‘Do you have the bottle to step up?’ Swindells asks eHealthWeek audience

NHS England director for commissioning operations and information challenged NHS IT leaders yesterday on whether they had “the bottle” to step up on embedding digital into care pathways.

In an uncompromising speech, at times scathing of parts of the NHS, Swindells said it was not enough to just implement new systems and software, the challenge had to be to ensure technology supported reduced cost, and improved quality and efficiency.

Recurring themes of his keynote presentation, opening eHealthWeek, were that many NHS leaders did ‘not get it’ and that the NHS lagged 10 years behind healthcare systems, with the US cited as the model for using technology to change delivery models.

“Do we have the bottle to step up?  Do you have the bottle? Or is it more comfortable to sit in your office delivering one more maternity system?”

He said technology was “not an end in itself” but had to support the improvements in patient care set out in the five year forward view, and supporting patient pathways.

“The measurement of success is, did we impact on patient experience, did we improve a patients’ outcomes?  Not to install systems and walk away.”

“This is not about making NHS more fun for the Apple Watch generation but enabling people to manage their lives better and keeping people from being admitted into hospital.”

He said the Next Steps update of the Five Year Forward View “makes 14 IT commitments with dates and objectives and fit with wider strategy”.  Swindells said the challenge for the NHS is to now embed these objectives into local strategies.

“We now need every CCG and community hospital, acute hospital, region, every STP, to be thinking about the technology element of their plans.  If this isn’t in your delivery plan you are missing the point.”

“We need to try and remember what we are trying to do: ensuring patients receive the right care at right time and place.”

He added: “The point of technology intervention in the pathway is to create a shift.  That’s the challenge we need to confront.”

The former Cerner executive said the “NHS is 10-years behind other healthcare systems on adoption of standardised pathways”, citing InterMountain Health, a Cerner reference site, on what needed to be done to get up to 80% of patients on standardised treatment pathways so doctors can concentrate on the 20% who aren’t standard.

Swindells also stressed that patients needed to be far better informed and involved in treatment decisions.  He cited a study on men in need of urological surgery who had been provided with information to choose whether to have surgery, leading to many choosing not to have surgery, and claimed: “We are taking a knife to people because they don’t have information.”

He said that to achieve the kind of service transformation required required board level commitment and deep engagement.  Swindells that during the Global Digital Exemplar negotiations some trust boards had questioned how they would spend £10 million of doctor and nurse time on implementation, showing they didn’t understand what was required.

“They are missing the point as we are trying to transform the NHS here don’t get that on a bunch of NHS IT guys running around.”

We Need to put tech in place that GP, hospital and social care record are all in one place so can make informed decisions, and we need to break down silos.

He described the current frustrations of NHS Digital, trusts and CCGs all claiming different figures on increases in hospital A&E attendance.

“It’s madness.  The number of people not getting hip replacements because we are sitting around arguing about who the referring GP was is just outrageous.”

“AI and predictive analytics and all those conversations are just pipe dreams if based on crap data. We have to get data sharing and data quality right