Digital Health’s editor-in-chief Jon Hoeksma looks back at some of the key themes and stories in digital health across the past 12 months.
2022 was the year that saw Russia invade Ukraine, the biggest war in Europe since WW2; the departure, and almost return, of Boris Johnson; the death of Queen Elizabeth II; the utter swivel-eyed madness of Liz Truss and the Tories; the ongoing melt-down in the UK’s public finances; sky-high heating bills and rampant inflation squeezing living standards.
The country is in a recession that the Bank of England says could stretch through 2024; we have industrial action on a scale not seen since the 1970s with nurses, ambulance staff, rail workers, and post office staff all striking.
The country is a lot poorer, colder and less confident as the year ends. Oh, and England went out to France in Qatar on a penalty miss.
While NHS IT and digital health weren’t in the same league as the above litany of national woe it still had a pretty tough year of change, confusion and uncertainty, but also some notable successes.
Exhaustion, fatigue and fraying consensus on NHS
Like the rest of their NHS colleagues, many digital health professionals found 2022 a gruelling marathon. A year to be endured, in which while the Covid crisis began to recede the demands and pressures did not.
How digital health can relieve some of these pressures on staff, on tackling the backlog of elective procedures and quality of care and outcomes remains the key challenge ahead.
But to do so requires adequate resources and sustained investment for the whole of the service, which can only come from a renewed commitment to the NHS from elected leaders. And as the year ends that political commitment is looking increasingly frayed: just two years and a half years on from applauding the NHS, mainstream media of the right such as The Telegraph, The Times and Spectator are now actively attacking NHS staff and calling for the abolition of the NHS.
Integrated Care Systems
In amongst all the excitement of the year, we had a new Health and Social Care Act that formally created the 42 Integrated Care Systems and Integrated Care Boards as legal entities. During the year, they gradually started to appoint digital leaders and chart their future course.
GSST melts down
Perhaps the worst outage of the year came in July in the record-breaking summer heatwave when the creaking air conditioning and servers at Guy’s and St Thomas’ literally melted down in 40-degree heat, leaving the London teaching trust without access to its EPR for almost two weeks. Green IT suddenly looks like a more business-critical issue than ever before.
The trust is now spending £450m on its Epic Apollo digital programme, which GSST CEO Prof Ian Abbs memorably described in march as “chickenfeed” compared to the overall NHS budget.
Perhaps the most notable NHS IT incident of the year, yet curiously underreported, was the August cyber security attack on supplier Advanced that took down multiple systems including NHS 111 and mental health EPRs. Four months on trusts are still trying to recover. Difficult not to think that had it been 12 teaching hospitals affected it would have been a huge national news story.
The attack, the worst in the NHS since Wannacry in 2017, showed that the NHS needs to be far more assertive in the assurance that its suppliers are cyber-secure and have visibility across its supply chain. Will 2023 be the year that zero trust starts to become the foundation for NHS cyber security?
The incident and aftermath were discussed in a December Digital Health Networks special debate, now available on demand.
Palantir, the romance continues
Relationships with suppliers, or rather one supplier, were the theme of the slow-moving scandal of the year. The ‘will they, won’t they’ oddball romance between NHS England and Palantir on the now £360m national data platform procurement, which had ballooned from £240m at the start of the year, continues into 2023.
Palantir’s involvement in NHS data is already spreading through the Faster Data Flow project, now the subject of a legal challenge.
The links between Palantir and US National Security agencies, plus founder Peter Theil’s reported hostility to democracy, led many to question whether Palantir was a fit organisation to work with the NHS. In a November blog, National Data Guardian Dr Nichola Byrne posted that suppliers should share NHS core values.
Data strategies and TREs
The year also saw the publication of Professor Ben Goldacre’s independent report, Better broader, safer: using data for research and analysis in April, followed by the long-awaited NHS Data Strategy, Data Saves Lives, reshaping health and social care with data in June. Though sharing many key points, the Goldacre report, which focuses on data for research, offered a highly readable and compelling manifesto of how to develop research environments, skills and capabilities while building public trust. Data Saves Lives, by contrast, is much wider in data scope, and while repeatedly referencing the importance of information governance tends to assume consent is owed rather than earned.
Reorganisation and change
The biggest theme of the year was uncertainty as NHS Digital and NHS England disappeared into the fog of re-organisation and introspection, triggering a familiar round of job moves, departures and programmes and initiatives being axed, forgotten or otherwise thrown into limbo
In March it was announced that NHS Digital and HEE would be merged into NHS England’s Transformation Directorate creating a mega-sized arm’s length agency that must surely be set to be split up sometime soon. By July the merger had become a full-blown cull with news that 40% of jobs were to go, including NHS Digital’s CEO Simon Bolton who announced in November that he was off.
The merger is now meant to be completed by January. However, sources suggest there remains no clarity yet on what programmes will have to be ditched to achieve such deep cuts.
Where have all the Matthews gone?
Other high-profile departures included former NHSX boss Matthew Gould who landed himself a very pleasant berth as CEO of London Zoo, and now can be seen in Twitter selfies with cuddly creatures. A significant improvement on his former boss Matthew Hancock who appeared on ‘I’m a Celebrity’ eating unspeakable bits of less attractive creatures, possibly to make the public forget about what a mess he’d made of the Covid response.
Going large in Manchester
A notable success came in September when all of the ten hospitals within Manchester NHS Foundation Trust went live in an Epic project called Hive, in what is believed to have been the largest EPR go-live to date in Europe.
The continued march of Epic was a feature of the year. Both Frimley Health and Royal Devon University Healthcare NHS Foundation Trusts went live with Epic EPRs in June and July respectively.
Convergence and levelling-up
Convergence and levelling-up remained the main policy themes with money sometimes attached throughout the year, with NHS England’s Transformation Directorate directing trusts and ICSs to draw up plans to procure or share systems jointly.
The twists and turns have been opaque with very little published in the clear but throughout the year money was available, then wasn’t, then was as long as it could all be spent immediately. Local CIOs speak of confusion and of being repeatedly marched up the hill and back down again
After an awful lot of naval gazing, NHS England decided to ditch developing its own measures and framework for digital maturity, to also not use the international HIMSS EMRAM benchmark it had long favoured, and instead commission its favourite reassuringly expensive consultants McKinsey. An apparent opportunity for some easy savings missed.
Queue a further flurry of urgent surveys and questionnaires
One dog that didn’t bark in 2022 was UX. Despite NHS England commissioning expensive national surveys on UX of NHS IT from KLAS at the end of 2021 almost none of the results or findings were published nationally.
The reason perhaps was because of how poorly the NHS scored, in comparison to other countries. What limited findings have been shared suggested that, with some notable exceptions, the NHS ranked in the bottom tenth.
Look to the future
As the year ended Frank Hester, CEO of TPP, threw down the gauntlet and questioned the current status quo and urged the NHS to look to the future and imagine a future beyond today’s current generation of EPR systems.
It will be interesting to see if this provides the starting gun for a much more transparent debate on what should be the costs associated with different levels of digital capability and maturity.