The 2016 Health and Social Care Innovation Expo wasn’t short on new policies, big reveals, and fancy tech. Ben Heather examines what we learned and the big event at what questions remain.

Paperless 2020 or 2023?

Making the NHS paperless by 2020 is a key health goal for the government, with health secretary Jeremy Hunt stating he was “relentlessly” committed to it as recently as June. But the paperless goal posts have shifted before and Dr Bob Wachter’s review, released during expo, said they should shift again to a less “unrealistic” 2023. Hunt was full of praise for Wachter’s review during his expo speech but strangely silent on the 2020 goal. He did let slip that “our objective is to bring everyone up to the standard of the very best by 2023, as Bob recommends”.

Matthew Swindells, at NHS England, seemed to have a bob each way. In one breath he claimed “obviously the secretary of state said 2020 so that must be true” and in the next that there “wouldn’t be a lot of complaint” if the last trust didn’t “systemically transform” till 2023. In short, expect the 2020 target to be quietly shelved without anyone in government admitting anything has changed.


The NHS “Ivy league”

The other big takeaway for Wachter’s review was splitting NHS trusts into three groups depending on their digitally maturity, giving money to the two top groups and putting the third lagging group on the naughty step to learn some digital manners. Initially Wachter said half of all trusts will be in the naughty group, who will have until 2020 to improve enough to deserve digital investment money and will be punished if they are still misbehaving by 2023.

The government has embraced at least some of this tiered scheme, with the announcement of money for 12 “global exemplar” trust (the top well-behaved group) and a further round of “national exemplars” (those that are “digitally fair” but could do better). While regional cooperation may be all the rage with the STPs, Hunt used a lot of competitive language to describe “exemplar” trusts and the rest in his expo speech. The exemplars would be the “Ivy League”, he said, but could be relegated to the lower leagues every year while the trusts below them could rise to the “Premier League”.


Block chains in the NHS?

Could block chain technology be the answer to all NHS’s digital woes? Probably not, but the concept of distributed ledger could be useful in fixing a few technical problems in the drive to link up more systems and give patients more control. During a session on block chains, Salford Royal NHS Foundation Trust chief information officer Rachel Duscombe said it could be used as a new infrastructure layer to “sweat the assets” and securely reconcile some information across the NHS. The NHS Spine and a planned patient identification service were two areas where the tech could be applied.

NHS Digital is looking at block chain tech and how it could be used in the NHS, particularly at a national level, but it is very early days. Dr Robert Learney, from Imperial’s cryptocurrency research centre, said there was a lot of hype around block chain, but changes were needed to make it fast enough to work for the NHS.

To learn more about block chain tech work start with Ewan Davis’ excellent column.


CCIO: The digital champions of the future

If you’re a chief clinical information officer, there was a lot to cheer about in Wachter’s review, which said CCIOs need more power and training. CCIOs were “rock stars” in US, Wachter said, and who doesn’t want to be a rock star?

The government responded to these recommendations with a “new academy to dedicated to training NHS staff in digital skills”. Hunt said the academy will be hosted by a university, which will be picked through a competition. CCIOs at Ivy League trusts will also be expected to share their know-how with other less experienced CCIO and spread the digital expertise around.


The disincentive to innovate

Some clever solutions are being tested by innovators supported by the NHS Innovation Accelerator, but many are running into resistance. Dr Keith Grimes, a GP in Eastbourne, is trying to distribute cheap mobile EKG monitors, from Alivecor, to other GPs so that patients can monitor their heart health from home and send the results in via mobile phone. The early pilot results were promising, detecting heart disease that would have been otherwise missed, but funding was limited and GP uptake was low.

Other innovators who spoke at expo said they had had to fundraise to support innovations that would save their trust time and money, and several blamed a payment system that discouraged trust from supporting innovations. Other said contractual arrangements with big IT suppliers often made it hard, and expensive, for trusts to buy products from smaller, more innovative, suppliers.


App Library 2.0 (and other patient digital widgets)

Hunt announced that a new NHS library for apps and wearable will be available from March next year and restated his goal to give patients more information control. There will also be an “instant access” patient online record available through the, the website that will replace NHS Choices. will offer a range of new bells and whistle including allowing patients to upload their own health data, book appointments, register for a GP, request prescriptions, and even access NHS 111.

If this all sounds a little bit familiar, that’s because most of it has been attempted before. An NHS apps library pilot was closed in October last year after a study found some apps could be leaking patient data. has been in development for more than a year and much of new functionality, such as an online NHS 111, had been announced previously. Going back to 2008, NHS Choices was meant to include many of the same patient services planned for It never quite got there.