HETT 2022: There may be trouble, ahead

This year’s Healthcare Efficiency Through Technology took place against a backdrop of economic turmoil and NHS reorganisation that could impact health and care’s ability to adopt many of the exciting new ideas on show. Highland Marketing reports from ExCeL London.

There was something slightly surreal about attending this year’s Healthcare Efficiency Through Technology show at ExCeL London.

Inside hall N1, there were the usual discussions about health tech policy, standards, and how to maintain the digital momentum generated during the Covid-19 pandemic. While outside, the fall-out from prime minister Liz Truss and chancellor Kwasi Kwarteng’s mini-budget gathered momentum.

As the pound and stock markets fell, the Bark of England was forced to intervene in the bond market to rescue pension funds caught up the melee unleashed by their decision to borrow to fund an energy guarantee and tax cuts that benefit the very wealthy (Financial Times).

An existential crisis?

The two events might not seem to be closely related. However, unless Truss and Kwarteng are right, and their policies generate enough growth to pay for themselves in the medium term, some combination of a row-back on taxes, interest rate rises, and public sector cuts will become inevitable.

And the impact of more cuts on the NHS could be very bad indeed. Sir Charlie Bean, a former deputy governor of the Bank of England, and member of the Office of Budget Responsibility, warned that public spending cuts of £50 billion a year could be required.

He told Sky News: “The only way you can really deal with this is with a very fundamental rethinking of the boundaries of the state… to be prepared, say, to move away from a health service that is free at the point of delivery.” Hopefully, the situation will stabilise before things get that far.

“Risk” to NHS digital budgets  

But the NHS is already under financial pressure from a combination of general inflation, rocketing fuel prices, and unfunded pay rises. The Nuffield Trust think-tank has calculated that the £35 billion uplift in the Department of Health and Social Care’s budget will be worth just £14 billion in real terms over the three years covered by the last comprehensive spending review.

The Treasury has refused to re-open the CSR ahead of the next fiscal event in November; and told spending departments to find ‘efficiency savings’ instead. The NHS must also pay for health and social care secretary Therese Coffey’s ‘plan for patients’ and £500 million social care discharge fund from existing budgets.  

In these circumstances, it wouldn’t be a surprise if money earmarked for NHS IT programmes was clawed back and switched to other priorities. As Simon Bolton, the interim chief executive of NHS Digital and chief information officer of NHS England, acknowledged.

Asked by conference chair Sam Shah whether funding for digitisation is “at risk”, Bolton told the first session of HETT: “Of course, particularly in the context of last week and this week and the fiscal event and the impact it could have.”

Losing the plot

Financial woes are not the only reason there is something of a hiatus in NHS IT. Following the passage of the Health and Social Care Act 2022, NHS England has embarked on a round of reorganisation. It has already absorbed NHSX (with former head Matthew Gould heading off to London Zoo) and will take-in NHS Digital in due course.

In the process, it is looking to reduce total headcount by 30-40%. In their HETT fireside chat, Bolton told Shah this would be a good thing, eventually, because it would drive a more “substantial collaboration” between NHSE, X, and D than had been possible when they were three, separate organisations.

But he admitted that for the moment “we have lost the narrative on this merger” (Health Service Journal) and got bogged down in talking about efficiency and job cuts when “we should be talking about how we work better together” and how to “deliver better value for patients and clinicians, more quickly.”

Driving better value, more quickly  

Shah naturally followed up by asking Bolton for his “main priorities” for driving better value, more quickly. Bolton gave him three: “recognising that we are part of the same team”; moving away from what he described as “a slightly old-fashioned approach to technology deployment” and delivering “in a more modular way”; and “focusing on outcomes.”

Pressed on what outcomes, he said Therese Coffey’s ‘abcd’ of ambulances, backlog, (social) care, and doctors and dentists. But, with financial and staff resources constrained, he acknowledged choices would have to be made.

“We have to prioritise, and we have to think about what the centre should do – where we can add value – and what should be left to the rest of the NHS, so we are not overlapping,” he said. Having said that, Bolton argued the centre needed a “more consistent message” and to be “more opinionated” about the issues gets involved in, such as the roll-out of patient record systems.

Cost and benefit of convergence

Bolton’s audience would have liked something more concrete. Veteran London IT leader Luke Readman thanked HETT for organising the discussion but argued the NHS really needs “three or four programmes” to focus on “for ten years” or long-enough to make “a real difference” to the existential challenges it is facing.

“So,” he asked, “what are those programmes?” Bolton didn’t answer directly. Instead, he said there were “three areas” that he’d like to see people thinking about: “front door channels” or “what we are doing to get people into the system”; EPR convergence; and getting integrated care systems to “join up health and social care.”

Ian Hogan, chief information officer at the Northern Care Alliance NHS Foundation Trust, pushed for some detail on point two. He pointed out that even if trusts consolidate on five EPR systems, there are big differences in their cost and functionality.

“So,” he asked, “how do we make sure organisations can afford the best solutions for them?” Bolton accepted there was a problem. “I would like the system to engage on this,” he said. “I stress this is not policy, but I would like to identify a smaller set of providers to agree a set of products at national prices and to build expertise in those products to optimise use.

“At the moment, we have high-40s of EPRs in the system, and while, again, I stress this is not policy, my personal perspective is that is too many. We would not let it happen in the private sector: it is too expensive and not efficient.”  

Show time  

Ironically, out on the HETT show floor, none of the major, single supplier EPR systems were on view – although Nervecentre had taken space to demonstrate the modular, mobile-first alternative it has been developing with University Hospitals of Leicester NHS Foundation Trust.

Instead, the focus was on Bolton’s other areas of interest; joining up health and social care and front door channels; with a lot of companies offering technology to support programmes NHS England has in place.

So, there was plenty of virtual ward and remote monitoring technology on display, aligned with the target of creating 7,000 physical and virtual beds this winter, and 40-50 virtual beds for every 100,000 people over the next two years.

There was also plenty of digital outpatient technology on view, to manage waiting lists, streamline pre-op, and safely implement patient-initiated follow-up, or PIFU. While Highland Marketing client X-on was out demonstrating its Surgery Connect cloud telephony, which Coffey wants to see GPs adopting faster as part of the ‘plan for patients’.

Multi-layer procurements  

Back in the conference theatres, the focus was on how to procure, implement, and adopt this new wave of technology effectively. Hogan chaired a session that was ambitiously titled: “Funding, commissioning, procurement, collaboration, and successful supplier engagement in the new ICS landscape”.

In effect, this tackled Bolton’s question about who should be doing what at a national, regional and local level, before considering how we can make sure that when ICSs and trusts buy things they buy the right things.  

Anna King, commercial director at Health Innovation Network South London, said areas should focus on the problems that they needed to solve and adopt a “multi-layer approach” to obtaining the tech they needed to solve them.

Integrated care boards, she suggested, should have “a good view of what is happening locally” and be able to work with providers to decide whether a national system, regional or local procurement was appropriate, and whether the technology required was mature enough to buy off a framework or needed more piloting.

Shane Tickell from TechUK said its Health and Social Care Committee has been doing a lot of work to make framework contracts more useful for buyers and suppliers. While the AHSN Network was very visible at HETT, promoting innovative ideas to address common problems.

Standards progress, slowly

A session on “delivering industry standard architecture and infrastructure for the NHS” agreed that it would be much easier to adopt this multi-layered approach if everybody adopted common standards. Charlie McCay, a non-executive director at the Public Record Standards Body, argued this doesn’t just mean technical standards, such as HL7 FHIR for messaging.

It also means standards to capture and then display information. Although he didn’t say it, Highland Marketing client Orion Health has just shown the way by proving it is possible to comply with the PRSB’s 1,600-line Core Information Standard.

However, one delegate expressed the frustration that many people working in and with the NHS have felt for years about the lack of interoperability between IT systems by asking: “Why can’t we just legislate to do this?”

Chair Beverly Bryant, who has worked in NHS IT at a national, supplier and trust level, suggested the answer is the National Programme for IT, which failed so spectacularly that “it has terrified every government” away from dealing with tech at a national level. Plus, trusts hold IT contracts.

People, process, technology  

Also, McCay argued, trusts need to address people and process issues before they worry about technology: getting people to use standard information sets and workflows can take organisations a long way. A session on day two titled “beyond the boom of telehealth: where are we now with remote care?” made a similar point.

Anne Marie Cunningham from Digital Health and Care Wales, said only a third of GPs were still using virtual working technology that had been rolled out during the pandemic. Why? Because GPs are choosing to spend the money that they could spend on technology on admin support for traditional ways of working.

Christopher McCann from Current Health said this showed the importance of “designing and building with people” and “focusing on outcomes” to make sure that staff and, critically, patients and carers, “are on board” with new ideas. Sam Shah said this was another thing that will take time – and money – to do well.

Nobody in the audience would have disagreed. In fact, McCann was making the same point as Readman when he said the NHS needs to focus on three or four, long-term, high impact programmes because: “People tend to think of technology as a quick fix, when in fact it is a slow one.”

However, as the financial turmoil that was roiling outside HETT starts to impact on a health and care system that is already under pressure, time and money are two commodities that the NHS is likely to find in short supply.