Matt Hancock has published a tech vision founded on open standards, innovation and encouraging local choice with a move away from reliance on mega-suites. But it’s going to be tough to square this with the current centrally-directed global digital exemplar programme, argues Digital Health editor Jon Hoeksma.

The new tech strategy published by Matt Hancock yesterday is founded on open standards and technical architecture. It encourages competition and innovation, and aims to place choice of vendors firmly in the hands of trusts and CCGs.

It also explicitly puts current suppliers on notice. Hancock – whose ‘tech revolution’ is outlined in a policy paper he describes as his initial tech strategy – makes clear those that block data sharing and refuse to adopt open standards will no longer do business with the NHS.

Though broad bush and notably short of timeframes or pledges of money, the document nonetheless constitutes a heady vision. It will give cheer to those who believe the NHS has allowed itself to become beholden to a small circle of suppliers, and so created a market effectively closed to new entrants.

While a lot of attention will be given to the technical architecture and standards, more notable still perhaps is that the vision appears to rip up the current policy direction embodied in the global digital exemplar programme.

At its core, this programme is based on standardisation of a handful of EPR mega-suites. A long view of NHS IT policy might well conclude that this is the default position of the Department of Health and Social Care.

After a very short period of post-National Programme for IT devolution, the Department, NHS England and NHS Digital quickly reverted to assuming they know how best to set local IT priorities. Anecdotal accounts suggest influencing local procurements from the centre remains the norm rather than the exception.

A conscious change of direction

The selection of GDEs and subsequent choices of fast followers and LHCREs all represented a significant change of direction and reshaping of the market.

The change has been a conscious and deliberate one. Matthew Swindells has explicitly stated a key aim is to standardise on a handful of solutions that get rolled out cookie cutter fashion from GDEs to a growing number of fast followers.

Speaking in July 2017, NHS England’s national director for operations and information said: “At the core of the GDE model is the idea that we should be learning from each other. If the GDE and fast follower model goes well in the future, nobody will run procurements to buy IT systems again.”

He later elaborated that if people wanted to procure non-GDE systems they would not get national funding to support implementation.

We now have 26 GDEs – including mental health and ambulance trusts – and 17 acute fast followers. The expectation is there will be more.

But Hancock’s vision of open standards and a vibrant market centred on local choice is incompatible with the oligopolistic situation driven by the GDE programme.

Though the programme talks about the importance of standards, they are not at its core. And so even relatively modest interoperability successes like Epic and Cerner systems exchanging data between Cambridge and West Suffolk – which did require a lot of local hard work to achieve – get magnified into triumphs.

The reality is that interoperability between hospital systems remain the exception rather than the rule. And problems of suppliers who refuse to interoperate, open up data and APIs, or drag their feet on using common standards remains a stubborn feature of primary care.

Threats that have proved hollow

We’ve had repeated warnings, including from Jeremy Hunt, that suppliers who don’t interoperate and adhere to standards will be replaced. It hasn’t happened and the threats have proved hollow.

Even setting aside the technical and standards issues, it’s highly questionable whether the vaunted mega-suites can deliver the kinds of clinical and productivity benefits the NHS needs, at a price it can afford.

Cambridge University Hospitals, widely regarded as one of the English NHS providers to have gone furthest on digitisation, is forecasting a deficit of almost £100m and seeking further financial support from the Department of Health and Social Care. It attributes its troubles in part to the implementation of its eHospital programme.

Is this really a route that others can follow? University College London NHS Trust, Cambridge’s fast follower, must certainly be among those hoping not.