On 17 October, 2018, the Department of Health and Social Care published a new technology vision for healthcare. Building on the Secretary of State for Health and Social Care’s recent speech at NHS Expo 2018, the paper sets out the key challenges, priorities and guiding principles for the NHS’s future use of technology and data.
The vision does not limit its gaze to the new and emerging technologies such as artificial intelligence (AI) that are currently dominating the health-tech sector. Instead, the vision addresses a wide spectrum of technology issues across the health service, from the interoperability of back-end IT systems, to open standards, and privacy and security. It attempts to set out the ‘building blocks’ for the digital architecture of the health and care system in England and, by requesting readers complete a questionnaire to provide feedback, invites interested stakeholders to play a role in shaping government policy in relation to the use and governance of technology in the public health system.
Key challenges to – and priorities for – a tech-driven NHS
The paper sets out the government’s view of the main challenges to a more technology-driven NHS as:
- legacy technology and commercial arrangements;
- complex organisational and delivery structures;
- a risk-averse culture;
- limited resources to invest; and
- a critical need to build and maintain public trust.
To meet those challenges, the paper sets out the following aims that should guide the NHS’s approach to technology:
- put in place the right infrastructure;
- buy the best technology;
- ensure that digital services meet people’s needs;
- enable health-tech and innovation;
- develop the right skills and capabilities; and
- build an open culture.
A change in strategy – cloud-first, decentralisation, streamlined IT procurement
In a departure from previous government policy, the vision recognises that “our health and care system will never be a centralised service, because it services the citizens of an entire nation, and so too should its infrastructure not be centralised”. However, it notes that appropriate access to data from any part of the organisation should be part of the approach.
In line with guidance published by NHS Digital in January 2018, the Department will adopt a ‘public cloud first’ policy, with the assumption that new online services should be built on public cloud infrastructure to save costs and reduce time to service.
While stressing the importance of partnerships between innovators and the NHS, the vision is in some places critical of the historical approach taken to contracting with the public sector: in the future, the Department wishes to avoid vendor and technology lock-in, disaggregate services to ensure vendors compete on quality, and break large contracts into a series of smaller contracts that allow the NHS to take advantage of the best new approaches and features in the market. The Department is keen for NHS buyers of IT services to develop the “technical expertise to understand contracts, to be better, more informed customers”.
The vision sets out the need to make IT procurement across the NHS easier and more manageable, with the Department aiming to “work across the system to reduce the burdens faced by small companies when trying to sell into the NHS and make it easier for NHS organisations to quickly identify and buy products, improving the accessibility and use of procurement frameworks and their supporting processes, building on the work of the government’s G-Cloud framework on the Digital Marketplace”.
Leading and regulating the health-tech ecosystem
In the paper, the Department signals its intent to set national open standards for data, interoperability, privacy and confidentiality, real-time data access, cyber security and data access rules. As part of this initiative, the Department will introduce a “health-tech regulatory sandbox”, working with the Information Commissioner’s Office, the National Data Guardian, NICE and other regulators. “The health-tech sandbox will let us test, iterate and de-risk the most promising innovations – and the relevant regulation – so that when they are ready for uptake across the NHS, clinicians can use them with confidence.”
There is an indication that the Department will seek to ensure that the use of emerging technologies in healthcare are appropriately governed. While recognising that “artificial intelligence has huge potential to improve diagnosis and care”, the Department stresses the need to continue developing the Initial Code of Conduct for Data-Driven Health and Care Technology released in September 2018 in order to influence and enforce good practice for the development of new technologies.
Beyond the NHS and public health, it is clear the Department has an appetite to help build a broader health-tech ecosystem as it seeks to set standards across the sector, communicate user needs, support access to finance and encourage collaboration between the NHS and industry. In this regard, the paper announces the creation of a new Health-tech Advisory Board chaired by Dr Ben Goldacre, reporting directly to the Secretary of State, which will include technology experts, clinicians and academics.
A welcome and ambitious health-tech strategy
The vision represents a welcome approach by the Department as it seeks to take a leading role in the development, evolution and governance of public health IT and the health-tech sector more broadly. By focusing on privacy, public trust, and innovation across the spectrum – from routine IT systems to exciting emerging technologies like AI – it is clear that the Department understands the need to implement technology in a thoughtful way that puts users (patients and clinicians alike) at the centre.
The vision also has implications for private sector provides. While it is clear that new innovators and traditional health-tech suppliers will continue to play an important role in public health IT provision, the vision suggests they will need to innovate further and accept a different approach to contracting than has historically been the case – including greater disaggregation of the service stack, and more flexible, shorter-term contracts.
Of course, while the vision will need to be implemented in a way that achieves its aims – the development of standards, rules and codes for governing the way, for example, data is used and exchanged by the various parts of the NHS still need to be designed and brought into force – it sets out a helpful framework for further work in the health-tech space.