You’ll have seen from Adam and Helen’s blog post that we’ve started up NHS.UK Alpha to develop the vision for NHS.UK.
I’m Dan Sheldon, Digital Strategy Lead for the Department of Health and part of the multidisciplinary team behind the NHS.UK Alpha. You can read more about us here.
We have an incredibly exciting opportunity to make things simpler for users and better for health and care professionals by bringing health and care into the Internet age.
This post will hopefully give a sense of some of the issues we’re grappling with as we are thinking about the future of NHS.UK. We’ll be posting more in detail about our approach over the coming days.
Healthcare is massive
The first thing that has struck us is the size and complexity of health and care in England. Health and care is a service, a system, an economy and a sector – all at once.
The NHS is – as fans of trivia will know – the fifth largest employer in the world. But in reality, the NHS in England is not a single organisation that acts as one. There are actually over 9,000 separate organisations involved in providing or commissioning NHS care, according to the NHS Confederation. And that doesn’t even include social care, pharmacies and dental surgeries.
(For comparison, central government has just 497 constituent organisations.)
We already know that digital transformation in such a large, federated environment is difficult.
We also need to understand how NHS.UK can help the public navigate the health and care system.
Deciding where to start
Our task is to set the vision for NHS.UK. There’s plenty of ways to tackle this – we have some choices to make about where to start.
An obvious place to start would be to improve how information is published by health and care organisations on the web. As Adam and Helen mentioned, there are over 3,000 live health and care websites on the nhs.uk domain, as well as some on gov.uk and other domains. We also have NHS Choices, a rich source of health information with over 20,000 pieces of content.
Alternatively, we could focus on service transformation. As the recent NIB 2020 framework – the vision for technology and data published by the National Information Board – stated:
“The consumer experience of care services remains much as it was before the mobile phone and the internet became commonplace.”
Surely it is time that many basic transactions in health and care like registering with a GP were available online. Getting this right will be key to making things better for users and saving the NHS money in the process.
But redesigning each service in health from scratch will take a long time. With central government focusing on platforms, perhaps we should be trying to understand health-as-a-platform: fixing common problems like identity and booking once, rather than expecting each digital service to invent its own solution.
Over the past few weeks we have been exploring and prototyping opportunities to make things better across all three – information, services and platforms. We’ll be writing about this soon – keep an eye on this blog over the coming days.
Where NHS.UK could help
We’ve also been looking at the major challenges facing the the health and care sector and asking how NHS.UK could help solve them.
Last year’s Five Year Forward View called for action on three fronts to protect the future of the NHS: demand, funding and efficiency. This will require a step change change in our approach to public health and prevention, action on safety and quality, empowering patients to take control of their own care and increased transparency of performance. And we’re going to have to get smarter about how we spend money, driving efficiencies to get better for less.
We are also seeing changes to how care is delivered, with the traditional divides dissolving between “family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment”.
And we’re also seeing a shift away from a world where health services are reactive, discrete events that take place in hospitals and surgeries. The future of care is continuing, preventative, proactive and personalised. This is what ‘new models of care’ means in practice.
Running through these reforms is the idea, promoted by our minister Jeremy Hunt in a recent speech, of making healthcare less system centred and more human centred. Our task is to use service design to build an NHS.UK that reduces the complexity of modern-day healthcare for everyone.
There are also loud calls for action on specific conditions and diseases. To take one high profile example, each year 24,000 with diabetes in the UK die early, according to DiabetesUK. Treating the 3.8m people with diabetes accounts for around £10bn of NHS spend each year, most of which is spent dealing with complications like heart disease and stroke.
So, how can NHS.UK be designed to meet the needs of those with particular conditions, and their carers? While we need to understand the commonalities and the ‘retail’ aspects of healthcare – appointments, medicines, observations – there is no one-size-fits all solution. Healthcare isn’t a transaction.
If we focus too much on individual diseases and conditions, we risk losing sight of the totality of a care for an individual. People don’t fit neatly into boxes marked ‘diabetes’ or ‘dementia’, not least those with multiple conditions. We need to be human-centred, not disease-centred in how we design NHS.UK.
And of course, there have been many years of hard work realising the benefits of technology in health and care. Electronic records done right have improved safety and efficiency; advances in medical technologies have improved millions of lives.
Technology has also raised challenges of its own: how is personal data being protected? When should data be shared between organisations? Even if we agree it should, how do we get different systems (often without open standards and APIs) to talk the same language? And what about the impact of online referrals and appointments on working practices in the NHS?
We also have a major task ahead to win the trust of patients, carers and health and care professionals. For the public, we need to meet their ever increasing service expectations and ensure we handle personal data in a way that is safe, transparent and consensual. For health and care professionals, we need to build credibility and deliver for them.
We know that we need to work hard to understand the needs of our users, whether professionals or members of the public. We need to make sure we’re actually making things better, rather than just making things digital. These two things are not the same.
Learning from others
The original idea for NHS.UK Alpha was compelling simple: that we needed to move from talking about the future of NHS.UK to doing. Instead of writing strategies and drawing diagrams – we’ve done that – we are building prototypes, testing in public and learning. Show the thing. We owe a debt to alphagov for the inspiration to start in this way.
But even this, to some extent, has been done before. Some committed, talented people have tried to do come up with a vision for what has been variously called an ‘integrated national information and advice service’, a ‘front door’, an ‘online portal’ and a ‘customer service platform’ for health and care. Many of them even built prototypes to bring the vision to life.
What we have lacked are the clear plans to turn these into a reality. So alongside the work we’re doing to understand user needs, build prototypes and articulate the vision, we will be pulling together that plan for how we can realise NHS.UK in practice.
It’s not complicated, it’s just hard
In this post, I’ve tried to give a sense of the backdrop of challenges and opportunities to our work in the NHS.UK Alpha. We’re trying to work out where we think NHS.UK can help.
But we’re not splitting the atom. We’re putting things online and making things simpler for users. There are patterns for this – health and care is well behind other sectors. Every day, professionals in the NHS are solving more complex problems than this one.
However, change is hard. Realising an NHS.UK that works for everyone will take time and a huge collaborative effort. We’ll need help and support from experts from across health and care and beyond.