via information exchanges’ that will, for the moment at least, rely on proprietary technology.
Big job or poisoned chalice?

NHSX will need to clarify what NHS IT is meant to be doing, how it is meant to be doing it, and what technologies it should be deploying. A task that has defeated many bodies over the years; even those less closely associated with a single individual and set up on a proper basis with money to spend.

Commenters on the HSJ website, well versed in the art of managerial machinations, noted that a lot will be riding on who gets the chief executive’s job. Will they have the clout and staying power to make sure NHSX gets to fly?

Highland Marketing is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies, built over 17 years. Read more analysis and interviews on the Highland Marketing website, or get in touch on: info@highland-marketing.com

By Dr Anas Nader, NHS doctor and former Darzi fellow.

We are seeing UK start-ups make huge strides when it comes to how patients are able to see their doctors. Technology-led solutions are increasing in popularity – from video-based consultations to remote tracking of conditions. But whilst the hype is currently focused on access, more attention should be paid to the desperate challenges facing NHS staffing.

The question going forward shouldn’t be, how can I see my doctor? But, will there be a doctor to see me at all?

The NHS’ staffing dilemmas are well documented. 2018 saw, for the first time, the number of junior doctors continuing on to specialist training following their foundation years drop below 50%. Whether taking a break, heading abroad or moving into locum work, this annual exodus is now staggeringly high.

And the recently released ten-year plan, which struck a hugely welcoming tone for a digitally-led future, attracted criticism over how it plans (or lack thereof) to approach some of the chronic issues at the heart of NHS staff shortages. The plan noted that a “significant uplift” in international recruitment would be needed to deliver on the plan’s laudable ambitions, but there was little in the way of detail about tackling the structural issues that have led us to this point.

There is a surfeit of people looking to train as NHS doctors and nurses – demand is not necessarily the issue. And additional efforts are being made to further boost the number of undergraduate and nursing places to keep numbers up. Instead, we are failing to retain those who qualify into NHS clinical roles.

Whilst the world of work has changed dramatically over recent years, the NHS approach and systems have remained largely static. Workplaces across the UK have become more flexible with hours, freelancing and remote working is on the rise, and portfolio careers are increasingly the norm. But the NHS, despite being Britain’s biggest employer, has failed to keep up with the times.

Indeed, the ten-year plan highlights the institution’s lack of flexibility and responsiveness “in the light of changing staff expectations for their working lives and careers” and states that many of those leaving their roles would remain if opportunities for development and more flexible working improved.

Our health service, but dint of scale and decades of gradual evolution, has created a rod for its own back when it comes to staffing. Hitherto unable to be the flexible, modern employer desired by its own staff, unsustainable solutions such as increasingly expensive reliance on agency locums and international staff have filled the void. This has created financial burdens for the system, whilst failing to tackle the root causes of staff churn. And the impact of this is something we can no longer ignore.

The health of our existing medical professionals is on the line. According to ONS figures, 430 health professionals took their own lives between 2011 and 2015. Two-thirds of doctors responding to the BMA’s 2018 survey said their stress levels in the workplace had increased over the previous twelve months. And figures released by the Royal College of General Practioners in December showed that a third of GPs said they wouldn’t be working in general practice in five years. Stress was cited as one of the most common reasons.

We are operating an unhealthy environment for clinical staff. We are all familiar with the macro and micro issues which have led us to this point – the strains and pressures of a system struggling to cope with demand. But NHS staffing and the happiness of our clinicians cannot continue to be the elephant in the room whilst we navigate our way towards a health service fit for 21st century challenges. The cracks in the system are too big to ignore.

NHS England and individual Trusts must be willing to challenge the status quo when it comes to what a career in the NHS looks like. We must focus energies on creating a modern workplace where modern clinicians want to stay and progress. Our junior doctor training should be less prescriptive. The route of General Practice shouldn’t be the only option for those seeking a semblance of work-life balance. Trusts shouldn’t have to rely on agency staff to fill rota gaps. And nor should doctors revert to locum work by default when they feel stretched to the limit by full-time practice.

As we put increasing amounts of energy into improving the way in which patients can access clinicians and track or share their health data, we mustn’t neglect the health and wellbeing of those whose job it is to protect ours. We have to focus on creating a sustainable, scalable working environment where clinicians are able to work and care for patients without burn-out, stress or low morale driving them away from the institution which has never needed them more.

The first meeting of Highland Marketing’s newly expanded advisory board discussed the NHS Long Term Plan and what will be needed to make it a success. Structural change, leadership, investment, spending on the right systems at the right level, and empowerment emerged as key themes. 

The NHS Long Term Plan was published at the start of January. The 134-page document sets down how the health service in England will spend the £20.5 billion a year “birthday present” that the government unwrapped for its 70^th anniversary last July.

Alongside headline-grabbing initiatives on mental health and primary and community care, the plan lays out an ambitious agenda to return hospitals to financial balance, while progressing the Five Year Forward View’s vision of population-level planning and funding, aligned with more integrated health and social care.

The plan says accountable care organisations – now called ‘integrated care services’ – will be rolled out across England by 2021, while a new ‘service model’ is developed to give individuals more ‘differentiated’ options for treatment, support and advice.

Almost every element of the plan depends on IT and technology gets its own chapter to outline proposals to complete the deployment of electronic patient records in hospitals, develop a new model for integrated care records, abstract and use data, and enable individuals to interact with the NHS through personal health records and apps.

A week after the launch at Alder Hey Hospital in Liverpool, Highland Marketing’s advisory board met to discuss the plan and what will need to happen to make it a success. “Was this,” asked chair Jeremy Nettle, “the birthday present that the NHS wanted?”

Great, but what about implementation?  

The consensus was that it probably was, although there is a lot in the plan that is familiar, and implementation will be critical. “It is encouraging, because it is more substantive than the Five Year Forward View, and it is proposing to invest in technology,” said James Norman, healthcare CIO, EMEA, DellEMC. “The question is how to do it.”

The ideas in the Forward View were supposed to be taken forward by 44 sustainability and transformation partnerships. But most have made only limited progress and just 14 areas of the country are “working towards” ICS status at the moment.

Meanwhile, acute deficits have hit £1 billion a year, and NHS performance against key targets has slipped. The advisory board argued that to make progress this time, board-level leadership will be vital. Also, that where it’s missing – or distracted by deficits and day to day pressures – the centre will need new levers to pull.

NHS England is already using the NHS operating framework and financial regime to move towards joint control totals for commissioners and trusts and to push CCGs to merge. But the plan lays out legislative proposals to undo some of the structural and competitive elements of Andrew Lansley’s 2012 reforms; and the advisory board felt these would be needed.

“It is hard to believe ICSs will not happen, because NHS England has said so hard that they will happen,” said Andy Kinnear, the director of digital transformation at NHS South Central and West Commissioning Support Unit. “But this is a hard agenda, and it will need legislative change.”

However it is achieved, the board felt that consolidation on a 1/7/44 model (a merged NHS England / NHS Improvement, working through seven regions announced just before Christmas, and mapped to 44 STP/ICS footprints) is the right way to go.

Jeremy Nettle, a health tech industry veteran who started his career in the NHS, argued the NHSE/I regions are already “looking a lot like the old regional health authorities” and that this was a good thing, because they had the coherence and authority to drive change in their patches.

Andy Kinnear agreed. “I am missing the old strategic health authorities,” he said. “I never thought I would say that, but it is true.”

Tech needs leadership and investment  

The board felt similar issues would apply to the technology agenda set out in chapter five. Andy Kinnear said board level leadership would be particularly important for IT and welcomed its call for a chief information officer or chief clinical information officer to be on every board.

He warned, though, that these new CIO and CCIOs would need appropriate skills and training. Money will be required. Both Andy Kinnear and James Norman noted that a lot of money has gone into NHS IT over the past decade and a half.

The National Programme for IT in the NHS had £17.4 billion to spend on national infrastructure, services, and contracts to roll-out EPRs, while former health secretary Jeremy Hunt launched tech funds for ‘paperless’ initiatives, such as e-prescribing.

However, NPfIT mostly failed, and tech fund money was diverted to other uses. So, the board argued, while money is undoubtedly needed, it will need to be spent wisely and its impact will need to be monitored. Also, it will need to be spent at the right level.

“At the moment, there is a lot of duplication,” Andy Kinnear pointed out. “Service desks, infrastructure, almost every hospital running its own IT department. There is a lot of money being spent to replicate things, so there are massive savings to be had from working together.”

Organising IT at a healthcare community level would also make it easier to get neighbouring hospitals onto the same EPR systems, or to roll-out a consistent architecture for information and data sharing, he suggested.

However, there are no quick fixes. “One of the things I had on my list to talk about was ‘patience’,” he said. “These things take years. Connecting Care [the integrated care record that NHS SCW CSU runs for Bristol and the surrounding area] has been going since 2012 or 2013, and it is only in the past four or five months that it has become embedded into the system.

“It’s taken that long for using it to become normal behaviour; and the plug could have been pulled at any point in the four or five years it wasn’t seen to be working.”

Getting the basics right 

One reason that tech projects can take so long to make an impact is that they are often not so much tech projects as business process change projects; and changing NHS pathways, processes or working patterns is notoriously difficult.

Ravi Kumar, the chair of Zanec Software Technologies who was chief technology officer at iSOFT, argued that the NHS will need to get better at going faster. “The whole point of the ICSs is to make structural change, but the question is how they will do this,” he said.

“Technology is an enabler, but that is going to be the bigger question.” Advisory board members felt the NHS would need to make a big investment in Lean and other industrial improvement methodologies to shift the dial.

Yet Cindy Fedell, chief digital and information officer at Bradford Teaching Hospitals NHS Foundation Trust, stressed that even if it did this, it would need to make sure technology was pulling in the same direction. “Sorting out clinical pathways is a huge focus for work at the ICS level,” she said. “But something we talk about a lot is how we make that happen when all our IT is set up to work within organisational boundaries.

“How can we make sure that a district nurse, who is being sent out to work differently on behalf of three organisations, can do that without using three logins to three different systems?”

Naturally, Andy Kinnear agreed. The plan may focus on creating integrated care records, but at a local level, he argued, the real need is for integrated infrastructure. “The plan can’t talk about that, because it sounds too boring and not transformational enough, but we need to get the low-level stuff right, because if we do it will make the rest a whole lot easier.”

Exit the SCR and enter the PHR 

When it comes to integrated care records, the plan seems to envisage turning the old Summary Care Record plus a care plan into a basic record, rolling this out at local health and care record exemplar level, and then abstracting data for population health management, research and other uses.

The advisory board had few problems with the idea: the old NHS Summary Care Record struggled to become established and still exists in only the most basic form, while the more advanced LHCREs, like Bristol, are finally seeing information shared to support both services and planning.

Andy Kinnear pointed out that the plan seems to think that LHCREs will need to be bigger than most of the information sharing projects that exist at the moment, and that they will need to work within a consistent architecture to realise NHS England’s data ambitions.

But he was more interested in the personal health record aspects of the plan, which both envisages that patients will interact with their care plans, and access booking, clinic, and advice services through the NHS App and an ecosystem of third-party apps using its NHS Login.

“I talk to a lot of CIOs who think that their job is to build a PHR for their organisation, and I don’t think that is right,” he said. “I think the job is to create a vendor neutral platform that makes data available from the clinical record to apps that share it back with the patient and their health team.”

Cindy Fedell said she agreed and wondered if those who didn’t had “misunderstood the use case.” “This is not just about data, it is about managing the plan for health and wellness,” she said.

Beware the disruptors 

Some organisations have already got this. Andy Kinnear praised University Hospital Southampton NHS Foundation Trust for building a PHR that has improved efficiency (a prostate cancer app delivers routine test results, cutting outpatient appointments) while delivering unexpected benefits (the same app has been used to organise support and social events).

But he argued that if the NHS as a whole didn’t move in this direction, it would find itself under pressure from disruptive new entrants. Primary care, he pointed out, has already been rocked by the GP at Hand service that has so impressed Matt Hancock and by Livi, which has just employed NHS App developer Juliet Bauer.

Ravi Kumar suggested that ICSs might even use services to do the disrupting; breaking up the traditional GP practice to create, for example, “digital first” packages for working people and dedicated visiting services for care homes. Jeremy Nettle suggested the real need is for policy makers, commissioners and providers to think differently.

“At the start of this discussion, we were talking about how the challenge facing the NHS Long Term Plan was going to be implementation,” he said, “but now I think it is empowerment. “The key insight is that people will need to be empowered to take its ideas and drive change.”

Key points: 

• The NHS Long Term Plan is welcome as a comprehensive document that recognises the importance of technology. The challenge will be implementation.
• Board level leadership will be essential. Legislation may also be needed to create regional bodies with the authority to drive change within integrated care services, when these are established.
• More investment will be needed to deliver the proposals in chapter five to complete the digitisation of hospitals, create integrated care records, make better use of data, and roll-out personal health records and apps.
• However, costs could be avoided, and savings could be made if more health and care organisations shared IT services; and bought the same systems.
• Many technology projects are business process change projects, and the NHS will have to make more consistent use of Lean and other techniques to deliver the plan. But even if it does, it will need to make sure it has the infrastructure in place to support new pathways and processes.
• The development of personal health records and apps linked to the NHS App are a major opportunity for the health service to develop new services for patients. If it fails to grasp it, it could see disruption by new entrants.
• The key to the success of the plan may be empowerment: people need to be empowered to take up ideas and the potential of new technology to drive change.

Highland Marketing advisory board members: 

• Jeremy Nettle, chairman, and past chair of the techUK healthcare group and former European director for Oracle Corporation Healthcare.
• Cindy Fedell, chief digital and information officer at Bradford Teaching Hospitals NHS Foundation Trust.
• Andy Kinnear, the director of digital transformation at NHS South Central and West Commissioning Support Unit.
• James Norman, Healthcare CIO EMEA, DellEMC
• Ravi Kumar, chairman ZANEC Software Technologies.

Highland Marketing is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies, built over 17 years. Read more analysis and interviews on the Highland Marketing website, or get in touch on: info@highland-marketing.com 

What will be the key health tech and security trends affecting the NHS in the coming year and beyond? Highland Marketing asked members of its advisory group for their predictions.

James Norman, healthcare CIO – EMEA at DellEMC

I think there are going to be a few key initiatives that will continue through 2019 and some innovations that take off in a niche way. The key initiatives are interoperability platforms and data analytics, by which I mean machine learning, deep learning and, to a lesser extent, AI. What the papers call the “rise of the bots”.

Interoperability platforms will be built through a combination of cloud and hybrid on-premise environments. There is a push from the centre to use public cloud, but a large percentage of the applications in use in the NHS will not run in a cloud environment; whilst long term storage ofdata in the cloud can be prohibitively expensive, because of the cost of retrieving it when needed.

Nevertheless, people are starting to accept that cloud is going to be part of the story; and some of the big providers have just made it easier to move data to and from their clouds: Microsoft Azure and AWS have announced systems that will make it easier to consume cloud services.

This should enable people to take advantage of the flexibility of cloud, while maintaining the security that comes with managing patient data on premises, and the cost benefits of archiving data on disk or tape.

At the same time, people are starting to understand that different cloud environments are good for different things; and in 2019 I think we will start to see the spread of what we call multi-cloud, with people managing data between different providers.

The exciting part of all this is that once you have built your interoperability platform, or your collaboration and research platform, you can start using the data differently. Until relatively recently, people either had to build their own analytics platforms or, if they wanted to go down the AI route, they had to work with companies like Google DeepMind or IBM Watson.

Now, there are new entrants writing applications for healthcare that organisations can plug and play; and we are starting to see trusts adopting them for simple things, like audit, readmission planning or drug dose checking, because they save time and improve efficiency.

Around the world, we are also seeing pockets of interest in using machine learning to identify disease and treatment trends, to risk stratify populations, change clinical decisions in real time, or even tell patients that they might be better going to a GP practice with open appointments than staying in A&E.

We will see a slow rise of this in the NHS in 2019; and it is the direction of travel for the LHCREs, especially now the research agenda is being brought in. My niche innovations, finally, are augmented and virtual reality. There is a lot of investment going into this area; and they’re definitely going to be featuring in future predictions with pockets of clinicians trying them out in 2019

Dr Saif Abed, founding partner and director of cybersecurity at AbedGraham

When it comes to making predictions, there’s the risk of making outlandish or wildly ambitious claims about what the future could look like. The technology sector is particularly guilty of this; there will undoubtedly be claims the 2019 will be the year of technology x, y or z or, even more cliché, the year of disruption.

The world of cybersecurity is no stranger to this. However, there are some inescapable facts that – as much as being predictions – are warnings to heed.

1. The cyberattacks won’t stop
   In fact, the volume of attacks targeting the NHS will go up. It’s simple maths. We continue to digitise NHS organisations with more applications and devices that are network connections; so there are more things to try and break or take control of.
2. The cloud brings new risks
   Transitioning to more cloud-hosted services in 2019 is going to yield productivity, workflow and security benefits for the average trust. That doesn’t mean it’s risk free. It simply means there will be new types of vulnerabilities that we have to be aware of and contending with. Attackers will be keeping a keen eye on this.
3. Interoperability and contagion
   Interoperability is the name of the game for 2019. We need major healthcare IT suppliers to work together to support regional workflows. However, if insecure networks and systems are connecting with each other then they introduce risks to one another that mean a single attack could compromise an entire region.
4. The Internet of Insecure Things
   IoT devices are now everywhere. That includes medical devices and more of them is going to be another upward trend. Unfortunately, many of these devices are woefully insecure. We will see more IoT attacks hitting the headlines in 2019 that will hamper everything from hospital facilities to patients’ medical devices.
5. Insecure start-ups
   My final prediction is the only one I think isn’t guaranteed for the coming year, although I do think that it is ultimately inevitable. In 2019, a major digital health start-up in the UK will suffer a major cybersecurity event that either takes down its services or leads to a patient data breach. Start-ups are notorious for paying little attention to security and regulatory standards and that’s no different in healthcare.

So those are my predictions for 2019. They might sound like doom and gloom; but in reality most of these are perfectly manageable if we work together to tackle them head on.

Andy Kinnear, director of digital transformation, NHS South, Central and West Clinical Commissioning Group, chair, health and care executive, BCS, The Chartered Institute for IT

I think 2019 will be remembered for three things. The first is the start of real consumerisation in the health and care space. We are going to see the launch of the NHS App, a big expansion of the NHS Apps Library, and an explosion of personal health record platforms of one form or another. This agenda has been bubbling under for a while, but this year I think that it will surface and be really exciting.

The second thing is a huge change in digital leadership. I think we will see boards start to take their responsibilities seriously and give a lot more time to the digital agenda. That’s because [health and social care secretary] Matt Hancock has signalled that we need the system to engage, but also because we are seeing a lot more interest in putting digital into the NHS operational model than we have done in the past.

Again, it is something we have been talking about for a while: but I think we will go from rhetoric to action this year. The other side of that is that we will continue to see investment in the calibre of digital leaders in the system. With the growth of FEDIP [The Federation for Informatics Professionals, part of the BCS], the success of the Faculty of Clinical Informatics, and the first cohort coming out of the NHS Digital Academy, there are influencers ready to change things.

It we want to increase professionalism in the IT space, I think we need to target leaders, because they bring their teams with them. I think we will see that in 2019. I think we are on the road to professional accreditation and that’s a good thing. I often say I want the people who do my job to be properly trained and accredited, instead of falling into it by chance.

The third thing is interoperability. It feels like 2018 was foundational, with the consolidation of the Professional Record Standards Body and INTEROPen, and the establishment of the local health and care record exemplar programme. So, I think that in 2019 we will see active spending on building interoperable health and care and the creation of regional platforms to support data flows. If that happens, and the NHS sorts out its regional and transformation structures, I think we will be in for a bright future.

Highland Marketing is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies, built over 17 years. Get in touch on: info@highland-marketing.com

The turmoil in UK politics makes it hard to look too far ahead, but it is long-term trends that will shape the NHS and health tech through 2019, and well thought communications that will ensure success for vendors, say Lyn Whitfield and Mark Venables.

Lyn Whitfield, director of content strategy, Highland Marketing: This July, the government found a “birthday present” for the NHS of “an extra £20 billion a year by 2023-4”; but we still don’t have crucial details, such as how inflation or pay increases will be handled, or how the money will be distributed.

The long-term plan that is supposed to determine future priorities has not been published; and there is no sign of the social care green paper. Which is hardly surprising when ongoing turmoil over Brexit makes it difficult to predict who will be in Number 10, the Treasury, or Richmond House next week.

A no-deal or hard-Brexit would have a terrible impact on the NHS. But if we assume public health information flows, staffing, medical supplies, and research relationships are maintained, it is long-term trends not short-term politics that will shape the health and care system in 2019.

The demand pressures caused by an ageing population and rising inequality are not going to let up. The £20 billion won’t go far toward addressing them, when the acute sector is £1 billion in deficit and the Treasury seems determined to get hospitals hitting key targets again.

Traditionally, the NHS’ response to a need for change when the fundamentals are against it has been a reorganisation, and the outline of one is becoming clear. NHS England, NHS Improvement and Public Health England have effectively announced a new regional structure.

NHS England chief executive Simon Stevens has insisted that the push for accountable care organisations (currently integrated care services) is “the only game in town.” And his deputy, Matthew Swindells, has said one clinical commissioning group per ICS might be plenty.

New health and social care secretary Matt Hancock has shown no interest in disrupting this direction of travel; which is anyway in line with reforms being pursued by health systems worldwide. So, a change in personnel or government is unlikely to derail it (although the acronyms might change again). On the tech front, this should create space for the further development of regional care records and predictive analytics.

The big question is whether it will finally force change in England’s hospital-focused model of care; and if it does, how the tech component of that will be addressed. Digital laggard trusts have a huge job of work to do, while leaders are starting to face legacy issues.

Growing agreement over what Hancock calls “interoperable data standards” will help to link-up existing systems, but with the global exemplar programme pushing single-supplier EPRs and the secretary of state pushing public-cloud located, internet-first applications, someone will need to broker an agreement about what the future looks like. And then find a way to deliver it.

Now, why does that sound familiar?

Mark Venables, CEO, Highland Marketing: It’s tempting to say that in 2019, winter will be cold, spring will be wet, summer will be very hot, and autumn will start getting cold again. Because it’s hard to see how 2019 will differ significantly from 2018.

The challenges facing the NHS and social care remain the same, and it sometimes feels as if the people working in them are so bogged down in the day to day that they don’t have the time to scope out, never mind adopt, the transformational change that everybody can see is needed.

Health tech companies still need to communicate their messages, though, so the right stakeholders hear them as often as possible and are ready to act on them when they have the headspace and resources. Selling to the NHS is a long-haul, and the key to success is to have a drip-feed of the right marketing, PR and sales content.

If it’s hard to see much change in the NHS and social care, there are changes on the technology front that are likely to have an impact in 2019. The idea that every hospital should have its own IT department, running its own server room, and sorting out its own network and devices is being questioned.

The idea that everything is just going to shift to the public cloud is unrealistic. But I would expect to see the wider uptake of hybrid models in 2019, with more major suppliers hosting their own systems, and more applications becoming cloud based.

That should free up chief information officers to focus on strategy and free up people in their departments to focus on more interesting things. Again, the role of PR and marketing in all this is to make sure companies have their messages in front of key influencers, and to show them the art of the possible, and how that will support them.

That’s particularly important because the health tech market is such a crowded space. It is a paradox that while health and care is a hard and cash strapped environment, there are a lot of companies looking to sell into it. In 2019, as in other years, it is companies that put the effort into understanding the market and shaping its thinking that will stand out.    

Highland Marketing is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies, built over 17 years. Get in touch on: info@highland-marketing.com

Medical histories spewing quietly unnoticed onto a desk in a busy ward, urgent information being sent to places that doctors can’t access, junior doctors leaving a patient’s bedside to pick up a piece of paper that has just been delivered then running back with essential information quite literally in hand. Welcome to 2018, where the NHS still runs on fax paper. 

However, as Health Secretary Matt Hancock announced this weekend, it won’t for much longer. From January 2019 NHS organisations will be banned from purchasing fax machines with a view to achieving a fully fax free NHS by 31 March 2020.

There are plenty of NHS fax horror stories – Richard Corbridge, Chief Information Officer at Leeds Teaching Hospital Trust, tells of a fax machine spilling never to be seen requests behind the cupboard on which it was sat for years on end. But the fax machine also presents a number of more mundane daily challenges to running a modern NHS. Information sent by fax cannot be easily shared with several colleagues at once, faxes have to be scanned onto electronic filing systems (a time-consuming exercise that makes information hard to search for), and sending faxes takes considerably longer than sharing information via digital formats.

Matt Hancock’s announcement will be welcomed, therefore, by anyone who cares about protecting the NHS’ staggering volume of personal data and those hard-working clinicians trying to get through their shift in an efficient way. It’s an important step forward in bringing the NHS’s 20^th century communications network up to date.

‘Axeing the fax’ should not be where this conversation ends. To increase efficiency and make the experience of healthcare better for patients and NHS employees alike, our health service needs to let go of other archaic technology and embrace the array of new healthcare solutions that the tech sector in the UK is currently creating.

One of the most encouraging elements of this weekend’s news was that it came off the back of a well-argued campaign from those working on the frontline, such as the team at Leeds. It’s the innovations and updates being championed by the grassroots which are really making an impact on healthcare delivery. Gone are the days of mass software roll-outs, instead increasingly replaced by the forward thinking and proactivity of NHS staff on the front line.

But what does a new technological chapter for the NHS look like – where should the next step in this digital revolution take us?

From my experience as an NHS Junior Doctor, it’s clear that it’s high time to part with the pager, end the risky use of WhatsApp, hang up the landlines, and finally put paid to paper. Our clinicians are slowed down, held up, and demotivated by the 1960s communications infrastructure upon which we are forced to rely. And the fax machine is just one component of this. A true digital revolution means investing in innovation and understanding that the next 70 years of the NHS’ life will look, in many ways, radically different to the first 70.

While we gather kindling for the bonfire of the fax machines we need to think about what comes next and how we can use the possibilities of the UK’s youthful tech sector to the advantage of the country’s most beloved grandparent – the National Health Service.