The NHS is over 70 years old, with more than 1.5m workers, deployed across over 30,000 different organisations in four different countries. With so many cogs in such a huge machine, where does the digital revolution begin?
Looking at such breadth within the NHS, where does transformation start?
‘The NHS is incredibly complex. As well as having organisations within the NHS, some will be private companies providing care and operating independently. Just to give an idea, the NHS in England is made up of almost 30,000 or so organisations, including GP practices, dental practices, optometrists, pharmacists, ambulance services, out of hours providers and hospitals - that’s an incredibly complex and challenging environment.
‘An organisation like NHS Digital has to be there to provide support at an infrastructure level across the system. These are, of course, national organisations and, in some ways, supporting policy might be an easier place to start. What's more difficult is the next layer down, which is where it gets more complicated, but at the same time where most of the change happens - we’re talking at the regional or local level.
‘We have to first recognise that the pace of the change will not be the same in all parts of the country. It requires leadership at a regional level to bring people together for a shared understanding, focus and outcome. This requires some development between local organisations that are delivering services. However, change has to span from commitment at the top, at a ministerial level, through to the very centre of the health system.’
Do you start with the big picture and work down, or the minutiae and work up?
‘One of the things that we should always start off with is, what is the user need? Why is this change coming about? What's the problem we're trying to solve? Because all too often, it becomes about the technology. For some of those people out there, the barrier is real: they end up using something that might be technology or digital but actually makes their life and their work more difficult; it contributes to burnout, it means that they're spending more time doing something rather than less time.
‘We start off with the need, then focus on the experience the users of the systems, products and services will have. We think about what sort of interfaces they might have to engage with to do that job. Sometimes technology is forced upon people. Sometimes there's a few people who might have designed something with the best will in the world but when you actually land it in a live environment, it doesn't necessarily have the desired outcome.
‘A classic example of that is the NHS referral system. The idea to digitise referral was great, but when you get into the detail, you realise that some of these things can add more time and burden to a clinician's processes - and they don't always result in a better outcome. So, it's really important to work with users to understand what the issues are, what problems they are dealing with and then how digital technology might solve them.
‘We want interfaces to actually cut down on work, reduce the burden and give back time.’
