The major work programmes mapped out in this Plan are underpinned by an agreed, costed and phased NHS technology plan, building on the recommendations of the Wachter review. It will simplify patient access to care, in the most appropriate location, while supporting people in managing their own health. Specifically, during the coming two years we will implement solutions that:
- Make it easier for patients to access urgent care online.
- Enable 111 to resolve more problems for patients without telling them to go to A&E or their GP.
- Simplify and improve the online appointment booking process for hospitals.
- Make patients’ medical information available to the right clinicians wherever they are.
- Increase the use of apps to help people manage their own health.
The way that people use services has changed over the past ten years, often expecting to have the option of accessing services online or by telephone. Over the next two years the NHS will make very significant steps towards increasing how its services can be accessed online, whilst remembering that healthcare is about people and that many patients want and need the reassurance of a real person to talk to face to face.
The NHS has led the world for ten years with its health and care website “NHS Choices” which provides comprehensive and trusted advice on conditions and services. In 2016 there were more than 1.5 million visits per day of NHS Choices; over 550 million through the year. Progress has also been made in enabling patients to access their GP record online: 95% of GPs offer online appointment booking, repeat prescriptions and access to their summary care record. 10.4 million people are now registered for online services with 1.9 million repeat prescriptions ordered online in February 2017, 1.1 million appointments managed online and 1 million views of patient records in the same period.
- NHS apps. In Spring 2017 we will launch the NHS Digital Apps Library with the initial offer including at least 20 apps with categories for Mental Health and Diabetes. This will comprise three tiers of application – ‘NHS approved’ apps which have a published evidence base, assessed by a process developed with NICE, demonstrating that they can help a person manage and improve their health; ‘NHS connected’ apps which means that they have been tested and approved for connection to NHS systems, allowing you to download information from NHS systems into the app; and ‘Health apps’ which will be directory of other health applications which you may choose to use. From April 2017, developers will have the ability to self-assess themselves against NHS criteria, such as where they store your data and whether they sell or use your data for other purposes. The ‘NHS connected’ category will become vibrant during 2017 and 2018 as we make it easier for app developers to connect to NHS data sources.
- Support for children’s health. From April 2017 parents in London will have access to their children’s health record through the online “red book”.
- Personal online access. By September 2017 we will have upgraded NHS Choices to become NHS.UK, which will offer a more personalised and tailored experience. It will then be possible for patients to book appointments and access their personal health record through NHS.UK.
- Free wifi in GP surgeries. Building on the success of the NHS wifi early adopter stage, which commenced in January 2017 and saw us roll out free wifi for patients and professionals across approximately 1,000 surgeries, the wider rollout to the remainder of GP surgeries over the next year, subject to HM Treasury approval, will help encourage the uptake of online health services.
While the NHS leads the world in the use of IT in primary care, the adoption of information technology in the acute, community and mental health sectors lags behind. In 2015, NHS England conducted a survey of information technology adoption, known as the Digital Maturity Assessment. From this we are able to see the best, the worst and the large number in the middle. In September 2016 we announced the first 12 Global Digital Exemplar acute trusts and since then we have announced four more.
Global Digital Exemplars. These organisations are the most advanced IT hospitals in the NHS and have committed to work to become world class exemplars for the rest of the NHS to learn from. Their task is not only to become great, but to work with other acute trusts to develop a blueprint that can be deployed to other hospitals, reducing the time and cost for further adoption. Our intention is that, in the future, hospitals won’t merely choose an IT vendor, they will choose a hospital that they want to partner with and implement the same system, keeping the IT 80% the same and making only the 20% of changes that are absolutely necessary to meet local needs. Subject to HM Treasury capital approvals, the first Acute GDEs are:
- Alder Hey Children’s NHS Foundation Trust
- Cambridge University Hospitals NHS Foundation Trust
- City Hospitals Sunderland NHS Foundation Trust
- Imperial College Healthcare NHS Trust with Chelsea and Westminster NHS Foundation Trust
- Luton and Dunstable University Hospital NHS Foundation Trust
- Newcastle upon Tyne Hospitals NHS Foundation Trust
- Oxford University Hospitals NHS Foundation Trust
- Royal Free London NHS Foundation Trust
- Royal Liverpool and Broadgreen University Hospitals NHS Trust
- Salford Royal NHS Foundation Trust
- Taunton and Somerset NHS Foundation Trust
- University Hospital Southampton NHS Foundation Trust
- University Hospitals Birmingham NHS Foundation Trust
- University Hospitals Bristol NHS Foundation Trust
- West Suffolk Hospitals NHS Foundation Trust
- Wirral University Teaching Hospital NHS Foundation Trust
In order to spread the learning and ensure that the blueprints really are suitable for other hospitals, the GDEs will be partnered with “fast followers” who will work with the GDEs during their implementation and begin deploying the blueprints elsewhere in parallel. The GDEs are currently identifying their “fast follower” sites, and these will be confirmed over the coming quarter.
Over the past few months we have also conducted a search for Mental Health digital exemplars. Subject to HM Treasury capital approvals, successful organisations will be:
- Berkshire Healthcare NHS Foundation Trust
- Birmingham and Solihull Mental Health NHS Foundation Trust
- Mersey Care NHS Foundation Trust
- Northumberland, Tyne and Wear NHS Foundation Trust
- Oxford Health NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
- Worcestershire Health and Care NHS Trust
NHS Digital Academy. By September 2017 we will launch a new academy to train a new generation of Chief Information Officers and Chief Clinical Information Officers. By increasing the skills to align information technology with business and clinical needs we will increase the chances of successful adoption of new information technology and its use to drive quality and efficiency.
Urgent and Emergency Care
- NHS 111 Online. Throughout 2017 we will be working to design online triage services that enable patients to enter their symptoms and receive tailored advice or a call back from a healthcare professional, according to their needs. We will be testing apps, web tools and interactive avatars in local areas and using detailed evaluation to define the best approach. By December 2017 all areas will have an NHS 111 online digital service available that will connect patients to their Integrated Urgent Care via NHS 111.
- NHS 111 Telephone: Clinical decision support systems are well used throughout the health system. They have supported our ambulance services and urgent care services for many decades. The developments in technology mean these systems are improving exponentially – becoming more personalised and intelligent and able to process more data in real time. From summer 2017 we will be developing and testing new specialist modules of clinical triage for Paediatrics, Mental Health and Frailty and demonstrating the impact of risk stratification. By March 2019 an enhanced triage will be available across integrated Urgent Care, with the potential to also support Urgent Treatment Centres, Care homes and Ambulance services.
- To ensure that patients get the right care in the most appropriate location, it is also important that clinicians can access a patient’s clinical record. By December 2017 every A&E, Urgent Treatment Centre and ePrescribing pharmacy will have access to extended patient data either through the Summary Care record or local care record sharing services. We will also have access to primary care records, mental health crisis and end of life plan information available in 40% of A&Es and UTCs.
- By December 2018 there will be a clear system in place across all STPs for booking appointments at particular GP practices and accessing records from NHS 111, A&Es and UTCs supported by improved technology APIs and clear standards.
- During 2017 we will begin the work with vendors to seamlessly route electronic prescriptions from NHS 111 and GP Out of Hours to pharmacies via the Electronic Prescription Service (EPS). This will speed up the supply of medicines, and significantly reduce the time and cost involved.
Elective access and unwarranted variation
Analysis of activity across the NHS shows very large variations in the number of patients being referred to hospital outpatients, being followed up repeatedly in outpatients and receiving elective operations. These variations cannot be explained by differences in health need and are often present between different GPs in the same area and different doctors in the same hospital. Patient and clinician time is wasted on repeating tasks because the information collected by another clinician is not available, and straightforward tasks that could be undertaken by many patients online are still done by clinical staff.
- By summer of 2017 GPs will be able electronically to seek advice and guidance from a hospital specialist without the patient needing an outpatient appointment.
- In the summer 2017 an updated online patient appointment system will be launched, providing patients with the ability to book their first outpatient appointment with access to waiting time information on a smartphone, tablet or computer. Alerts will advise patients which hospitals have longer waits so that that they can avoid these hospitals if they wish.
- The NHS e-Referral Service is currently used by patients to arrange just over half of all referrals into consultant-led first outpatient appointments. By October 2018 all referrals will be made via this route, improving patients’ experience and offering real financial and efficiency benefits.
Digital contribution to research
The ability to collect, aggregate and analyse the data generated by the NHS is not only critical to delivering the triple aims of healthcare, but also underpins the NHS and wider life sciences research strategies. Interoperability will be key to successfully making use of NHS data to support the life sciences research strategy.
The UK has a world-leading life sciences industry which is both a magnet for investment and an engine for economic growth – enhancing productivity, driving healthcare innovation and employing over 220,000 people across the regions of the UK. Many important healthcare technologies – from vaccines to MRI scanners – have been nurtured by our strong science base and universities, innovative culture and leading healthcare system.
Over the past year alone:
- NHS England agreed to commission nationally 33 ground-breaking new treatments, including auditory brainstem implants for people with profound hearing loss; microprocessor controlled prosthetic knees for people with lower limb loss; and Ivacaftor for young children with cystic fibrosis.
- A new Innovation and Technology Tariff (ITT) aims from April 2017 to expedite uptake and spread of innovation across the NHS. The first six innovations will mean 160,000 patients eligible to benefit. These products include those that reduce obstetric anal sphincter injuries as a result of episiotomies; reduce incidence of ventilated associated pneumonia which causes between 3,000 and 6,000 deaths every year; and provide effective treatment for clostridium difficile without the use of antibiotics.
- We have also established a national Clinical Entrepreneurs Programme, and the NHS Innovation Accelerator which has supported adoption of innovations that at least 390 organisations are now using.
- 13 new NHS Genomic Medicine Centres have been established across the country to collect samples, engage patients and family members in the programme to establish the infrastructure needed to make genomic medicine a routine part of NHS care. These centres have collected over 25,000 cancer and rare disease samples. Over 20,000 whole human genomes have been sequenced. By sequencing the genomes in these samples not only can we better understand these diseases, we can also target specific treatments on the patients who will benefit most from them.
- PHE has supported ground-breaking research which has led to a new technique for sequencing the genome of the bacteria that causes tuberculosis. This technique will enable faster and more targeted treatment of people with TB. Speedy diagnosis will also help scientists detect and respond to potential outbreaks as they happen. This matters since the UK still has one of the highest rates of infection in Europe.
- The NHS has invested in the Small Business Research Initiative Programme to support 80 small and medium enterprises.
For 2017/18 and 2018/19 the NHS will take further steps to enhance our global position:
- Begin the roll out of new treatments funded by NHS England’s specialised commissioning, including mechanical thrombectomy treatment for stroke.
- NHS England will publish an Implementation Plan setting out its delivery contribution to the UK Strategy for Rare Diseases in 2017/18.
- Expand the NHS’s genomics capability, collecting 50,000 samples in 2017/18 rising to 90,000 in 2018/19. By the end of the 2018 calendar year, 100,000 whole human genomes will have been sequenced. By the end of 2018/19, we will also have developed a genomic medicine service for England, underpinned by a new consolidated genomic laboratory infrastructure and facilitated by informatics, data and analytical platforms to enable the sequencing data we generate to improve clinical practice.
- Create a more fertile environment for clinical trials by enhancing the Health Research Authority, harmonising approval and recruitment processes, and streamlining bureaucracy including through the use of digital tools.
- One of the unique features of the NHS is the central role of general practice and this creates valuable opportunities to study ‘longitudinal’ data. NHS England and MHRA increased the number of GP practices registered on the Clinical Research Practice Data Link system (CPRD) by 25% in 2016/17 and in 2017/18 we will recruit an additional 1800-2000 practices to CPRD.
- In 2017/18, the NHS Innovation Accelerator will select another round of innovations that address the population challenges prioritised by STPs.
- Academic Health Science Networks and ‘test beds’ will take collective responsibility for driving national adoption of proven innovations, in line with the Accelerated Access Review.
- The NHS’s international reputation has already led to major agreements with China, the Middle East and Latin America over the last few years, helping put money back into the NHS and UK economy and strengthening our investment in R&D. Healthcare UK (the export organisation for the UK’s health and care sector) has helped health sector organisations win over £5 billion worth of contracts over the last three years. Healthcare UK aim to grow our exports by around 15% per annum to 2020.
More generally, under the banner of the government’s Industrial Strategy, the life sciences sector deal will bring government and the NHS together with industry and charities to create new jobs and economic growth across the UK as well as aiming to improve care for NHS patients. The NHS is a key contributor and a committed partner to providing an environment where technologies can be developed and tested, and used to transform services to improve outcomes and reduce cost. This opportunity sits alongside further strengthening of the science base and clinical trials capability and the creation of an environment which enables small biotech and medtech companies to thrive and grow, and enhancement of our medicines manufacturing capabilities.
As medicine transforms over the next 20 years, the cutting-edge technology in our Universities combined with the NHS presents unique conditions to create new industries, companies and jobs based in the UK and transform the way innovation is delivered to patients, offering an attractive place to research and test new treatments in partnership with innovators. Potential areas include artificial intelligence, the application of genomics to medicine, the development of a range of new diagnostic tools, and therapies for conditions that will enable more healthy aging.