The health service’s IT infrastructure badly needs an update. But modernisation efforts must not focus solely on the technology, believes Matt Fetzer of Reform.

Credit: Sergio Santos/CC BY 2.0

If a device or medicine was widely known to be unsafe, expensive and ineffective and was in use across the NHS, it would be a national scandal. 

Fortunately, there are rigorous checks and balances to ensure this does not happen. Yet the same cannot be said for the service’s digital foundations. Legacy – old or outdated – IT is everywhere in the NHS and it is known to be unsafe, expensive, and ineffective. Often it will be out of security support from the supplier, making it vulnerable to cyberattacks, or be unable to share information with other systems, trapping vital patient data.  

As the secretary of state for health and social care Matt Hancock put it, IT in the NHS is “clunky, clunky, clunky”.

Yet while successive governments have highlighted the issue, and numerous attempts have been made to root it out, legacy systems persist. 

To understand why it remains a problem after all these years, it is important to examine why projects to remove it have failed in the past. 

One of those projects was the National Programme for IT. Aimed at digitising patient care records, the programme was finally abandoned in 2011, after nine years and £10bn. 

The NHS needs to involve clinicians and wider health professionals in the design phase of products; too often technology is developed without much input from the people who are using them

The 2016 Wachter review looked at the reasons for its failure – top of the list was the belief that it would simply be a technical update. There was little consideration of what would need to change about how the frontline works to use the new technology.  

Despite this recommendation, the National Audit Office found in May last year that NHS IT programmes were still focused more on the technology itself than how people actually work and would use it.

The pandemic, however, has revealed just what can be achieved if measures are focused on helping clinicians change the way that they work.  

For example, during the first wave, 71% of GP consultations were conducted remotely and 25% face to face. One year earlier the situation was almost the exact opposite. 

What changed was not any new technology – remote consultations have largely taken place over the phone – but the environment, where GPs had no other option than to create new ways of working with the tools that were available.   

Policy makers will not be able to recreate the catalysing effect of a pandemic, but they can take the principles of what has worked over the last 12 months and try to apply them moving forward.

This means ensuring that any legacy migration programme focuses on people and how they work, not just the technology. 

Post-pandemic plans
A recent Reform Policy Hackathon – bringing together policymakers, innovators and clinicians – focused on how to create this mission-like focus to business change, without the background of a pandemic. The experts in the room identified three ways to make this happen. 

First, the NHS needs to involve clinicians and wider health professionals in the design phase of products. Too often technology is developed without much input from the people who are using them. 

Allowing workers to test out products before they are put in place provides a safe space for feedback. Any changes to the ways people work would then be easier, as the technology is more tailored for how they would use it.  

Second, organisations need to be shown how they can be visibly improved by removing legacy. Historically, legacy IT migration projects have been de-prioritised at the local level because of the large cost and lack of clear immediate benefits to care.

However, getting off legacy clearly improves capabilities in areas like data sharing. NHSX should therefore reward organisations for removing it by providing them with additional funding to use these capabilities to experiment with more innovative technology. 

Third, the wider digital workforce who will actually be using the new technology have to be on board. The teams in charge of legacy migration committing to monthly “show and tells” of their progress would build trust, maintain momentum, and ultimately make individuals more receptive to any changes made. 

The government has already signalled its intention to reform the health and social care system after the pandemic. Successfully rewiring the NHS’s digital infrastructure so it is fit for the future is central to the government achieving its goal of a modern, integrated system. 

Putting the workforce at the centre of any future reform programme will ensure they avoid the pitfalls of the past.