Review of the NHS and health tech year, 2021

The Covid-19 pandemic abated, only for the omicron variant to bring it back again. It was all change at the top of the NHS, with Matt Hancock and Sir Simon Stevens leaving the Department of Health and Social Care and NHS England and being replaced by Sajid Javid and Amanda Pritchard.

It was also all change at the top of NHS IT, as NHS England announced it would absorb NHSX and NHS Digital into its new transformation directorate. Before this happened, NHSX came up with a new digital aspirant programme and some useful documents for the integrated care systems that will start work next year.

But NHS Digital resurrected the ghost of care.data with its swiftly abandoned plan for GP Data for Planning and Research. ICSs got bogged down in legislation and complex board arrangements, but there was a wave of company acquisitions to consolidate the technology offers they will need. Lyn Whitfield looks over an eventful 2021 as it was captured in Highland Marketing’s weekly newsletters.

January

A second year dominated by the coronavirus pandemic opened with the government being pushed into a chaotic third lockdown as deaths from Covid-19 rose to 1,000 per day for the first time since the previous April (8 January). By the end of the month, the grim milestone of 100,000 deaths within 28 days of a positive test had been passed. However, the vaccine programme also started in earnest, as the Oxford Astra-Zeneca jab arrived in GP surgeries and vaccination centres. Looking to the future, CliniSys launched a new laboratory information system for genomic laboratories in the UK (15 January).

February

The third wave of the pandemic peaked at the start of February, creating space for attention to return to the reform of the NHS. Health and social care secretary Matt Hancock published the Integration and Innovation white paper. This outlined proposals to give ministers more control over day-to-day decisions, to merge a number of central bodies, to remove many procurement safeguards, and to put integrated care systems on a statutory footing. Medical bodies and think-tanks asked whether these were the wrong reforms, at the wrong time; but health tech leaders urged colleagues to ‘engage’ and for ICSs to put digital leaders on their boards (12 February).

A week later, the Health Service Journal reported that the shake-up could lead to the abolition of NHSX and its incorporation into an expanded NHS England (19 February). NHSX itself launched its Digital Technology Assessment Criteria, to help organisations and suppliers understand what is expected from new tech. The government announced a plan to ‘unlock’ England, with schools and shops allowed to reopen in March and April, households allowed to mix indoors in May, and all controls to be lifted in June. Scotland and Wales announced their own, more cautious, plans (26 February).

March

Chancellor Rishi Sunak followed up with a Budget to give the economy a “soft landing” and the NHS another £3 billion to tackle waiting lists, mental health, and the long-tail of the pandemic (5 March). The campaign group, Bereaved Families for Justice, called for a judge-led review of the government’s handling of the pandemic to start as restrictions were lifted. Digital Health Rewired went ahead online, and Matt Hancock announced a second wave of Digital Aspirant trusts (19 March). Derbyshire announced that it would be using Orion Health to meet the government’s target for all ICSs to have a ‘basic’ shared care record in place by September. 

April

As the country hoped that the worst of the pandemic was in the past, attention turned to the backlog of elective care. The NHS waiting list reached ‘record levels’ in April; and then grew at around 100,000 per month for the rest of the year (16 April). There was another change at the top of NHS IT, as NHS Digital chief executive Sarah Wilkinson announced she would be leaving in the summer (23 April). And then NHS England chief executive Sir Simon Stevens rocked the health and social care world by announcing that he would leave in July (30 April).

May

Simon Bolton was named as the interim chief executive of NHS Digital, having arrived in the NHS via Jaguar Landrover and Test and Trace, while the departure of Sir Simon (now Lord) Stevens’ departure provoked a debate about his legacy. Supporters highlighted his influence on two governments, his commitment to integrated care and public health, and his leadership during the Covid-19 crisis. Detractors flagged the NHS’ command and control culture and financial problems as downsides of his time in charge. Everybody agreed that his departure marked the end of an era (7 May).

The state opening of Parliament went ahead, with the Queen’s Speech promising a Health and Care Bill to implement the Integration and Innovation white paper, but nothing for social care. The government promised that a judge-led inquiry into Covid will be held next year (14 May). Only for ex-prime ministerial adviser Dominic Cummings to get out ahead of the coming inquest by giving explosive testimony to MPs about what he described as the “complete garbage” strategy pursued by the “smoking ruin” of the Department of Health and Social Care (28 May).

June

In the face of tabloid grumbling, NHS England reversed its ‘digital first’ guidance for primary care by ordering GPs to resume face to face appointments for anyone who wanted them. Then NHS Digital properly annoyed GPs and privacy campaigners by publishing a blog post about GP Practice Data for Planning and Research. This initiative, dubbed the #GPDataGrab or care.data2, had to be “postponed” in the middle of the month after a mass opt-out by patients (11 June). Matt Hancock appeared at the NHS Confederation’s virtual annual conference and promised that the NHS data strategy would be out the following week.

The strategy, Data Saves Lives, was duly published; but attacked for focusing more on collecting and using data than protecting patient confidentiality. Meanwhile, NHS England published draft guidance on the structure of ICSs. The new organisations were told to have two boards; but were not required to put a chief information officer on either of them (18 June). In a sign of things to come, Barnsley General and Derriford Hospital in Plymouth went to OPEL-4 or ‘black alert’ in the face of such enormous pressure on their emergency departments that they were unable to maintain safe care (25 June).

July

It was all change at the top of the Department of Health and Social Care when secretary of state Matt Hancock had to resign after being filmed in a “steamy clinch” with an aide in defiance of social distancing guidelines. Serial department head Sajid Javid took over (2 July). The following week, prime minister Boris Johnson threw caution to the wind and, a month later than planned in the spring, removed all of England’s remaining Covid-19 controls. The NHS was awarded the George Cross for its efforts during the pandemic (9 July).

August

After speculation about who would take over from Lord Stevens as chief executive of NHS England, his deputy Amanda Pritchard was announced as the ‘continuity’ appointment. She said she was “honoured to [be] the first woman chief executive of an organisation whose staff are three-quarter female” (30 July). As NHS services continued to see an “extreme surge” in demand, Scotland issued an NHS recovery plan and promised its own, judge-led Covid-19 inquiry. Think-tanks started to lobby for a “realistic” settlement for health and social care in the coming comprehensive spending review (26 August).

September

The NHS Confederation and NHS Providers argued that a “realistic” settlement would be an additional £10 billion a year to cover the costs of the pandemic and recover elective services (3 September). The following day, the government floated the idea of a tax rise to fund health and social care. The following week, it announced a health and care levy that will start as a National Insurance increase. Over the next three years, most of the new money will go to health, despite a growing consensus that the collapsing social care sector needs to be first in line for any funding that is available (10 September).

Ministers also outlined a ‘plan A’ of limited Covid controls for the autumn, with a ‘plan B’ to follow if these didn’t work. Meanwhile, NHSX finally published its What Good Looks Like and Who Pays for What Documents to guide the technology decisions of ICSs and integrated care providers. And the Professional Record Standards Body launched its standards partnership scheme (17 September). At the start of what became an autumn trend for company acquisitions, The Access Group acquired Rio-provider Servelec.

October

With a full-blown autumn crisis underway, Wales and Scotland introduced new Covid-19 controls, including vaccine passport apps. Boris Johnson resisted calls to move England to ‘plan B’; but NHS England started to deliver Covid booster jabs. Northern Ireland’s health and social care service picked CliniSys for a single LIMS and became the first customer for GLIMS Genomics (1 October). An evaluation of the global digital exemplar programme concluded it had “largely” succeeded to helping GDE trusts to “implement ambitious programmes of digitally-enabled transformation”; but it needed to leave a legacy and had not reached laggard trusts (8 October).

In the continued absence of news on who will lead England’s judge-led inquiry into the pandemic, or when it will start, two Commons committees published their own, damning reports into the government’s handling of Covid-19 (15 October). Rishi Sunak delivered his second Budget of the year, alongside the outcome of the comprehensive spending review. The NHS got a capital uplift inline with the revenue increase implied by the health and care levy, with £2.1 billion earmarked for IT (29 October). Cambridgeshire and Peterborough announced that it had also chosen a shared care record from Orion Health to meet the ‘basic’ target.

November

The Cop26 climate change event in Glasgow saw all four of the UK’s NHSs commit to net zero, as part of an initiative involving 50 countries. NHSX unveiled a Digital Aspirant Plus programme that appeared to draw on the GDE report by promising central and buddying support for trusts in need of core EPR functionality. However, just four trusts went into the first wave (12 November). A week later, Sajid Javid gave a speech to the NHS Providers conference about reform and leadership and described the national tech leadership split between NHS England, NHSX and NHS Digital was “odd” (19 November).

A week after that, HSJ’s February scoop was confirmed, when it was announced that NHSE will absorb NHSX and NHSD into its transformation directorate, with Simon Bolton becoming interim CIO (26 November). In other IT news, Nervecentre launched an EPR as a Service offer (5 November), WiFi SPARK took over Hospedia with plans to shift away from its ‘patient pays’ model, Barts Health NHS Trust announced that it is working with Sectra on a digital pathology project that will benefit 3 million people in London (12 November), and shared care record provider Graphnet acquired remote monitoring pioneer Docobo (19 November).

December

The government finally published its much-delayed social care white paper to near-universal disappointment. The paper outlines a ten-year vision for social care and three-years of funded commitments; but think-tanks and lobby groups lined up to say it would do little to address the near-collapse of the sector. The World Health Organisation identified a new Covid-19 variant of concern and named it omicron (3 December). The government put the Covid booster jab programme “on steroids” to avoid ‘plan B’, only to go to ‘plan B’ anyway, as footage emerged of 10 Downing Street staff laughing about lying about parties that took place when London was in tier 4 restrictions last year.

Alcidion announced the two trusts using its Miya Precision platform to underpin their electronic patient record ambitions had made significant deployments of its patient safety and flow modules. Then it announced that it had acquired UK patient administration system provider Silverlink Software to create a modern, modular EPR offer for the NHS (10 December). However, as the year ended, normal NHS operation looked some way off, as NHS England moved the health service back to incident level 4 so it could centrally control operations and free-up capacity for the expected wave of omicron hospitalisations (16 December).