NHS England claims it will be all-digital within the decade

Stop us if you've heard this one before

NHS England has once again pledged to improve the state of digital services to benefit patients and staff in its Long Term Plan, with a fully digital secondary care and access to digital consultations promised by 2024.

The 136-page document (PDF), published at midday on 7 January, aims to provide clarity on the government's plans for the NHS over a longer period of time, setting out how the 70th birthday funding boost – an extra £20.5bn on top of 2018-19 levels by 2023-24 – will be spent.

It includes 10 priorities and 10 milestones for digital healthcare, with the broad promise that at the end of the next decade, there will be "an NHS where digital access to services is widespread".

NHS hosptial photo, by Marbury via Shutterstock

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The document makes the usual promises about scrapping outdated kit, creating joined-up systems and digital patient records, linking genomic and clinical data, and making better use of tech from artificial intelligence to apps.

Such pledges will no doubt sound familiar, both in the short and longer term, as they have been rolled out ad nauseam over the years, many of the schemes meeting little success – examples include the scrapped £11bn National Programme for IT and the botched Care.Data programme.

More recently, health secretary and, er, app minister Matt Hancock has been trotting out his "tech vision" for the NHS at every opportunity, while the PM has hitched various announcements to the AI bandwagon.

In that sense, much of the document repeats and restates former promises – the NHS app, investments in genomic databases and integrated records, for instance – but the Long Term Plan collates these and puts in place deadlines for the work.

One target that has been shifted is that secondary care providers in England will be digitised by 2024 – a year later than had been mooted previously, and much later than one former dream of a paperless NHS by 2018.

National Health Service Trusts have already been told they can't buy any more fax machines from this month, and the devices will be banned by 2020. Meanwhile, all providers across acute, community and mental health "will be expected to advance to a core level of digitisation by 2024".

This should include clinical and operational processes across all settings, locations and departments, the document said, with data "captured, stored and transmitted electronically, supported by robust IT infrastructure and cyber security".

The NHS will support this by speeding up the roll-out of the Electronic Patient Record system and associated apps, it said, including a range of Software as a Service and cloud-based variants.

Security? We've heard of it

And, by the summer of 2021, NHS organisations in England will have "100 per cent compliance with mandated cyber security standards across all NHS organisations in the health and care system". Do you hear that, NHS techies?

In the aftermath of the 2017 WannaCry attacks, and more recent reports of a breach of DNA data, this target may not be soon enough – but the starting point has to be considered, as it was recently found that a quarter of trusts have no staff with security qualifications.

By 2020-21, people will have access to their own care plan and communications from care professionals by the NHS app, and by 2023-24, every patient in England will have access to digital-first primary care.

"There are about 307 million patient consultations at GP surgeries each year," the document said. "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."

The aim is to reduce the pressure on GPs, and increase the time they can spend on face-to-face appointments with people who do come to the clinic.

Similarly, the document brands the current outpatient model "outdated and unsustainable" – echoing the picture painted in a report from the Royal College of Physicians last year.

The government said it would redesign services over the next five years to remove the need for 30 million outpatient visits each year, which it said would avoid the associated £1.1bn bill.

The plan also proposes that over the next three years, all staff working in the community will have access to mobile digital services, including their patients' care records, so they can, um, focus on doing their jobs.

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The milestones are accompanied by 10 "practical priorities" that are needed for these lofty aims to be met.

They include "straightforward" digital access to services, ensuring clinicians can access patient records wherever they are, using predictive techniques to help local health systems better plan care, and ensuring NHS systems and data are interoperable and secure.

Observers would be hard-pressed to argue with the aims – most people have experienced first hand the frustrations of a practitioner that can't access certain records and the NHS's much-hyped reliance on fax machines attests to the legacy kit still in use today.

But in order for them to be successful, NHS organisations across the board need significantly more resources for digital, training and communications work to help patients benefit from the new tech.

Moreover, the NHS needs to tackle the systemic non-digital problems that cause knock-on problems elsewhere – and the organisation has, historically, fallen short of the mark when implementing ambitious plans.

"In the NHS it is always difficult to take changes from the whiteboard to the ward," said Nuffield Trust chief exec Nigel Edwards.

"Success depends on extra effort and initiative from staff. But relations are frayed by shortages and increasing burnout, so some real leadership will be needed."

Edwards said the biggest obstacle was a lack of staff, which has been estimated at a 250,000 shortfall by 2030, and the impact Brexit would have on this.

He added that Brexit would increase costs and work for the NHS, while noting "the extra funding will actually be below the historic average and what experts thought was needed". ®

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