UK plan for health and care digitisation is both ambitious and comprehensive

Developers will welcome the planned development of a clear pathway for adoption including NICE’s new early value assessment (EVA). This, alongside the proposed new regulatory framework for medical devices, should give them a more transparent, proportionate and responsive route to market in the UK.

The plan will help inform the decisions that integrated care systems (ICSs), their constituent members in local health and social care systems, and their tech industry partners are taking now.

An ‘in-pocket’ health and social care service

The vision outlined in the government’s plan for digital health and social care is to use NHS national digital channels, the NHS app and the NHS website to enable an ‘in-pocket’ health and social care service that helps people get well, stay well and manage their health. The service will build on the advances that have been made during the pandemic, along with established good practice acquired from decades of attempts at digital transformation of the NHS before the pandemic.

However, disparities exist in the use of mobile health apps by income and education level, as well as age and often there is a lack of awareness – or even mistrust of the security of health apps – which could lead to inequalities. With this in mind, it is good to see that mitigating the risk of digital exclusion is one of ICSs’ top priorities. Because of this, the plan emphasises the continuing availability of traditional healthcare access through in-person, phone and online services.

NHS trusts to increase digitisation

A recent government spending review has backed its ambitious digitalisation program with £2 billion in funding, intended to support electronic patient records in all NHS trusts.

By December 2023, ministers want 90% of NHS trusts to have electronic patient records in place, with the remainder in the process of implementing them.

Other elements of the digital plan include expansion of remote patient monitoring at home – with an objective of increasing this from the 280,000 patients at present to 780,000 by March 2023. A ‘virtual ward’ strategy will be implemented in September 2023, allowing patients to carry out hospital pre-assessment checks from home. Ministers also want social care systems to have a standard, digital social care record that can be joined up with electronic patient records.

Digitisation is clearly a priority for NHS England, with its digital transformation expectations reflected in its oversight arrangements for trusts and ICSs. NHS England is currently exploring embedding technology into wider NHS oversight arrangements too, and it plans to work with the Care Quality Commission (CQC) to agree a process for digitising its assessment framework across health and social care – including implementation of the GP IT Futures programme.

Enforcing technical standards on suppliers

Suppliers will need to pay close attention to upcoming technical standards, including climate-resilient and low-carbon standards – which are both a priority for NHS England. Its legal powers to enforce technical standards among healthcare providers were originally set out in the 2012 Health and Social Care Act but have since been strengthened in the 2022 Health and Social Care Act.

Providers’ compliance with such standards is mandatory, but their ability to meet them is partly down to their IT suppliers’ conformity to the standards, and so particular attention needs to be paid to the Department of Culture Media and Sport’s (DCMS) Data Reform Bill. The Bill 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. The Bill will also provide a power to enforce these standards through compliance notices and financial penalties, along with a power to establish and operate an accreditation scheme.

Availability and access to data

Publication of the government’s final strategy for data in the health and social care sector in July 2021 was a welcome step since availability and access to data will be key to delivering its vision for digitalisation. Drawing on lessons learned about the power of data from the response to the pandemic, the data strategy includes a range of commitments to connect systems, and details how health and social care data will be used to continually improve services while maintaining the highest standards of privacy and ethics.

Underpinned by technical standards, all relevant health data will to be accessible by those with a legitimate right to access it at the point of need, no matter where it is held. £200 million will be invested through the ‘data for research and development’ programme to transform access to and linkage of NHS health and genomic datasets for data-driven innovation and inclusive clinical trials. The results of those results will be critical to ensuring public confidence in data access for research and innovation purposes.

Engagement commitments set out in the data strategy include a three-year program of activity starting in July 2022 that aims to enhance positive patient and public support for sharing of health and genomic data. The 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.

By March 2025 data for research and development will be available through a federated network of trusted research environments (TREs). An England-wide network of TREs will be developed to allow researchers access to secure, high-quality, linked data sets to support research using data generated from across the NHS, including genomics, imaging and pathology. This scheme should help to support a broad range of types of research, including across priority areas such as cancer diagnosis, and development and validation of AI-enabled tools and technologies.

Data security and connectivity

The government has rightly identified resilience to cyberattack as a priority to safeguard patients and people’s private information. Its cyber-security strategy for health and social care is due to be published later this year and will outline how NHS digitisation will be kept secure.

The success of the plan will also rely on NHS England’s ability to tackle connectivity issues, which present a major challenge to digitisation projects. In a welcome step, the government has pledged to promote and fund movement to cloud services when it is prudent to do so. Best practice guidance on funding cloud adoption is expected to be published in July 2022.

Early value assessments

NHS England is currently developing clearer policies for accrediting digital health technologies (DHTs) that are likely to be adopted nationally and NICE is scheduled to pilot a new early value assessment (EVA) through summer and autumn of 2022. While initially focused on cardiovascular and mental health products the plan is to expand this procedure to other therapy areas.

The process aims to 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 get a positive full assessment may be approved for wider use in the NHS. to support their further evaluation.

Looking ahead

Best practice guidance on funding cloud adoption is expected in July 2022.The new digital service expected in August should allow care providers and suppliers to identify which standards related to interoperability they must conform to and where to find the documentation.  The draft standards and interoperability strategy was published in May for feedback. The final strategy is expected in September.

Powers to apply and enforce technical standards to suppliers of IT systems and services are expected to be included in the Data Reform Bill which is currently going through parliament. A cyber security strategy for health and social care is also worth watching out for later in the year.