From pagers and paper to AI and IoT: Can the NHS' technology transformation plan really succeed?

The health service is faced with increasing demand for its services combined with underfunding. Can it use technology to reinvent itself?

NHS embarks on its digital transformation: Where do you start? NHS has paper-based systems, multiple technologies and needs a data architecture. ZDNet UK Editor in Chief Steve Ranger talks about the moving parts and the challenges getting the NHS ready for innovation in the future.

In 1948, the height of computing technology was a computer named Baby, housed at the University of Manchester. This technological marvel was the first machine to run a computer program: a feat of engineering 17 lines long. In the same year, another innovation came into being: the National Health Service, an organisation designed to give healthcare to anyone who needed it, entirely free. 

Now, 70 years later, both computing and the NHS have moved on more than their original developers could ever have imagined. Today, can tech give the NHS the jump start it needs?

This year has already seen the release of two key reports that will guide the NHS' tech strategy for years to come: the smartly titled Long Term Plan, setting out the health service's policy for the next 10 years with IT playing a central role, and the Topol Review, detailing how staff should be prepped to be able to use all the new technologies that the next decade brings.

Like any large organisation faced with financial pressures – in particular inadequate funding in the face of rising demand for its services – the NHS is looking towards technology to help drive efficiencies and cut costs. The Long Term Plan sets out a number of aims, including improving out-of-hospital care, reducing pressure on emergency services, patients having more control over their own data and personalized care, increasing provision of digital health services, and better population health.

SEE: Digital transformation: A CXO's guide (ZDNet special report) | Download the report as a PDF (TechRepublic)

While NHS IT has been subject to several overarching plans over the years – most notably the National Programme for IT – with varying degrees of success, the Long Term Plan is different in that's driven by trends in consumer IT: both patients and staff are used to using increasinlgy nimble devices and services, which they now expect the NHS to embrace. 

"I do think we're making progress… People are paying a lot of more attention to this, and in some way this must be driven by what's happening in the rest of people's lives – they've got iPhones in their pockets that are more powerful than the computers they're using. I think it does feel like that's different from the when National Programme for IT was around – there is a different attitude towards these kinds of IT. I do like to think we turned a bit of a corner around National Programme for IT, and the approach that's being taken today is a qualitatively different one to the one that's taken back then," says Harry Evans, a researcher at health charity and think tank the King's Fund.

The Long Term Plan is, at its heart, optimistic about the transformative power of technology, painting a beautiful picture of how things could be, without detailing the scale of the work that lies ahead.

"The NHS is a hotbed of innovation and technological revolution in clinical practice," it says. That might be true, but it's also a hotbed of outdated technology: one where faxesransomware, pagers, and paper notes are still all too common.

"Digital and technology are quite important enablers to the wider ambitions for the Long Term Plan, thinking about more joined-up integrated care systems, the ability for data sharing to really support that, population health and [disease] prevention," says Rachel Hutchings, policy researcher for think tank the Nuffield Trust. "It's clear that digital is quite high on the health policy agenda, and I think that's really positive. There definitely is that capacity and buy-in to do that, it's just about making sure it's implemented in the right way."

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Technology will play a key in underpinning some of the other NHS aims detailed within the plan: for example, using technology to improve elder care. In order to prevent as many emergency admissions by older people, the plan sets out that the NHS is going to rely on greater use of Internet of Things technologies: a location tracker for someone with dementia for example, and equipment to model levels of drugs in the blood at home. The aim is to have it all connected up to the patient's health record, so doctors can monitor changes in someone's condition without having to call them into the surgery. "The connecting of home-based and wearable monitoring equipment will increasingly enable the NHS to predict and prevent events that would otherwise have led to a hospital admission," the plan says. 

Perhaps the greatest change that the Long Term Plan sets out is the ability for patients to have consultations digitally, either by phone or online. While some use of phone consultations is becoming the norm among many GPs surgeries as a way of sorting routine appointments from more urgent queries, appointments via videoconference are a far rarer thing, and more commonly provided by private companies. 

"Over the next five years every patient in England will have a new right to choose this option – usually from their own practice or, if they prefer, from one of the new digital GP providers," says the document – another sign of the creeping privatisation being wrought on the NHS. "New digital-first primary care is proving convenient and popular, and is bound to grow," it adds. 

While some patients may be keen to see their GP remotely, not all physicians are convinced about the usefulness of such services, which could potentially slow down adoption. 

Digital-first GP services by 2023 or 2024 are "technically possible, financially probably not even that expensive, but there are lot of patients and a lot of GPs out there who still need convincing that this is a worthwhile thing", says the King's Fund's Evans.

There are also concerns around whether encouraging greater use of patient-facing technology risks leaving some behind, like older people, people with disabilities, and people with multiple chronic conditions.

Another problem: in order to deliver on this vision, the NHS is going to have to put in place systems for better data sharing between all the various entities – GP surgeries, hospitals, pharmacies, and services including mental health bodies, social services and so on. Right now, gaps between each often leave health professionals without the full picture on their patient. 

SEE: Sensor'd enterprise: IoT, ML, and big data (ZDNet special report) | Download the report as a PDF (TechRepublic)

It's a problem that the Long Term Plan acknowledges "the burden of managing complex interactions and data flows between trusts, systems and individuals too often falls on patients" it says, but expects to see solved. It lists rigorously enforced technology standards as one of its priorities. 

"We've got this vision for world-leading technology in health and social care, but actually the current capital spending on IT is quite a small proportion of that spending, and that's potentially going to hinder our ability to get to that stage," says the Nuffield Trust's Hutchings.

"It's not only the initial funding that's required in order to make sure things are kept are up to date and organisations are prepared for future technologies, it's really important there's a sustainable funding model for digital so organisations can invest in that workforce and infrastructure, and are able to sustain that good work." 

Dale Peters, research director at TechMarketView, believes that – while there are challenges ahead – the direction of travel is promising.

"Things are changing but it's very hard when the system's under so much pressure to actually review and implement new systems and that's always going to be the case," he says.

Change needs to happen, he says: "But you need to do it alongside those working on the front line and make sure you're considering culture change alongside the introduction of the technology, rather than just introducing it for technology's sake."