Digital Health’s review of the year, 2016

Few people managed to predict the big events of 2016. From Brexit to the election of Donald Trump as president of the US, the big events of the year were things that most commentators had not expected to happen (and many had hoped would not happen).

In healthcare IT, change was lower key but still significant, with personnel changes at NHS England and NHS Digital driving a switch in focus from digital maturity assessments and local digital roadmaps to exemplar trusts and sustainability and transformation plans.

This against an all-too predictable NHS financial crisis, and increasing concerns about the robustness of critical IT infrastructure and the NHS’ ability to withstand hack attacks.

The year opened with trusts filling out digital maturity assessments and clinical commissioning groups working on the local digital roadmaps that Beverly Bryant, the director of digital technology at NHS England, had asked them to produce the previous autumn.

However, in a hint of things to come, NHS England’s annual policy and planning guidance said future tech funding was likely to be linked to the sustainability and transformation plans that would locally implement the Five Year Forward View project to close a potential funding gap of £30 billion by 2020-21.

In other news, Blackpool Teaching Hospitals NHS Foundation Trust became the third to take the openMaxims electronic patient record. And the government’s chief technology officer, Mark Walport, suggested blockchain might have a role in the public sector.

Health secretary Jeremy Hunt found himself on Andrew Marr’s BBC sofa, and used the opportunity to announce that the Treasury had set aside £4.2 billion for NHS IT; with around £1.8 billion of this likely to go on the ‘paperless’ agenda.

In the first of a number of changes at the top of NHS IT, Kingsley Manning, the chair of what was still the Health and Social Care Information Centre, announced that he was leaving after three years in the role. The chair was later taken by Noel Gordon, an NHS England non-executive director.

In other news, Lord Carter’s latest review of NHS productivity was unveiled, urging further ‘back office’ savings and a shake-up of pathology services. And Great Ormond Street Hospital for Children NHS Foundation Trust put out the biggest EPR tender of the year.

Life sciences minister George Freeman told the first Digital Health Leadership Summit that the “stars are aligned” for healthcare IT, thanks to Hunt’s money, political interest, and an agreed strategy for digitisation. Andy Williams, HSCIC chief executive agreed, saying everyone was up for a “collaborative” approach.

Daniel Ray, the former director of informatics at University Hospitals Birmingham NHS Foundation Trust, became director of data science at the HSCIC.

Also on the analytics front, Wirral Partners announced it was bringing Cerner’s population health management to the UK. And Google announced that its artificial intelligence business, DeepMind, was working with Royal Free London NHS Foundation Trust on an acute kidney injury app, in what seemed like an uncontroversial move.

NHS England published the digital maturity assessments, which Paul Rice, its head of technology strategy, kindly described as “mixed.” After all the millions invested during the National Programme for IT era, some trusts had very low digital capabilities, and e-prescribing use was low across the piece.

Despite this, it emerged that £500 million of the Treasury’s £1.8 billion for ‘paperless’ would go on NPfIT contracts. In another little straw in the wind of change, the HSCIC announced that was going to become NHS Digital.

In other news, GP IT suppliers agreed to standard open application programming interfaces. And University Hospitals of Morecambe Bay NHS Trust, the very first NPfIT early adopter for the iSoft/CSC Lorenzo electronic patient record, decided to stick with it.

Change started to accelerate at the top of NHS IT. A letter confirmed the commissioning board’s operations and information directorate, led by former Cerner executive Matthew Swindells, would be strengthened – but that Beverley Bryant was going to leave for the HSCIC / NHS Digital.

Meanwhile, West Suffolk NHS Foundation Trust showed that it is possible to make a big-bang work with e-prescribing when it went live with its Cerner EPR, while Clatterbridge Cancer Centre NHS Foundation Trust went live with Meditech.

The 56 Dean Street clinic in London’s Soho received one of the biggest ever fines from the Information Commissioner’s Office for an email blunder that lead to the leak of almost 800 patient email addresses. And, amid a press outcry, the ICO was asked to look into patient privacy concerns about the Google DeepMind / Royal Free link-up.

As the 44 STP footprints got ready to hand in their first drafts, two reports cast doubt on government and policy projects in which a lot of hope had been invested. First, that it should be possible to save money by joining up health and social care, as tested by the ‘integrated care pioneers’ and, second, that there would be major gains from giving patients ‘personal health records.’

Any lingering hope that the STPs would be delivered in a calm, optimistic environment were dispelled when NHS England chief executive Simon Stevens and NHS Improvement chief executive Jim Mackey appeared at the NHS Confederation conference in Manchester, and warned that a financial ‘reset’ was on the way, because the acute sector had overspent by £2.4 billion the previous year. Then Brexit happened.

In a set-piece speech, Matthew Swindells compared NHS IT systems to those of a 1950s bank, and suggested the answer was not to “throw more money” at the problem but to tap into new sources of innovation.

Pushing in the same direction, Sir David Dalton, the chief executive of Salford Royal NHS Foundation Trust, told the health select committee the NHS should designate trusts with “a track-record of successful implementation and delivery as project managers for implementations at other trusts.”

A few days after his speech, Swindells’ position was strengthened by the appointment of Professor Keith McNeil as NHS England’s first chief clinical information officer, and of Will Smart as its first chief information officer.

Meantime, the government was gripped by a post-Brexit reshuffle. Jeremy Hunt was retained as health secretary, but George Freeman handed his health IT brief to Nicola Blackwood.

If all this had not been happening, the big news of the month would have been the third Caldicott report. This called for new IT security standards, for boards to take more responsibility for IG, and for a redesigned IG Toolkit. The care.data project was scrapped on the back of the report; although news of its death may have been exaggerated.

With so much going on, the National Programme for IT drew to a close with barely anybody noticing, as the majority of its contracts stopped in the North, Midlands and East.

As the straws in the wind of an NHS IT policy change became a veritable haystack, NHS England announced that it had selected 26 trusts to bid for a £100 million pot of funding to become ‘centres of global digital excellence’. It indicated it would expect these trusts to share their expertise “with other organisations through networks.”

In other news, King’s College Hospital NHS Foundation Trust went live with the first elements of its Allscripts’ Sunrise Clinical Manager, while the Isle of Man announced its ambition to beat England to paperless healthcare, using System C technology.

In foreign news, it was revealed that NHS England’s former digital guru, Tim Kelsey, was back in government, this time as chief executive of the Australian Digital Health Agency.

The thinking behind NHS England’s IT appointments and its digital excellence pot became clear when US digital doctor Professor Robert Wachter finally published his review of NHS IT. Wachter, whose review had been held up by the ‘purdah’ around the EU referendum, concluded that there was not enough money to meet the government’s paperless by 2020 ambitions.

Instead, he said trusts should be divided into three groups, with the most digitally advanced getting any money that was going, and the rest getting ready to get support from them.

Hunt backed the plan, announcing the first 12 ‘exemplars’ to be picked from NHS England’s long-list, and saying they would become an ‘ivy league’; to the understandable annoyance of those relegated to bog standard comprehensive status.

Wachter also called for a significant investment in NHS IT leadership. A few days later, it became clear that the NHS’ new CCIO, Keith McNeil, had secured more clout by getting the chair of a new Digital Delivery Board.

Meanwhile, the NHS’ annual ‘to do’ list was issued some two months early, and confirmed that STPs are now the only game in town when it comes to change, IT plans, or funding for either.

In non-Wachter, non-crisis news, NHS Digital announced a major investment in new cyber security services. And Leeds Teaching Hospitals NHS Foundation Trust suffered a spectacular pathology systems crash.

As NHS England tried to keep the STPs under wraps, councils started leaking them. Footprints were interested in analytics, shared care records, and digital patient services – but wanted central cash to pay for them. Early indications are they will not get it.

However, perhaps recognising that Hunt’s ‘ivy league’ comments had struck a wrong note, various NHS IT leaders promised that further, national exemplars would be announced; and include mental health, community and ambulance services.

In other news, auditors found the new computer system for the Scottish helpline NHS 24 was 73% over budget, costing £500,000 a month, and still not live.  And, in a rather different straw in the wind, the Care Quality Commission announced that it had inspected two providers of online, private GP services – Dr Now and Babylon – and given both a clean bill of health.

The National Audit Office issued its annual ‘Financial sustainability of the NHS’ report – and concluded for the third year running that the NHS’ finances were not sustainable. Also, that there was no tested plan in place to make them sustainable.

In a final move at the top of NHS IT, Andy Williams, the chief executive of NHS Digital, announced that he was going to retire, after two years in the job. However, Daniel Ray unveiled plans for NHS Digital to offer a business intelligence service to “disrupt the market”. https://www.digitalhealth.net/analytics/48314/nhs-digital-proposes-analytics-service-to-disrupt-market

Otherwise, healthcare IT seemed to be pottering along quite normally until a ‘bug’ in the NHSmail 2 service caused a Croydon contractor to send a ‘test’ email to the entire NHS address list. The service ground to a halt as a flood of ‘reply all’ emails came back.

In other news, University College London Hospitals NHS Foundation Trust announced that it was set for an Epic adventure, after deciding to use the Epic EPR to replace its IDX LastWord system.

But, across London, St George’s University Hospitals NHS Foundation Trust had a bad couple of weeks. First, the board heard about a major IT crash, and then the whole trust was rated ‘inadequate’ by the CQC.

Northern Lincolnshire and Goole NHS Foundation Trust had an even worse time; it was infected by a virus that turned out to be Globe2, and all but shut down its operations for three days.

As 2016 drew to a close, there was a sense that while a lot had changed in healthcare IT, not much had happened. With a complete change of IT leadership at NHS England and NHS Digital, the digital maturity assessments had been and gone; but the ‘exemplars’ were still to be confirmed.

Local digital roadmaps had not been published ; and it remained unclear how STP reconfiguration and IT plans would be funded. With the weather getting colder, norovirus rampant, and funding fears shifted to social care, the NHS and its IT looked set for an ‘interesting’ winter.

Meanwhile, Google DeepMind and the Royal Free pushed on with their AI project, in the face of the ongoing ICO investigation. And there was a further flurry of trust infrastructure failures and cyber security incidents.

Still, Gloucestershire Hospitals NHS Foundation Trust managed to go-live with its InterSystems EPR, after more than a year of delays. So, progress is possible. Happy New Year.