The NHS is under mounting pressure; can smarter use of technology help bridge the gap between what the system can provide and what patients expect?
"A digital health system is the only way that healthcare will still be affordable in five years' time," says Richard Corbridge, chief digital and information officer at Leeds Teaching Hospitals NHS Trust. "Efficiency can only be generated through modern, digital practices."
Corbridge points to the digital transformation that has already led to significant disruption in sectors like banking, travel and entertainment industries: now, it is the turn of healthcare to face similar disruption, he argues.
"The need to deliver a single solution for the citizens of the UK for health and social care can only be achieved by embracing transformation and inspiring patients and clinicians alike to see the benefits of going digital," he says. "In pockets across the NHS, we see innovations daily; we need to find new ways to share these in an unselfish way, in a way that inspires the spread of impactful ideas."
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Few would argue that -- despite a number of major efforts in the past -- there is still much to do when it comes to the use of technology by the NHS.
"The role of CIO in the health sector requires the most innovative minds and a skill set beyond the traditional IT leader," he says. "Digital leadership in healthcare is now a business transformation role, a people-leader role and then, third, a technology role."
But getting momentum behind the transformation agenda in the health service is far from straightforward. Corbridge says digital leaders in healthcare face a complex environment. For those looking to drive transformation, he points to four major concerns: legacy, experience, cost and size.
Corbridge says the modern NHS often lives through its legacy technologies. "Whether its aged Windows infrastructure attached to high-cost clinical devices, or the fax machine beloved of so many areas in healthcare, the move towards a true digital transformation must be done part by part and -- as funding arrives -- system by system," he says.
In terms of experience, Corbridge says healthcare organisations generally lack digital leadership capability. He says there are not enough high-skilled digital professionals. Corbridge believes the next generation of highly motivated and innovative minds isn't coming to healthcare in the volumes the sector needs.
"It's becoming harder and harder to find graduates with a desire to work in a public organisation with a long-term mission, rather than working in a high-earning role in the enterprise sector that offers instant gratification," he says.
Corbridge refers to cost concerns and suggests healthcare digital leaders face a tough funding environment. "IT isn't free, yet expectations of digital transformation are high and funding does not always match these expectations," he says.
"The need to manage delivery at pace -- where the benefits and outcomes are expected quickly, with minimal budget -- runs across all aspects of the public sector. Perceived failures in the past in the NHS have heightened expectation and the need to deliver on promised benefits at high speed."
When it comes to concerns associated to size, Corbridge says the scale of the NHS and the width of culture that exists in the organisation is a significant challenge. "It's very difficult to create single programmes of change that can impact on healthcare throughout the system," he says.
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So, digital leaders in healthcare must drive change with limited budgets and high expectation in organisations that often rely on ageing systems and an inexperienced workforce. It sounds like an intractable challenge -- yet Corbridge says transformation through technology is the key to reducing complexity.
Corbridge points to the Local Health and Care Record Exemplars programme as a positive attempt to showcase successful local best practice. The initiative aims to support other organisations across the NHS as they adopt similar approaches swiftly. He says this type of programme highlights how digital healthcare, rather than being driven by vendor-led changes, needs to adopt standards and innovation to create a system of systems approach.
It's an approach Corbridge is taking at Leeds, which could help his organisation overcome the challenge of driving change across a large Trust with a diverse organisational culture. Yet there is still work to done, here -- and Corbridge recognises that dealing with the broad range of systems and resource remains a tough nut to crack for those involved in pushing healthcare transformation.
Corbridge says many NHS organisations rely on ageing off-the-shelf systems. These systems -- often originally built for procurement tasks in blue-chip businesses, rather than for healthcare -- have evolved over two decades to become clinical systems and are usually built on legacy code.
"Healthcare IT professionals must be wary of the fact that the procurement of systems from big-name suppliers often only delivers benefits after significant local configuration," he says. "They require a huge amount of modification to make them work in the NHS settings of our hospitals."
Such localised spot solutions to healthcare challenges also create integration issues. Corbridge says that while the heavily criticised National Programme for IT led to a stranglehold on system creation through its flawed attempt to create a single, centrally-mandated electronic care record for patients, the search for fresh approaches has sometimes led to the reverse scenario -- healthcare organisations are now so open and willing to try something slightly different that integration becomes an intractable challenge.
"There's always going to be barriers to what we need to do and how we do it," says Corbridge, reflecting on the dual concerns of balancing budgets and delivering change. "Maybe the answer is to consider building elements within the NHS against standards that enable the connectivity of systems and enable professionals within the health service to move closer together; less islands of excellence and more a system of systems."
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