Gov.UK
Policy Paper
29 June 2022
infolabhealth
Site version edited by
Joaquim Cardoso MSc.
Digital and Health Transformation — Institute
Digital Health — Unit
July 2, 2022
SECTION 1: EMBEDDING DIGITAL TECHNOLOGIES
Digital services give people more control over their lives.
They allow people to decide when and where they connect with their health and social care providers.
They also give people access to resources for managing more of their own health and care when and where they choose.
At the same time, a range of digital technologies working in the background can help health and social care systems to improve the quality of all their care and prevention services, online and otherwise.
Together, these developments free up staff to spend more time with those most in need of human care. In short, they create a virtuous cycle.
Scaling and sustaining that cycle is essential if health and social care services are to manage capacity and continue to provide high-quality care, given our workforce challenges.
Along with learning lessons from the past and building trust with people, it is the key to making health and social care services sustainable.
For the cycle to gain momentum, there needs to be a faster flow of approved, high-quality digital solutions from industry into services; and regulatory mechanisms need to enable its acceleration.
Below, we describe actions we are taking to drive digital transformation across the health and social care system.
- 1.Equipping the system digitally for better care
- 2.Supporting independent healthy lives
- 3.Accelerating adoption of proven tech
- 4.Aligning oversight with accelerating digital transformation
1.Equipping the system digitally for better care
We are furthering the uptake of digital technologies that ensure people have access to the right data at the right time.
Our plans for key technologies are outlined below.
- Digitising health and social care records
- A life-long, joined-up health and care record
- Digitally supported diagnoses
Digitising health and social care records
We have already invested significantly in supporting the adoption of electronic patient records (EPRs), primary care records (GPIT) and shared care records (ShCRs), and more recently digital social care records.
In secondary care, EPRs are a critical attribute of digital maturity.
We know that digitally mature providers operate with approximately 10% improved efficiency compared with their less digitally mature peers.
We know that digitally mature providers operate with approximately 10% improved efficiency compared with their less digitally mature peers.
At present, only 20% of NHS organisations are digitally mature, although 86% have a form of EPR in place. Only 45% of social care providers have any form of digital care records.
Our goal is for all ICSs and their constituent organisations to have all the attributes of digital maturity, including electronic records and other critical systems, by March 2025.
We have set this out in What good looks like.
We are also exploring how to converge on fewer EPR products, which will make it simpler for staff and service users to interact with them.
Meanwhile, increasing the spread of digital social care records, with the aim of achieving 80% coverage for CQC-registered providers by March 2024, will allow carers to spend less time on administrative tasks and more time with the people they care for.
…increasing the spread of digital social care records, with the aim of achieving 80% coverage for CQC-registered providers by March 2024,
will allow carers to spend less time on administrative tasks and more time with the people they care for.
We are also providing national support, including funding, for locally led digitisation of frontline health and social care services.
This includes defining the baseline systems providers should aim for in What good looks like as well as providing funding, advice and guidance for local oversight and specific funding to support uptake of digital social care records.
Details are in Appendix A.
A life-long, joined-up health and care record
Digitising separate health and social care records will help create a functionally single, life-long digital health and care record for each person.
Digitising and connecting records provides access to the right information at the right time, which can improve the quality, safety and productivity of care.
When all the people involved in meeting a person’s health and social care needs — including that person, their family and unpaid carers — can see what each of them has done and is doing, in real time, they can co-ordinate as one team to meet that person’s needs and preferences.
Our expectation is that, by March 2025, all clinical teams in an ICS will have appropriate and secure access to a complete view of a person’s health record, including their medications and key aspects of their history.
Non-clinical staff in social care settings will also be able to safely access appropriate information and input data into digital records in real time.
To address clinical needs, record-sharing through EPRs should be available to relevant staff in all settings, including community midwives and health visitors.
In particular, primary care networks (PCNs), including their partners in third-sector organisations, pharmacies, high-street optometrists and community diagnostic centres (CDCs), will benefit from the seamless flow of data between frontline teams.
Details are in Appendix A.
Digitally supported diagnoses
Current constraints on sharing diagnostic images and pathology records mean diagnostic tests and images are often repeated.
Digitally enabling diagnostic services avoids this needless repetition.
It can also:
- improve the accuracy of a diagnosis
- bring tests closer to home
- reduce the person’s wait for a confirmed diagnosis
- avoid unnecessary referrals
Current constraints on sharing diagnostic images and pathology records mean diagnostic tests and images are often repeated.
Digitally enabling diagnostic services avoids this needless repetition.
Our planned investment in new diagnostics capacity, especially in CDCs, aims to deliver these benefits, in particular through image-sharing and clinical decision support based on AI.
This investment will also help to streamline planned urgent and emergency pathways, and support elective recovery.
AI also has great potential to help with waiting lists, productivity and levelling up under-served areas, as shown by the NHS AI Lab’s AI Health and Care Award recipients.
With its ability to analyse large data sets, AI can support health and care professionals to make better informed decisions, especially in NHS screening services where the technology could speed up the diagnosis and treatment of conditions including cancer, stroke and eye disease.
The NHS AI lab is already helping to determine the areas where AI has the most potential to be deployed and scaled.
The lab is setting up the regulatory frameworks and ethical assurances to help ensure it can be adopted safely and effectively, including ensuring data sets used to train AI reflect the diversity of the UK’s population to avoid bias in decision-making, and appropriate quality control and transparency of algorithms to avoid bias and unintended consequences.
We will continue to explore how AI and machine learning can supplement the decision support systems already used for triaging patients on urgent and emergency care pathways.
Details are in Appendix A.
We will continue to explore how AI and machine learning can supplement the decision support systems already used for triaging patients on urgent and emergency care pathways.
We are also using robotic process automation (RPA) to emulate human actions and interact with digital systems.
As we automate basic manual and repetitive tasks to save time for staff, we will ensure that the way and reason automated decisions are made are understood by humans.
Many clinical and non-clinical roles within the health and social care workforce will evolve as AI and other digital technologies permeate clinical disciplines, such as radiology, pathology, cancer, surgery and also administrative functions.
Emerging examples in mental health demonstrate how digitally enabled interventions can be used to augment care pathways to provide productivities to release clinician time for care, while enabling a more personalised and responsive care offering in between traditional care contacts.
We will ensure our health and social care workforce have the right skills to apply these technologies successfully and our organisations have cultures that foster innovation.
This is happening through a number of initiatives, including a long-term workforce plan as well as short-term measures to expand the supply of specialist digital skills in the workforce.
Details are in Appendix A.
We will ensure our health and social care workforce have the right skills to apply these technologies successfully and our organisations have cultures that foster innovation.
Supporting independent healthy lives
We are doing this by expanding and improving the 2 national digital health channels and through measures to increase the uptake of proven, high-quality, easy-to-use and safe digital products.
- Putting NHS services in people’s pockets through digital channels
- Scaling digital health self-help, diagnostics and therapies
Putting NHS services in people’s pockets through digital channels
We have 2 principal national digital channels (NDCs), the NHS App and NHS.uk, the NHS.uk website.
We have 2 principal national digital channels (NDCs), the NHS App and NHS.uk, the NHS.uk website.
The NHS.uk website now has an average of 80 million views a month and is the largest source of health information in Europe.
The NHS.uk website now has an average of 80 million views a month and is the largest source of health information in Europe.
The NHS App, through which people can interact conveniently with the services they need, now has over 28 million sign-ups, with the app being used by people an average of 2.7 million times a week.
It is poised to become a ‘front door’ to health and care services generally.
The NHS App, through which people can interact conveniently with the services they need, … is poised to become a ‘front door’ to health and care services generally.
Our vision is to use our national digital channels (NHS App and NHS.uk website) to help people stay well, get well and manage their health.
Our vision is to use our national digital channels (NHS App and NHS.uk website) to help people stay well, get well and manage their health.
Over time we would also expect to make key social care information viewable via the app for people and their carers.
Over the next 3 years, we will increase the functionality of both these channels so they become platforms through which people, their families and unpaid carers can:
- access more services and resources proactively
- have more control over their care
- benefit from more personalised and preventative offers
Our initial focus this summer and autumn is going to be on helping people manage their health — giving users access to their health record, the ability to manage their hospital appointments, receive notifications and messages, and amend their contact details and preferences.
Our initial focus this summer and autumn is going to be on helping people manage their health — giving users access to their health record, the ability to manage their hospital appointments, receive notifications and messages, and amend their contact details and preferences.
Looking beyond the management of NHS interactions, our ambition is to support people throughout their life, providing an ongoing connection to their health and care.
We will move towards a holistic and inclusive offer — starting with giving parents or legal guardians access to their child’s record from birth, through to tailored prompts for early mental health support, the opportunity to participate in relevant clinical trials, and accessing support following a new diagnosis such as stroke or dementia.
Looking beyond the management of NHS interactions, our ambition is to support people throughout their life, providing an ongoing connection to their health and care.
If we get the offer right, informed by what users tell us they want and embedding best practices, our national channels can prevent needs from arising or escalating, and provide access to tailored advice and care when they do.
Our initial prevention priorities focus on
- blood pressure management and
- vaccine bookings and reminders, and
- this will be followed by targeted digital health checks.
We expect our prevention offer, over time, to reduce demand for traditional NHS services and allow for a more efficient use of estates.
Full details of the action plan for the NHS App and NHS.uk website are in Appendix B.
Our initial prevention priorities focus on: (1) blood pressure management, (2) vaccine bookings and reminders, and (3) followed by targeted digital health checks.
Enhancing access to digital health channels raises the risk of excluding people who can’t afford a digital device or mobile data, don’t have ready access to WiFi or who lack confidence in using digital tools.
Lack of trust in the security and reliability of digital technologies is another barrier to digital uptake.
The risk of digital exclusion is particularly high among those who already face health inequalities and have difficulty accessing traditional health and care services.
We will continue to work with the Department for Digital Culture Media and Sport (DCMS) and other partners to lower the barriers to digital uptake, especially for those most at risk of exclusion.
Digital services will always be part of a multi-channel offer that includes in person, phone and online services.
We will continue to work … to lower the barriers to digital uptake, especially for those most at risk of exclusion.
Digital services will always be part of a multi-channel offer that includes in person, phone and online services.
Scaling digital health self-help, diagnostics and therapies
We are supporting the rapid uptake across the health and social care sectors of proven, high-quality, easy-to-use, safe and effective digital products that offer value for money.
To speed progress, working with the Medicines and Healthcare products Regulatory Agency (MHRA), National Institute for Health and Care Excellence (NICE) and the tech industry, we are devising clearer policies for accrediting digital health technologies (DHTs) that are likely to be adopted nationally by the NHS.
NICE will pilot a new early value assessment (EVA) through summer and autumn of 2022, initially focused on cardiovascular and mental health products.
This process will streamline evaluation of evidence for the clinical and cost-effectiveness of products that address NHS priorities.
NICE will conditionally recommend promising products to be available to the NHS, enabling their developers to collect more data before submitting them for full NICE assessment.
These products will be available for local procurement via a single national framework. Products that pass the bar at the full assessment stage may be approved for wider use in the NHS.
The EVA builds on a project to assess digitally enabled therapies (DETs) used in IAPT services (NHS talking therapies), which will continue to run through summer 2022.
We will extend access to DETs to more people, widen the choice of therapies, and offer more personalised treatment and opportunities for people to manage their own care better, all of which will improve service productivity, experience, safety and outcomes.
Following our departure from the EU, the MHRA is also developing new regulations for medical devices, including software and artificial intelligence as medical devices.
The MHRA’s future regime for medical devices is aimed at increasing patient and public safety, transparency of regulatory decision-making, and alignment with international best practice.
Importantly, the MHRA hopes to achieve more flexible, responsive and proportionate regulation of medical devices.
The new regulations will come into effect in July 2023.
While these initiatives primarily address digital health technologies, others support adoption of transformative technology in the social care sector.
While these initiatives primarily address digital health technologies, others support adoption of transformative technology in the social care sector.
Details are in Appendix A.
Accelerating adoption of proven tech
We are spreading good tech through the health and social care system faster by supporting research and development partnerships and better tech procurement.
- Systematising tech research and development partnerships
- Buying tech better across health and social care
Systematising tech research and development partnerships
The UK has a vibrant health tech innovation sector, with many teams working to solve prevention, diagnosis, treatment and operational challenges faced by the NHS.
However, we know innovators still find the NHS a hard market in which to scale. This is partly because of a disconnect between innovators and those frontline teams well placed to identify the most promising technologies.
That said, a few NHS trusts and primary care groups have developed strong processes for partnering with innovators and venture builders on developing and configuring sustainable solutions, and generating the high-quality evidence needed to demonstrate their impact.
This evidence is crucial for rapid uptake of these technologies.
We are committed to supporting and systematising this good partnership practice.
We are also working with regulators to speed the spread of well-evidenced technologies across the NHS.
And we are supporting NHS organisations in their commercial negotiations with industry and funders to align the interests of all concerned behind products that make a real difference to people, staff workload and system productivity.
Similarly, we are making it easier for NHS organisations to collaborate with industry on researching, developing and mainstreaming tech-enabled service innovations that improve health and care outcomes, reduce staff workload and mitigate health inequalities.
In these collaborations, we will ensure data shared, accessed or hosted by researchers or industry partners will only be used for clinical, research, managerial and planning needs to deliver better patient care and prevention.
Details are in Appendix A.
Buying tech better across health and social care
NHS and social care buyers of digital technologies need to be sure they buy products that meet technical standards that ensure:
- interoperability
- usability
- clinical safety
- cyber security
- sustainability
Tech sellers need to know the technical standards their products must demonstrate to win NHS accreditation.
We are setting and enforcing clear technical standards (see the section ‘Enforcing standards’ below), including open standards to avoid challenges in changing suppliers.
We are also working with suppliers to champion climate-resilient and low-carbon standards, as well as business models with a ‘circular economy’ approach.
In line with the government’s priority to buy once and use many times, and also to contain system-wide tech costs, we are leveraging the system’s purchasing scale more often, as we have done recently with the N365 deal and do routinely in medicines.
Building on guidance for trusts in Procurement Framework Strategy Recommendations, which we will keep updated, we will consolidate digital and IT procurement frameworks.
Our aim is to:
- simplify procurement processes
- improve quality
- remove duplication
- reduce costs
Currently, similar products or services are often covered by multiple framework agreements, which has disadvantages for both buyers and vendors because:
- buyers may not know the right framework to use for their requirement
- vendors find they must apply to several framework agreements for the same things
- buyers cannot always tell if the vendors on framework agreements meet the minimum standards that they expect
We are equally committed to helping adult social care providers buy appropriate technology for social care records and other priorities, and to scale technologies that have proven benefits.
We have already published a list of assured suppliers and draft standards and capabilities for digital social care records, which we will expand to cover other technologies.
We will also work with sector partners to help local authority commissioners become confident and capable purchasers of care technology.
Details are in Appendix A.
Aligning oversight with accelerating digital transformation
As noted above, current levels of digital maturity vary widely and no ICS is yet making full use of the transformational potential of digital technologies.
To make and sustain the progress we expect over the next 3 years, we need to include our expectations of digital transformation in oversight arrangements for trusts and ICSs.
We also need to define and communicate how we will support compliance and intervene where compliance proves difficult to achieve.
- Using our regulatory levers
- Enforcing standards
- Supporting social care
Using our regulatory levers
At present, there are limited formal mechanisms for overseeing delivery of NHS digital priorities. Digital does not yet feature in the provider licence, System Oversight Framework, or CQC assessments. We are exploring options for filling this gap in discussions between NHSE and the CQC, and through a review and consultation with system leaders and frontline staff.
We need to use our regulatory levers to:
- signal that digitisation is a priority
- identify the non-negotiable standards of digital capability
- explain how we will monitor and support compliance
For social care, we will support the sector in understanding and meeting defined standards of digitisation, and explore how we can use incentives and levers to encourage providers to accelerate digital adoption.
This work will build on What good looks like and planned digital maturity assessments (from autumn 2022) to help ICSs prioritise actions in their local digital plans, and make sure those plans are robust.
In particular, we are helping ICSs to understand their levels of digital debt, the consequence of not addressing or investing in digital properly, and help them quantify expected benefits from digital investments by providing examples.
Details are in Appendix A.
Enforcing standards
Getting health and social care providers and their tech suppliers to adopt the same technical standards will ensure useable data can flow between IT systems in different organisations. It is the key to making systems interoperable.
It is the key to making systems interoperable.
We have been developing and publishing the necessary standards, and in social care we have published a standards and capabilities roadmap for digital social care record solutions that assured digital social care records suppliers will need to comply with.
In the NHS, we are currently working on how to make clear which standards are ‘musts’ for the sector and how we plan to enforce them.
Our legal powers to enforce technical standards among healthcare providers were originally set out in Section 250 of the Health and Social Care Act 2012.
These powers have been strengthened in the Health and Care Act 2022 to ensure that all health and adult social care providers comply with any standards that we publish as information standards notices (ISNs). Their compliance with ISNs is mandatory.
These changes will result in data being in a standard form, both readable by and consistently meaningful to any reader anywhere in the health and social care system.
Service providers’ ability to meet mandatory standards is partly a function of their IT suppliers’ conformity to the standards.
We are therefore working with the DCMS to include in the forthcoming Data Reform Bill further changes to Section 250 of the Health and Social Care Act 2012.
These will include a power to apply technical standards to suppliers of IT systems and services equivalent to those applied to health and social care providers.
They will provide a power to enforce these standards through compliance notices and financial penalties, along with a power to establish and operate an accreditation scheme.
Details are in Appendix A.
Supporting social care
We know from engagement with the social care sector that some of the biggest barriers remaining to digital transformation in social care are the levels of digital skills and basic digital foundations, including connectivity.
Over 60% of care homes are still using internet connections that will not support full digital transformation.
Over 60% of care homes are still using internet connections that will not support full digital transformation.
The adult social care reform white paper, People at the heart of care, announced an investment of at least £150 million over the next 3 years to support digital transformation.
We will ensure that all care providers can:
- access high-speed connections
- increase workforce digital skills and confidence
- build their cyber resilience
The adult social care reform white paper, People at the heart of care, announced an investment of at least £150 million over the next 3 years to support digital transformation.
With these enablers in place, we will support 80% of social care providers to adopt a digital social care record, and ensure the 20% of care home residents who are identified as at high risk of falls are protected by sensor-based falls prevention and detection technologies by March 2024.
These are important in tackling some of the most common and avoidable causes of admissions to acute care.
With these enablers in place, we will support 80% of social care providers to adopt a digital social care record, and
ensure the 20% of care home residents who are identified as at high risk of falls are protected by sensor-based falls prevention and detection technologies by March 2024.
Details are in Appendix A.
Originally published at https://www.gov.uk.
Names mentioned
Sajid Javid, Secretary of State for Health and Social Care
Dr Timothy Ferris, National Director of Transformation
