The US ‘Digital Doctor’ brought in to conduct a review of NHS IT says clinical engagement is essential to both successfully deploy new technology and overcome the ‘productivity paradox’ that initially stops it delivering expected savings.
Speaking to the NHS Confederation’s annual conference in Manchester, Dr Robert Wachter said he had been hoping to deliver the results of his review. But he had been prevented, or ‘purdahed’, from doing so by the civil service’s rules on issuing reports in the run up to the EU referendum.
Instead, Professor Wachter went as far as he could, while also battling a sore throat, which he joked he had picked up watching the rival EU referendum flotillas on the Thames on Wednesday, by setting out the context surrounding his report and ten of its key themes.
The background, he said, was the National Programme for IT in the NHS, which was set up in 2002 to create a national infrastructure, programmes such as Choose and Book for the NHS, and to deliver electronic patient records to hospitals by placing large contracts with companies contracted to major software firms.
Wachter noted that this part of the programme had “largely failed to meet its goals” and had left hospitals less digitised than GPs.
Also key to the background was the ‘Five Year Forward View’ issued by NHS England chief executive Simon Stevens in October 2014. The plan aims to close a potential NHS deficit of £30 billion by 2020-21 through a focus on prevention, new ways of working.
The government’s decision to invest in IT, on which “around £5 billion” is due to be spent over the course of this Parliament, was another key part of the context.
Wachter said the US had spent about $30 billion on digitising hospitals as part of its response to the crash of 2008, and this had delivered significant upsurge in the number of hospitals using IT systems. He argued the NHS could learn from this experience that central money, combined with local choice of systems, could work.
However, he said the NHS also needed to learn from the US experience that clinical engagement was crucial, and that interoperability should not be forgotten.
Wachter told the audience of policy makers and NHS managers that IT projects were “not just a matter of switching something on”, and that they required “adaptive change”.
He said clinical engagement was essential to making sure this happened.
Engagement was also needed to overcome the “productivity paradox” seen in many industries that had adopted technology; where little pickup in efficiency was initially seen in return for investment.
“The good news is that the productivity paradox vanished over time,” he said; but he added that this only happened if people started to change the way they worked.
In a rattle-stop presentation to a large audience at Manchester Central, Wachter then set out then “insights” from his review for the NHS.
These were:
1. Digitisation is not an end in itself, but a means to delivering safer, higher quality care.
2. Clinical engagement is “central”
3. The US experience shows that central money and local spending can deliver digital hospitals.
4. Good central infrastructure, of the kind that NPfIT did deliver to the NHS, is essential and should be built on not thrown out
5. Government should not over-regulate IT
6. Interoperability is also essential.
7. Usability – a subject on which Wachter was expected to say more than he did – is another essential.
8. IT needs to evolve to help overcome the productivity paradox
9. IT is a backbone for working in new ways
10. It is important not to “over-promise”.
In a debate cut short by the session running over time, he also agreed with a questioner that it was important to get decision support systems in place to get the most out of IT systems; but he warned these rarely came “out of the box’ and needed to be developed or added to core systems.