16 January 2013, Jeremy Hunt, Policy Exchange, From notepad to iPad: technology and the NHS
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
In 1953, when the NHS was just five years old, two men named Smith took a flight from LA to New York. They started chatting.
One Mr Smith was the head of American Airlines. He was having a nightmare coping with the explosion in demand for airline travel.
Back then it could take 3 hours to book a single ticket. They were dependent on the amount of work that 8 people huddling around a single rolodex could manage and they had reached their limit. Mr Smith was desperate.
The other Mr Smith worked for IBM.
That chance encounter transformed the industry.
It led to a new computer system that allowed any travel agent anywhere in the country to know which seats were available on any flight, book and issue a ticket all in a matter of minutes.
The implications were massive. Flying went mass-market - and American Airlines became one of the most successful airlines in the world. And we are still using the same system 60 years later - with the internet allowing us all to become our own travel agents.
But think how history would have been different if the man from IBM had been sitting next to a Mr Smith from the NHS.
What they introduced to the airline industry 60 years ago, we still haven’t done for health and social care today. The revolution that has transformed so much of our daily lives has only just started to touch healthcare.
Today I want to talk about why we need to embrace that revolution with enthusiasm - but also the pitfalls if we get it wrong.
The NHS today
Right now, one of the biggest challenges facing the NHS is the Francis Report about the appalling abuses of care at Stafford Hospital, shortly due to land on my desk.
I am clear that our response to that report must be about getting the culture and values right in the modern NHS as about regulation and systems.
Technology is not the answer to this. It can never replace human interaction, nor the care and compassion that must be at the heart of what the NHS stands for.
But today, I want to argue that it does have a role to play if we are to give doctors and nurses the time and space to deliver on those core NHS values.
The clearest example of this is patient records.
Because they are mainly paper-based, they can only be in one place at a time, only seen by one person at a time.
So they’re no use to a patient on holiday in Gloucester if his file is in a GP surgery in Godalming.
Or to a paramedic picking up a frail elderly woman in an emergency who, if he had her notes, could see she was a diabetic with a heart condition who had a fall last month.
They’re no use to a hospital doctor who might not be aware of a patient’s other medication and prescribe drugs incorrectly - potentially lethally - because the notes have got lost.
Unaware of a patient’s full history, complications arise in surgery.
Diagnostic tests are repeated unnecessarily.
And patients find themselves having to repeat their medical history over and over again, sometimes several times on the same day in the same hospital.
Other countries are making great strides.
In Denmark, people can see all their hospital records online, and this year will be able to see their GP records too.
In America, military veterans, who have their own healthcare system not unlike the NHS, can download their own health records. Something that almost 20,000 veterans do every month.
In Sweden, over 85% of prescriptions are transferred from doctor to pharmacy online.
Here in the UK we too have some interesting pioneers.
King’s College Hospital, for example, is on track to become fully paperless by the end of this year.
The drive comes from the clinicians who demand to have the right information in the right place at the right time. They’ve introduced electronic prescribing, and nurses use an iPod Touch to record and monitor a patient’s vital signs at the bedside.
Maudsley Hospital’s ‘MyHealthLocker’, gives their patients online access to their hospital and GP records, a world’s first in mental health. They can also feed back on their care plan, helping them to take control of their own healthcare.
And Newham University Hospital is piloting using Skype for diabetic outpatient appointments that don’t require an examination.
Missed appointments are down by 11%, patients don’t have to travel and the quality of care is improved.
But today I want to argue that we need to go much further, much faster.
So today I am setting a new ambition for the NHS.
I want it to become paperless by 2018. The most modern digital health service in the world.
Patients will be at the heart of this change - which means allowing for those unable or unwilling to engage in technology.
But between the NHS and social care, there must be total commitment to ensuring that interaction is paperless, and that, with a patient’s consent, their full medical history can follow them around the system seamlessly.
This will be a profound change with huge impact, impossible to underestimate. And with profound change come profound challenges.
First, unsurprisingly, is money.
If Labour failed to do this with their billions, how can we hope to do it on a much more limited budget?
We shouldn’t forget that local hospitals and local GP practices spend their own money on technology all the time. We just need a much more ambitious vision as to how to make that money and that investment count.
Every NHS organisation, including all 266 NHS trusts, has a major incentive to do this because the savings are so enormous - £4.4 billion annually according to today’s PWC report - that money, released to spend on better care, can go a long way towards helping them deliver health services sustainably in a time of real financial pressure.
Second, there is the objection that this should not be a priority because we want nurses talking to patients not looking at iPads.
But how many times do we see a nurse station in a ward with nurses unable to catch your eye because their heads are buried in paperwork? Proper investment in technology means more contact time with patients - which is why the Prime Minister announced a £100m fund to help nurses take advantage of it.
Then there is the objection that patients don’t want technology. It’s true that only 3% of people book GP appointments online. But 29% say they want to.
Before online banking became available, were customers marching in the streets, demanding that banks put their accounts online? Of course not. But that didn’t stop people going online in droves - with 80% of us, including a third of pensioners, now banking online . Never let it be said that this is only something of interest to younger generations.
Then there is the critical issue of data security, which Fiona Caldicott is reviewing right now. Clearly we need protocols so that people can be comfortable that their data is only being accessed when necessary and with their permission.
But if the banks can make people confident that their money is safe, we must surely be able to develop a system that keeps medical records safe too.
Then there is the importance of the doctor-patient relationship. There will be many times when only a face-to-face meeting will do.
But allowing repeat prescriptions to be booked online will free up much more time for such meetings, as well as offering a better and more convenient service for patients.
Finally, people say that we’ve been here before. That Labour tried it and failed. The truth is that Labour had the right idea but the wrong approach.
Labour’s Connecting for Health became the NHS equivalent of ordering an aircraft carrier. A project that became over-centralised, over-specified and ultimately impossible to deliver.
What works - and you can see this everywhere - is local solutions, local decisions and local leadership.
Most systems won’t necessarily need to be replaced, just updated or adapted so they can talk with each other. A thousand different local solutions linking together using common standards.
If this sounds incredibly complex, it’s actually very commonplace. It’s why your Blackberry can talk to my iPhone. It’s why all of those apps on our phones integrate so seamlessly. It’s why you can use any computer, phone or tablet and log on to the internet to catch up on the latest news or watch a video on YouTube.
Things don’t have to be the same. They just have to be compatible.
Why do it
Today’s report by PWC confirms what we already know. That the right sort of technology, used in the right way, can release billions of pounds to be re-invested in better, safer care - and millions of hours of staff time for better patient care.
And it can do something else too.
Over a million people have some form of contact with the NHS every 36 hours and have done so for over 60 years. This produces mind-boggling amounts of data that, if properly utilised with the right safeguards, can help improve treatments, unlock new cures and transform the face of modern health and social care.
The stakes are high. But already we have made real progress in preparing the NHS for a paperless, digital future.
In November, I announced in the NHS Mandate that by March 2015 everyone who wants it will be able to get online access to their GP record, as well as book appointments with their GP and order repeat prescriptions online.
E-consultations, like those in Newham, will also become much more widely available.
Today I can confirm that the NHS Commissioning Board have agreed that hospitals should be able to share digital data from April 2014, and to adopt paperless referrals from April 2015. It is currently working on detailed guidance to help local NHS organisations make the leap.
This follows on from other recent steps:
- Changing the standard NHS contract to insist that providers comply with defined information standards.
- Setting up ‘care.data’, a service to give local commissioners timely and accurate information on the performance of providers.
- From this summer, we’ll begin to publish huge amounts of clinical data on a wide range of surgical procedures, everything from vascular surgery to bariatric surgery. Bringing unprecedented transparency to great swathes of NHS performance.
- And to drive all of this, from 2013/14, the NHS number will become a patient’s primary means of identification within the health and care system, enabling all of their records, wherever they are held to combine around the individual person.
So, to conclude, technology is not a holy grail or a silver bullet for all the challenges facing the NHS. It must always be a means to an end and not an end in itself.
But properly adopted, it has the potential to play a central role in facing up to the core challenge of dealing with an ageing society in which patients insist on a more personalised service.
As Bill Gates said, “Never before in history has innovation offered promise of so much to so many in so short a time”.
Well, health needs to be at the front of the queue in taking advantage of that promise - and I am determined it will be.