Matt Hancock, the recently appointed Health and Social Care Secretary has announced a new technology vision for the NHS that aims to build "the most advanced health and care service in the world" underpinned by a modern technology architecture, a set of open standards and a focus on interoperability.
His six-part plan sets out to ensure that health systems can talk to each other, introduce shorter procurement contracts, build a world-leading healthtech ecosystem, drive internal innovation, develop new technical skills across the NHS, and to form a culture in which technology can deliver against ever-changing needs.
No new funding has been allocated for the proposals, which will instead have to rely on the £487 million that Hancock made available for NHS technology projects in July.
"These robust standards will ensure that every part of the NHS can use the best technology to improve patient safety, reduce delays and speed up appointments," promised Hancock.
"A modern technical architecture for the health and care service has huge potential to deliver better services and to unlock our innovations. We want this approach to empower the country’s best innovators — inside and outside the NHS — and we want to hear from staff, experts and suppliers to ensure our standards will deliver the most advanced health and care service in the world."
Hancock became interested in technology during his previous role as Secretary of State for Digital, Culture, Media and Sport. His faith in open standards attracted praise from some in the healthtech community, but critics raised concerns about how the vision would come to reality.
Will new standards resolve old problems?
Hancock noted that digital technology in the NHS was built up in a piecemeal fashion and that top-down attempts to improve a new national IT system on the entire service had failed. The result is that hospitals, GPs, social care organisations, pharmacies and community care services all use different IT systems that aren't integrated.
The new open standards attempt to address this problem. All health and social care organisations and suppliers will have to adopt the standards when they're published in the coming weeks.
To support their development, NHS Digital has published a new draft NHS digital, data and technology standards framework laying out early ideas on the use of data, interoperability, design and IT commercial standards within the NHS.
No IT systems will be eligible for purpose if they don't meet the standards, and existing systems will have to be upgraded in line with the new requirements. APIs will be introduced to allow approved people to interrogate other systems for data.
Don Redding, the director of policy and partnerships at National Voices, a coalition of health and social care charities, welcomed the new principles and standards, but added that the lack of collaboration with service users and healthcare organisations could limit their effectiveness.
"What's missing as a result of lack of user engagement is any sense of patient and public engagement in achieving the vision eg in governance, development of data sharing, applications of shared data and safeguarding ethical standards when that data is opened to outside parties," Redding tweeted.
Others were concerned about the lack of details on how the standards would protect privacy and security.
Sam Smith, coordinator of campaign group MedConfidential, believes the standards will have little effect without a timeline for implementation and the right success criteria.
"The NHS knows what good working technology looks like, but to get there, you can't just turn A&E off and on again and see if helps," he said.
"Mr Hancock says 'we are supportive' of stripping the NHS of its role in oversight of commercial exploitation of data. That should be a cause for widespread concern. If Matt thinks the NHS will never get data right, what does he know that the public don't?
"The widely criticised National Programme for IT also started out with similar lofty vision. This is yet another political piece saying what 'good looks like', but none of the success criteria are about patients getting better care from the NHS. For that, better technology has to be delivered on a ward, and in a GP surgery, and the many other places that the NHS and social care touch.
"Reforming procurement and standards do matter, and will help, but it helps in the same way a good accountant helps – and that's not by having a vision of better accounting. There’s not much detail in here. It’s not so much 'jam tomorrow', as 'jam… sometime' – there's no timeline, and jam gets pretty rancid after not very long. He says 'these are standards', but they're just a vision for standards – all the hard work is left to be done."
New procurement principles
The government will phase out systems that don't meet the new technical standards and end contracts with providers who don't adhere to the principles. Outside of the mandated standards, NHS organisations will have the freedom to choose the technology that they need
"Out with the big service contracts," said Hancock. "In with more agile in-house teams that can be smarter at contracting."
The new architectural principles are putting tools in modern browsers, being both internet-first and public cloud-first, building a data layer with registers and APIs, adopting the best cyber security standards, and separating the layers of the patient record stack for isolated development.
Hancock is also creating a HealthTech Advisory Board composed of tech experts, clinicians and academics and chaired by Dr Ben Goldacre to act as an ideas hub and highlight where change is needed and where best practice isn't being followed.
Ben Moody, TechUK's head of health and social care, welcomed the plans and announced that the technology trade body will soon publish a list of key priorities for Hancock.
"It is great to hear Matt Hancock reiterate his plans for a technologically advanced NHS and it is vital that local bodies are empowered to drive innovation throughout the system," he said.
"Technology has the potential to improve outcomes, make the NHS more financially sustainable, and offer the public a much better service than many currently get."