Five Year Forward View must have ‘digital fabric’ at its core

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Following the publication of the NHS England’s Next Steps on the Five Year Forward View, IMS MAXIMS CEO, Shane Tickell highlights how clinical IT systems can underpin transformative changes, if interoperability challenges are addressed and much-needed funding from government is released.       

 The Five Year Forward View (FYFV), when published in 2014, set out a suitably courageous strategy for the NHS to deliver the triple aim of better health, better care and better value, in the context of overcoming a £22 billion funding gap by 2020.

Premised on New Models of Care (NMC), it pledged to replace traditional healthcare boundaries determined by organisations, with networks of care centred around the patient. In doing so, it set out to reform national and local leadership, reinvigorate and strengthen the NHS workforce, exploit the information revolution and address the well-documented productivity and efficiency challenges.

Three years on much has been achieved in planning the redesign of services, with the New Models of Care Vanguards showing promise. However, it now leaves just two years for delivery, which given the continued funding constraints and resource challenges placed on the NHS, is too ambitious.

It’s right, therefore, to have a pragmatic plan focused on realistic goals, as set out by NHS England chief executive Simon Stevens last month in his review of the FYFV. Turning its attention to what is achievable in the time available, the document prioritises improved access for patients and better performance in urgent and emergency care, mental health and cancer services. With technology, NMC and Sustainability and Transformation Plans (STPs; created since the FYFV was published) underpinning delivery.

Its success however, isn’t without risk, with a government initiative set to support the strategy – the Global Digital Exemplar (GDE) Programme – vulnerable to derailment and technical challenges to integration not yet resolved.

Enabling transformative change

Technology and innovation are rightly recognised as enablers to meeting the triple aim set out by Simon Stevens. Clinical digital systems, for example, are helping Trusts deliver safer and more effective care. A year since deploying our open source electronic patient record, Taunton and Somerset Foundation Trust has transformed patient experiences by making some of its biggest bottlenecks – the admission, transfer and discharge for patients – more efficient and coordinated. These improvements have also freed up clinicians’ time to have quality interactions with more patients.

The Trust is on course to meet government’s paperless vision by 2018, and achieve tens of millions of pounds in cash savings and service benefits over the lifetime of the contract. There is also the prospect, via the Somerset Integrated Digital Electronic Record initiative, to connect all the region’s main clinical systems to have one version of the truth.

Clinical IT systems empower organisations to work quicker and smarter, and crucially, in partnership with each other. Moreover, with STPs giving digital planning a new focus – with greater emphasis on area-wide requirements rather than a single enterprise – this infrastructure, or what I consider to be the ‘digital fabric’, is fundamental to the success of the FYFV.

Investing in our digital future

Recognised for its digital success, Taunton and Somerset has been appointed to government’s GDE Programme. Designed to make the most digitally advanced Trusts world-leading, and blueprinting their success for others to follow, it will be an integral part of the campaign to ensure technology is adopted at scale and pace.

The GDEs are primed to lead the delivery of the much-needed digital fabric. The priority now is funding for implementation. The government’s commitment to invest £100 million into the programme is applauded, but for it to be successful, the funds must swiftly flow down to the Trusts. Without it, the programme is at risk of being derailed.

A delay to funding not only affects GDE delivery milestones but the mindset of those involved. Bob Wachter was right to highlight during his recent review of IT in the NHS, that successful projects are 80% people and 20% technology. The Trusts and end users are invested, but they must know that government is too. It gives them the impetus to change.

There’s also the impact on advancements made by NMCs and STPs if the digital fabric isn’t embedded throughout the NHS. This vital infrastructure underpins much of what the FYFV sets out for these localities, as the NHS moves from a structure rooted in competition and silos, to one of system-wide integration and collaboration.

Interoperability is key

The GDE Programme will be the catalyst for the diffusion of the digital fabric, but interoperability will be the factor that determines its success at scale.

We currently have a disparate healthcare sector, that is without a rigorous and precise information standard that is universally adopted by healthcare organisations and vendors. It’s, therefore, surprising to see interoperability referenced only once in the FYFV Review. Now more than ever, integration across the care continuum, enabled by interoperability, is paramount.

Software suppliers such as IMS MAXIMS are taking their share of responsibility in addressing this issue, for example by developing open APIs and promoting open standards. The creation of the action group, INTEROPen, is also strong evidence of a commitment amongst suppliers, clinicians and standards bodies to collaborate and resolve the challenges of having such a complex NHS. The same must be true of government, by providing endorsement and support to initiatives such as INTEROPen, which are gaining real traction.

 The risk of inaction 

Three years is a long time in the healthcare sector, and a lot has been achieved and should be applauded. But there’s much still to do if, together, we are to achieve the practical plan set out by Simon Stevens.

To futureproof the NHS, it is right to remain ambitious. As John F Kennedy famously said: “There are risks and costs to a programme of action. But they are far less than the risks and costs of inaction.”

The risk of inaction is far greater in healthcare; however, we must avoid the risks to implementing the digital fabric given how it underpins so much of what we hope to attain by 2019/20.



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