Health and Social Care Secretary speech to Policy Exchange
Sajid Javid delivered a speech on the plan for digital health and social care at the Policy Exchange.
Before I start today, I’m sure that many people, like me, are thinking of Dame Deborah. We all heard the sad news last night.
She inspired the whole nation, and she leaves behind an incredible legacy in the many lives that she saved in her work.
Thank you very much to everyone at Policy Exchange for hosting this event today.
I dropped into your summer party last night, and I had enjoyed your company so much I thought I’d come back again today.
Dean just referred to my many different roles in government, and I’ve certainly had a fair few.
I’ve always massively appreciated your insight on the most important policy issues, including your recent reports on elective recovery, primary care reform and building hospitals of the future.
And there are few more important issues for policymakers across the world than the one that I’d like to talk to you about today: digital transformation.
New technologies are something that I’ve personally always been passionate about. I’ve always been interested in electronics.
When I was growing up I was always poking around the back of the TV and reassembling it. And sometimes the TV would even work again afterwards.
And when I was aged 16 I had such an interest that my school’s careers adviser recommended I’d have a promising career as a TV repair man.
Now I have responsibility for digital transformation of a different kind, and it’s an exciting day as we’re setting out this plan, and where there is a huge opportunity to make a difference.
After all, few organisations employ more people or touch more lives in this country than our health and care system.
Policy Exchange celebrated its 20th birthday, and next week the NHS turns 74.
The NHS is one of this country’s most cherished institutions, and the founding principles remain just as important as they were back in 1948.
I find it heartening that these founding principles enjoy cross-party support in our country, and that although the NHS has been shaped by parties of all colours, the key tenets remain the same.
We all want a world-class health service, free at the point of use, paid for out of general taxation.
And as steward of our NHS, and our social care system, I feel the responsibility very keenly, and I want it to thrive and be sustainable for long after I have left government.
The most valuable friend isn’t one that just tells you what you want to hear, but tells you, the British people, the unvarnished truth.
I am not just the steward of the NHS, but also as a warrior for the patient, putting their interests first, and battling for them when they are unheard or don’t get the service they deserve.
And the truth is that our health and care system is following an unsustainable path that is too often not delivering for patients.
Earlier today, Tony Blair said the NHS must radically reform how it operates in order to remain viable.
Although he welcomed our moves towards the integrated care, the integrated care systems, he said “as presently constituted, the NHS cannot be the service we now need.”
The truth is that on the left and on the right, there is now widespread acceptance that healthcare must modernise.
Our ageing population, the rising costs of care, the COVID backlogs and pressures in primary care and A&E – these are all huge challenges. And we cannot simply hope, I’m afraid, that “things can only get better”.
At the start of this century, health spending represented some 27% of day-to-day public service spending. By 2024, it is set to account for 44%.
Yet can any of us in this room really say we’ve seen an equivalent improvement in outcomes?
I don’t want anyone’s children to grow up in a country where more than half of our national budget is being taken up by healthcare at the expense of everything from housing to education.
So the only option for responsible policymakers is reform and modernisation: to address the very real challenges we face today as well as the huge changes that we know are coming down the line.
If we don’t do that, the only alternative is an ever-expanding state, with no improvement in the nation’s health, while the long-term challenges that we face remain unresolved.
Recently, when reports came out of cabinet the other week that I’d described the NHS as like “Blockbuster in the age of Netflix”, those reports caused a bit of a stir.
I said this because when Netflix launched in 1997, Blockbuster was a giant multinational with some 9,000 stores.
And when Netflix offered to sell to Blockbuster for 50 million dollars just 3 years later they were laughed out of the room.
Now, that looks like one of the bargains of the century.
We all know the story: Blockbuster did not adapt, and now there’s just one single Blockbuster store – a museum – that hosts 1990s-themed sleepovers.
Now this metaphor sparked all kinds of conversations, but I stand by the point.
All parts of our society, whether they are public or private, must adapt if they are to meet the public’s expectations, to improve services now and to be sustainable for the long term.
Digital transformation is the engine that will drive this work, and I am spearheading one of the biggest digital transformation projects that this country has ever seen, across the full spectrum of technology, and underpinned by an equal focus on skills and leadership and culture, to make sure that the technology really work for patients.
From the pioneering new pathways for care, like the state-of-the-art surgical robots that I saw on a recent trip to Liverpool, to the less glamorous but equally important building blocks, such as putting the right digital infrastructure and connectivity in place.
Because we must look at the huge advances of the pandemic, not just as a quirk of history, but the start of a new era of digital transformation, and a platform upon which to build.
But we also know that digital transformation in health and care has been tried for decades, and it only works when you have empowered patients and a relentless focus on getting the right skills and leadership in place – no matter what the technology is.
So our plans place a huge emphasis on building and backing those equally important ingredients of modernisation.
On Monday, a couple of days ago, I marked my one year anniversary in the role, and it’s been a year punctuated by important milestones of digital transformation.
Only 2 weeks ago, at London Tech Week, I launched our data strategy called ‘Data saves lives’, showing how we can reshape our health and care system through the power of data.
Today I’m announcing the next step: our plan for digital health and care.
It sets out in one single place how we will have a more digitised, more efficient and more personalised system of health and care, putting more power into the hands of patients and our brilliant frontline innovators.
It takes forward what we have learnt from the pandemic, and what we’ve learnt from tech pioneers across the world, along with our acquired learning from decades of attempts at digital transformation before COVID.
We embark on this mission from a strong position.
Over 28 million people, that’s almost two-thirds of the adult population in England, now have the NHS App in their pocket. Over 40 million people have an NHS login. And we’ve just announced £150 million of funding for digital adoption in social care.
But we must keep going.
Because these technologies move quickly and so must we, if we are to reap the seismic rewards that the country can get from its health and prosperity.
This plan will help us to bust the COVID backlogs, deliver more personalised care for patients, and make life easier for the staff on the front line, while delivering benefits for the next decade, running to billions of pounds in efficiencies, economic growth and private investment.
That means we will be able to cut waste, improve patient outcomes and prosperity, because, as I have said before, economic freedom and public health are mutually reinforcing.
Let me offer a few practical examples of what this will mean in practice for health and care.
First, lets take that NHS App.
This app is now part of life for so many people, and last year it was the most downloaded free app on the iPhone app store in England.
In the first 4 months of this year alone, it was used to order almost 6 million repeat prescriptions, and book almost half a million GP appointments.
To encourage adoption even further, we need to show even more people that the app will make how they access healthcare so much easier, and that it is now a permanent feature of how we would do healthcare in this country.
This plan outlines how we will make this app the front door to NHS services, and add an array of new features over the coming years.
In the short term, this means giving users access to their own health record and the ability to manage hospital appointments.
But my long-term vision for the app is that it will move services from generalised to personalised, and become an assistant in your pocket, helping people to manage their own health.
The plan shows the cutting-edge features that we want to add, including:
- a ‘heart age’ tool that estimates the health of your heart
- tools to track your blood pressure and have that automatically shared with your GP
- personalised content to help people to find healthy choices
Each month we will be adding new functionality to the app making it ever more useful for even more people: from booking hospital and GP appointments to delivering video consultations and mental health care.
This is a real opportunity to put healthcare literally in people’s hands.
So I’ve put in place a target for 75% of all adults in England to be registered on this app by March 2024, giving them a gateway to preventative and personalised care.
Now of course, people vote with their fingers when they go onto the Apple Store or the Play Store in what they choose to download.
It’s not about telling people to get on the app – although I think they should!
It’s about making it easy and an attractive digital offer, that people can’t imagine ever having done it a different way.
Second, the plan demonstrates how we will lift up, and level up, digital provision across the board.
There’s a striking statistic in this plan. There’s many, but one I’m going to pick out is so-called ‘digitally mature providers’.
Now, ‘digital maturity’ is an odd concept, because it implies an end point to digital transformation, when the reality is that this is a permanent endeavour. But for today, what I mean by this: those who meet the current core standards of digital transformation.
These providers are around 10% more efficient than those who are less digitally mature.
There’s no trade-off between technology and efficiency – they are 2 sides of the same coin – making every aspect of care more efficient and effective for patients.
I was at one of our best hospitals, Great Ormond Street, today and they’re leaders in this. They have an app: MyGOSH app.
I spoke to a young boy getting help from the hospital, and a mother, and each and every one of them was getting help.
When we consider these clear and obvious benefits, it is even more unacceptable that digital capability is uneven.
So I want to use the transforming force of technology to improve performance across health and social care, and we’re investing around £2 billion in the digital foundations of the NHS to do just this.
There’s no better place to start than the basic information that health and care relies on.
We all remember the days when you’d get your bank statements in the post, and if you wanted to know your bank balance you went to a cash machine to get information.
It seems incredible that for many people, their access to their health and care, a matter of life and death, is much the same.
So we must join up data across the health and care system to improve the experience of patients and colleagues, no matter what part of the system they use.
The plan shows how we will effectively create a single, life-long digital health and care record for everyone, giving patients a chance to easily access their own data, with these records in place universally by 2024.
This will build on our work to accelerate the adoption of electronic patient records, which will mean all clinical teams within the new integrated care systems will have secure and appropriate access to a complete view of a person’s health record.
I’ve heard from clinicians on the front line how these records have transformed the way they work, saving them precious time, and allowing them to deliver better, safer care for their patients.
At the moment, 86% of NHS trusts have a form of electronic patient record in place, and we’re on target to hit my aim of 90% by the end of next year, whereas just 45% of social care providers currently have any form of digital care records.
Although this is huge progress, when we look at where we were a few years ago, still though we must keep pursuing this approach across the board, so that the benefits can be felt far and wide.
So my plan commits to 80% of CQC-registered social care providers having digital social care records in place by March 2024, and to ensuring that electronic patient records are in place across integrated care systems in England by March 2025.
Just as we are putting the right technology in place, we also need to make sure that people are confident and supported in using this technology.
One of my first decisions in the role was to bring together what was NHSX and NHSD, and bring it together into NHS England, putting all of the NHS’s digital bodies into the heart of a single organisation, exactly where it belongs, so ownership would sit right at the top of the NHS.
I’ve held leadership roles in lots of organisations, and it seemed to me actually quite incredible that one of the important levers for change – digital – would sit outside the organisation.
But digital leadership cannot just come from the boardroom.
The recent leadership review of health and care rightly highlighted digital skills as one of the most important skillsets for leaders at all levels of organisation – and, actually, everyone who works in an organisation, and not just those with digital in their job title.
The plan also shows how we will relentlessly focus on digital skills, leadership and culture, so we can make this transformation right across the board.
Third, the plan sets out how we will make the most of new technologies, that have so much potential to transform care.
When I saw those surgical robots in Liverpool a few weeks ago, I heard that not only could these robots deliver more accurate surgery, but that instead of patients going home after 5 days after their operation, they would go home on average the next day.
This is a perfect example of the benefits that digital transformation can bring.
It applies to remote monitoring. Remote monitoring has allowed patients to use technology to keep an eye on their condition from home. So their clinicians can keep an eye on them from home – keeping them out of hospital if they don’t need to be there and supporting more independent care.
This has been especially valuable during COVID, this boom during COVID, when a trip to the hospital came with an infection risk too.
Over 280,000 people have already used remote monitoring at home or in care homes for long-term conditions in the last year, and the plan that I’ve set out today shows how we can support up to a further 500,000 people by March 2023.
This means problems will be picked up earlier, that there will be fewer hospital admissions, and there will be shorter stays for those who do need hospital care.
We must also make sure that this country is the natural home for the tech pioneers to make their breakthroughs.
Growth in healthtech is nearly 6 times larger than growth across the rest of the economy, and so making ourselves known across the world as a health and care system that encourages innovation is so fundamental I think also to our economic success.
The plan also describes how we will support promising new technologies through our AI Health and Care Award, which has already backed 80 promising AI projects through funding of over £100 million, and how we will spread the most transformative technologies throughout the health and social care system more quickly, through a more nimble processes for procurement, and striking partnerships with innovators at the cutting edge.
You know that technology and policymaking hasn’t always been a successful partnership.
In 1895, a member of the House of Lords, Lord Kelvin said that X-rays would prove to be a hoax.
We cannot afford to be caught on the wrong side of history, and so we must make the most of the huge advances in digital technologies that will deliver vast benefits for everyone involved in health and care.
The British state must modernise if it is to deliver now and to face the great challenges of the decades to come.
This is not a choice.
We must modernise and adapt or we will fall behind, and we will rightly be condemned for our failure to reform when we should have done.
As a warrior for the patient – I refuse to let that happen in the NHS, and the plan I have set out today is a vital step on this path of reform.
Thank you all very much.