Last week NHS England held a public board meeting at which key technology and data projects from NHS Transformation Directorate were discussed.
An update on a range of programmes were shared, including the frontline digitisation programme, federated data platform, shared care records, patient access, waitlist management, and other areas.
Electronic records and digital foundations
NHSE established their prior commitment that NHS organisations will have a core level of digital maturity and EPR in place by March 2025, with 80 percent of CQC-registered adult social care providers to have digital records in place by March 2024.
They share that 86 percent of NHS trusts currently have an EPR in place, with this figure expected to rise to 91 percent by December 2023. 52 percent of social care providers now have a digital social care record, up form 41 percent in December 2021. All ICSs have a shared care record in place.
On funding, NHSE notes that they will continue to support the coverage and convergence of EPR systems across secondary providers to a baseline level of digital capability, and added that £2 billion in investment has been committed to ICSs to support this.
Federated Data Platform
The update shares that procurement for a Federated Data Platform on behalf of the NHS in England began on 10 January 2023, with the ambition of awarding the contract in autumn 2023.
“A commitment to maintaining the confidence of patients and the public in the security of their personal data has been at the heart of this work from the outset,” the minutes note, “and we continue to undertake extensive public engagement to ensure any concerns are answered. Control of data access remains in the hands of local NHS leaders.”
Tools are being trialled locally around data platform usage, and some results were shared at the meeting. An elective care coordination pilot in East Sussex removed 16 percent of the waiting list through error identification, with the system to go live in 36 trusts by the end of March this year.
In addition, in North Tees, a discharge pilot reduced patients staying for 21 days or more to 12 percent over a 12-month period, compared to the national average of 20 percent. This is to go live in 16 trusts by the end of March.
Data for research and development
“Supporting trusted partners to access data to support research into diseases and other conditions affecting the population can both help support the development of new diagnostics and treatments, improvements in clinical practice and the prevention of ill health, as well as supporting the development of the UK Life Sciences sector,” NHSE state.
They go on to share a commitment to develop an interoperable network of Secure Data Environments by March 2025, in order to enable more rapid and efficient health tech innovation. Over £13.5 million of investment is to support this.
NHSE highlights how a draft standards and interoperability strategy was published in April 2022 to define key terms and set out proposed solutions in this area. The final strategy is due to be released in spring this year.
“We also want to make it easier for third-party suppliers, from large, well established software companies to small start-ups, to design products which can integrate and connect to our platforms and services,” they write.
“To achieve this, we are improving the way we deliver our information feeds or Application Programming Interfaces (APIs), including our exemplar Personal Demographic Services API, which will enable third-party suppliers, where there is a legal basis, to securely access the national electronic database.”
Electronic bed management
Here, NHSE explains that they are “exploring development of cross-ICS bed management systems to improve the flow of patients through hospitals and across the healthcare system.”
Work in this area includes quantitative analysis to understand potential benefits in key areas of performance, such as length of stay and A&E waits, when comparing an electronic bed management system against other methods. In addition, the team are conducting frontline interviews and performing site visits to identify opportunities and barriers.
Improving call access in primary care
Since December 2021, additional outbound Voice over IP (VoIP) capacity has been provided across primary care to help free up practice phone lines for inbound calls.
More than 92,000 GP practice staff are currently enabled for Microsoft Teams Outbound Telephony, and since the launch, 6.8 million minutes of calls have been made.
An ambition is shared to increase usage levels of this capability via promotion through NHSE’s primary care team.
NHSE state that more than 31 million users are registered for the NHS App, “making it the most popular non-commercial app.”
They commit to achieving a target of 75 percent of adults registering for the app by March 2024, and share some of the key benefits of the app. For example: “Online appointment management and repeat prescriptions have saved a total of approx. 3m hours of GP practice time, equal to approx. £28.4m between April – December 2022.”
Features have recently been added to enable users to receive notifications from their GPs and view/manage their hospital appointments, and this month NHS intend to “make it easier for people to take part in clinical research by promoting it on the homepage.”
Work is currently in progress with the Department of Health and Social Care to “go further and faster on key aspects of the roadmap for the National Digital Channels, originally set out in June 2022 through ‘A Plan for Digital Health and Social Care’. NHSE say: “We are working closely with the DHSC to expedite necessary funding and business case decisions to support this work.”
Digital health technologies
An Early Value Assessment is being jointly developed between NHSE and NICE, which is to “set clear standards and improve the process for DHTs to be adopted by the NHS”.
As part of the pilot, NICE is to assess at least 15 products on their emerging evidence for plausible clinical or cost effectiveness by March 2023, and will streamline evaluation of products that address NHS priorities. Products receiving a recommendation from NICE will be ready for NHS procurement within a month.
The NHS AI Lab has so far funded seven technologies through the AI in Health and Care Award, which have been rolled out to 65 hospital sites and helped over 200,000 patients.
An example is shared of one recipient, Brainomix, which has been shown to “triple the number of stroke patients recovering with no or only slight disability” from 16 percent to 48 percent.
Cardiovascular disease prevention
The NHS Long Term Plan included an ambition to prevent 150,000 strokes and heart attacks through better acute treatment and effective early identification and intervention. NHSE has commissioned a national primary care audit called CVDPREVENT which “automatically extracts and presents data from GP records to help clinicians understand where their patients might be unidentified, undiagnosed, under-treated or possibly over-treated, and therefore help to identify where there is potential to improve health and care outcomes”.
In addition, a case finding tool is being explored to help local health partners to act on CVDPREVENT and identify individuals whose treatment can be optimised. NHS is working to test the tool with a small number of ICSs, with a national roll-out to come.
Eliminating unwarranted variation in clinical standards and outcomes
“Our Getting it Right First Time (GRFT) programme aims to support the adoption of validated, efficient and cost-effective best-in-class services across the whole of the NHS,” the notes state. “It is informed by a clinically-led and ambitious approach to the use of data to improve services.”
Key highlights in this area are shared, including conducting 42 specialty reviews of all providers in England and developing 1,100 GRFT metrics on the Model Health System across 16 specialties. This is to grow to cover 24 specialties over the next 18 months.
NHSE say: “GIRFT has seen a positive trajectory in clinical performance, including reductions of length of stay in many specialties, reductions in litigation in orthopaedics, increases in target day case rates and increases in best practice adoption in terms of procedure type and perioperative care.”
The programme also offers support to regions, systems and trusts to improve their pathways and theatre productivity, along with underpinning the new investment in elective hubs with regards to guidance on operating models, pathways and best practice.
“Though we must remain mindful of the risk of digital exclusion, there is potential for digital solutions to help to reach communities with less engagement with traditional health services and thereby reduce health inequalities (highlighted by the NHS Race and Health Observatory),” NHSE states. “Digital technologies can also make it easier for people to report their characteristics, helping identify previously hidden inequalities and enabling more sophisticated population health management.”
Mitigating the risks of digital exclusion is highlighted as a continuing priority for action on health inequalities, set in operational planning guidance for systems.
The notes draw attention to the Good Things Foundation guide on mitigating these risks, and says: “Following the recommendation of the Wade-Gery review that NHS England should develop national frameworks, guidance and best practice in designing and implementing digital solutions to reduce inequalities, NHS England will publish a framework for NHS action on digital inclusion by May 2023, setting out future plans to support ongoing learning and action.”
The board meeting notes can be accessed in full.