Interview: NHS Digital director on ‘the power of technology to transform patient care’

Eve Roodhouse talks to PublicTechnology about the organisation’s 2018 plans, the impact of WannaCry – and how an app has helped her family’s dental regime

Having taken only taken on its present guise in August 2016, NHS Digital entered its first full year in existence with a pretty full plate.

The organisation began 2017 with a remit to drive wide-ranging transformation initiatives in no fewer than 10 areas, addressing the needs of a workforce of more than 1.5 million NHS employees, plus about 100,000 social workers – not to mention 55 million patients. Each of those 10 priorities (detailed below) covers several major individual projects, with landmark schemes including creating the NHS.UK online home for all online interactions with the public, rolling out e-referrals for hospital appointments, providing access to the newly launched Health and Social Care Network (HSCN) infrastructure, and implementing free WiFi at NHS locations across England.

Those are just a few examples, with many, many more transformation initiatives contained in each of the 10 focus areas. And in September this not-insignificant workload was added to with health secretary Jeremy Hunt’s announcement that, by the end of 2018, NHS Digital would have developed an app and web platform allowing every NHS user in England to book GP appointments and view their medical records.

This is just some of the most notable proactive work being undertaken by NHS Digital. The organisation also has a remit to react to developments and issues in the healthcare technology world as they occur, as well as taking point on the NHS’s response to any cybersecurity threat. You may recall there was a pretty big one of those in May 2017.

We are making really good progress on e-referrals. We have a large number of trusts that have started their projects, and we have all the incentives in place in terms of financial resources

Despite – or, perhaps, because of – such a huge and wide-ranging remit – the organisation has, by its own admission, encountered difficulties in making the progress it would have liked. Published by NHS Digital in July last year, the Fit for 2020 Capability Review report assessed how the agency had performed against a number of key metrics. Its headline conclusions were that, in striving to achieve its goals, NHS Digital has to fight against a lack of collaboration internally and with other NHS bodies, an IT estate that features “out-of-date technology in key areas”, and a need for greater clarity of purpose.

Talking to PublicTechnology late last year, NHS Digital’s director of implementation and programmes Eve Roodhouse says that the organisation’s work is so wide-ranging that “sometimes our partners say: ‘just what is it that you do?’.”

“We are the digital partner for the health and social care system, and we are a partner for the other arm’s-length bodies. We also see ourselves as a partner of GP practices, helping them make the most out of our products and services,” she says. “That is how I would describe our purpose and vision.”

A key part of the organisation’s role in the future will be forging and maintaining the right relationships – both within and without the NHS – to ensure the products and services it designs are used to full effect.

“We are committing to developing a relationship-management function in the organisation – that is about monitoring our relationships,” she says. “We have always been focused, and proudly so, on our delivery record. But we need to shift beyond a focus on delivery to strategic partnerships to make sure we know where the opportunities are, and that we take advantage of those.”

A drive to embed digital skills more widely across the health and social care sector will also see the launch of a new pilot scheme: the Clinical Informatics Fellowship Programme. The programme will offer nurses, pharmacists, therapists, and social workers the chance to undertake a year-long secondment at NHS Digital. The long-term goal is that they will subsequently take the digital skills they learn and disseminate them across the NHS and social-services sector when they return to their employer.

The pilot version of the scheme – which is limited to the north of England – was open to applications from workers in the NHS’s band 6 or band 7 pay brackets. Four people, including one social worker, will shortly be chosen to take part. Another intake has already been planned for 2019.

Cybersecurity focus
The 10 focus areas defined in NHS Digital’s plans are all being worked on concurrently, and Roodhouse says that “we are making progress across all” of them. She picks out cybersecurity space as being of particular significance.

“We are really taking the lead in the cyber space, given what we went through with WannaCry – and we are quite clear that it will happen again,” she says. “Both to prevent cyberattacks and to deal with them when they happen, we set up our Data Security Centre and we work very closely with the National Cyber Security Centre. We provide a number of services to the NHS. And we have put out a £20m tender for a partner to strengthen that even further.”

One of the problems highlighted by the WannaCry ransomware assault was the need for a diversity of contact methods that can be used to provide updates and advice during a cyberattack, as email is often disabled as a precautionary measure. To which end NHS Digital’s CareCERT emergency response unit launched an SMS alert system in November, Roodhouse says.

She adds that another consequence of WannaCry is the elevation of cybersecurity as an issue, and an increased awareness of its importance.

“I think what [WannaCry] did do, in the health and social care sector, was put it on the agenda of the chief executive – not just the CIO’s desk,” she adds. “No one can deny that cybersecurity is right at the heart of patient care.”

NHS Digital’s 10 priority areas for 2017/18

  • Patient engagement, self-care, and prevention
    Programmes include: WiFi, health applications, citizen identity, NHS.UK, widening digital participation, and personal health records

  • Urgent and emergency care
    Programmes include: Clinical triage platform, access to service information

  • Digital transformation in general practice
    Programmes include: GP operational systems and services, existing GP services, technology for GP transformation, and GP data for non-direct care uses

  • Social and integrated care
    Programmes include: Interoperability and architecture, social care, digital interoperability platform

  • Digital medicines
    Programmes include: digitising community pharmacies, pharmacy supply chain and secondary uses, integrating pharmacy across care settings

  • Elective care
    Programmes include: Digital referrals and consultations

  • Paper-free at the point of care
    Programmes include: Digitising NHS providers, digital diagnostics; digital child health; digital diagnostics; building a digital-ready workforce

  • Data outcomes for research and oversight
    Programmes include: National data services development; innovative uses of data; data content and new data collections

  • Infrastructure
    Programmes include: NHSmail2, and the Health and Social Care Network

  • Public trust and security
    Programmes include: Data and cyber security, national data opt-out, and information governance

Improving the health and social care sector’s network infrastructure is another of NHS Digital’s core objectives. To which end, HSCN went live last year and, replacing the outgoing N3 network, through which services were provided solely by BT. In November, a dynamic purchasing system was launched to allow health and social-services organisations to procure connectivity services for the new network. The agreement went live with nine suppliers, and seven more have since been added. More will follow in due course.

Roodhouse claimed that HSCN will play a key role in driving digital transformation at a local level.

“I think it is going to be transformational for local plans,” she says. “Being able to have a social worker in the same room… [and] jump on the same network is quite a significant step forward. It is something that will underpin local transformation.”

Improving patient care
Of course, the end goal of all NHS Digital’s work is to improve the quality and efficiency of patient care. While the schemes to improve security and connectivity infrastructure will most obviously benefit the working lives of healthcare professionals, other programmes of work are more directly targeted at front-line care provision.

The most obvious of these is the NHS app announced by Jeremy Hunt at an event in September. The health secretary specified that the app, which is due to launch by the end of 2018, must allow patients to do the following things: access the NHS 111 urgent-care helpline; book an appointment with their GP; order repeat prescriptions; obtain support for managing long-term conditions; access their personal healthcare records; express their preferences for how their data is shared; and opt in or out of organ donation. All of these services should also be available for access through a web browser, Hunt said.

In addition to its own app, last year the NHS also launched a public beta version of its app library. The site features 45 healthcare apps that have been tested and deemed to be safe for use by those affected by conditions including anxiety, depression, dementia, and learning disabilities.

One app – the myCOPD app to help sufferers of chronic obstructive pulmonary disease better manage their condition – has full ‘NHS Approved’ status, certifying that it has been tested and found to be clinically effective. Three more are currently being trialled by NHS professionals: the Cove app that allows users to create music to reflect their mood; Chill Panda, an app designed to help manage stress and promote relaxation; and Cypher, an anonymous social network through which people can share feelings in confidence and receive support from others.

Other apps singled out for praise by Roodhouse include Couch to 5K, which offers a nine-week programme for new runners wanting to build up gradually towards the ultimate goal of running 5km, and Brush DJ, an app which provides advice on dental care and plays two minutes of music – interspersed with reminders to switch sides – to help encourage users to brush their teeth for the optimum amount of time. This app has proved a hit with the children (and possibly the grown-ups too) in the NHS director’s household, she says.

Roodhouse adds: “There are [something like] a quarter of a million health apps. It is very hard to know what is good and what is not. Apple ranks them by download – not whether they will do you any good. That is why we have developed our apps library.”

I think what WannaCry did do, in the health and social care sector, was put it on the agenda of the chief executive – not just the CIO’s desk. No one can deny that cybersecurity is right at the heart of patient care.

The rollout of electronic referrals for hospital appointments is another ambitious programme of work scheduled to complete this year. GPs and NHS hospital trusts are facing a deadline of October 2018 for completely ditching paper systems and conducting the referral process entirely through digital methods.

At present, only a very small number of trusts have achieved this, and some doctors have expressed doubts about the feasibility of the deadline. But Roodhouse claims the programme is on track.

“We are making really good progress on e-referrals,” she says. “We have a large number of trusts that have started their projects. And we have all the incentives in place in terms of financial resources.”

She points to a utilisation rate of e-referrals that, as of late November was approaching 60%, and has since risen to 61%.

“Utilisation rate is a [good] base indicator, being that we have had a petty static utilisation of 54% for years, so to see that increase is great,” she adds.

When asked what goals she would like NHS Digital to have achieved by the end of 2018, Roodhouse reiterates the goals of delivering the NHS app, the WiFi services in primary care providers, and “finishing the job on e-referrals”. She adds that she would also like to be “substantially closer” to delivering the completed Child Protection – Information Sharing project, which aims to link the IT systems of healthcare and social services to allow professionals to share information between the two sectors, so as to enable them to better protect vulnerable children.

“I would also like to see an increase in usage of solutions we already have out there, whether that is Care Cert or Summary Care Information [or others],” she adds.

But, Roodhouse concludes, all these activities and more are, ultimately, all in the service of just one, simple goal.

“We have got some fantastic people at NHS Digital who are really committed, really caring, and really do believe in the power of digital and technology to transform core patient care – and that is what we want to do.”

Sam Trendall

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