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“Outdated” IT and digital skills gap hinder NHS digital transformation, say MPs

New report reveals legacy tech is a barrier to progress for the health service.

By Sophia Waterfield

Legacy IT systems and challenges in building an inclusive digital health service have “frustrated” the progress of NHS digital transformation, a committee of MPs has found.

The government needs to meet numerous challenges, such as helping the NHS workforce digitally upskill, to succeed with its plans, the lawmakers say.

Cross-party MPs in the Health and Social Care Committee published a report today entitled Digital Transformation in the NHS, which looked at barriers for the national health service to achieve its “top priority” of digitally transforming its operations. The report features conclusions based on several oral sessions held during the inquiry period, which launched in May 2022 and looked at the current use of digital technology, as well as exploring what needed to change in the NHS to deliver improvements for patients.

The committee also looked at the digital transformation of health and records, interoperability across primary, secondary and social care, and legacy IT systems in the health service. Digital health inequalities, and how to educate patients on the potential benefits of digital healthcare, were also discussed.

The committee found that a shortage of skilled digital professionals working for the NHS had been a barrier for the health service to date and that pay packages were one of the reasons people remained in the private sector. This meant that the NHS were reliant on third-party suppliers – something that could potentially open it up to higher costs, according to the Competition and Markets Authority (CMA).

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MPs expressed some optimism about the government’s approach, but said that the NHS lacked the most basic functioning IT equipment, and that previous attempts to digitally transform had been “thwarted” by legacy IT systems that couldn’t handle the demands of modern digital systems.

Recommendations were made around the NHS App, which rose in popularity during the Covid-19 pandemic, and the committee is asking that the Department for Health and Social Care (DHSC) and NHS England “clearly demonstrate” the app’s continued value. Without doing this, the committee said that there was a risk people would disengage from using the NHS App, which has been cited as a key factor government’s goals of reducing waiting lists and improving access to GPs.

A DHSC spokesperson told Tech Monitor that legacy IT equipment in the NHS was “being updated with new systems” but when asked about the timescales, they said that this “wasn’t being announced today” and that “it is in train”.

As part of the inquiry, the committee had an opportunity to visit the US, and found it surpassed the UK when it came to digitally transforming health records.

“On a visit to the US, we saw digital patient records being used seamlessly in hospitals,” said Steve Brine MP, chair of the Health and Social Care committee. “[In the UK] it can take more than 15 minutes for a clinician to turn on a PC because kit is outdated.”

The report says it supports the recommendation in ‘The Hewitt Review: an independent review of integrated care systems‘, which says that DHSC, NHS England and Integrated Care Systems (ICSs) should improve interoperability and data sharing within and between systems: “This should include working closely with sectors that could feed into shared records in the future, including pharmacy, mental health and community health, to ensure that what is put in place meets their needs,” the Health and Social Care committee report says.

Brine also warned that the NHS needed to offer higher salaries to digital workers in its workforce to be able to compete with the private sector: “It won’t be able to attract the people to deliver the transformation that’s needed to run a modern health service,” he said.

The committee has recommended that DHSC apply to implement the Digital, Data and Technology (DDaT) Pay Framework for NHS England DDaT specialists, allowing for additional pay measures including bonuses and capability-based allowances for staff.

Investment is also recommended in the wider workforce’s digital skills, with the committee explaining that digital is “understood as a thread that runs through healthcare, not as a specialist skillset that is only relevant to some staff and occupations.” DHSC needs to work with NHS England to ensure that digital training is integrated throughout its wider learning programmes when devising professional training, the report says.

It makes the case that the NHS workforce needs to be given the “time and headspace” to engage with the process of introducing digital initiatives. Without this, staff could perceive digital transformation as an “unwelcome, time-consuming imposition.”

“Co-designing digital initiatives with staff – including but not limited to clinicians – is essential to ensure that these offer workable improvements to existing practices,” the report says.

The committee also advised the government that if it does not address the digital skills gap, digital transformation of health and social care will be further hindered.

The DHSC spokesperson added: “Harnessing technology to improve services for patients is one of the health and social care secretary’s key priorities and we are working closely with the NHS to upskill the workforce.” They added that DHSC is working to “professionalise” the specialist DDaT and informatics workforce and is currently creating a “consistent method of defining and banding job roles to stabilise pay.” One of the ways they are doing that is by “defining career pathways that are vertical and horizontal.”

The same day the committee report was published, NHS England revealed its long-awaited NHS Long Term Workforce Plan. While it does mention that private sector pay proves a factor in issues retaining and recruiting talent, there was no mention of DDaT pay bands.

Dr Owain Rhys Hughes, NHS surgeon and founder of online referrals platform Cinapsis, told Tech Monitor that policy leaders in government and the NHS needed to prioritise the introduction of more “efficient, interoperable and intuitive” software systems to support and maximise innovation.

“By doing so, we can ensure that true digital transformation is not just a lofty aspiration but a tangible reality for the NHS, helping strengthen and support our healthcare services to ensure they can continue to meet evolving patient demand,” he says

The surgeon explained that while advancements in new digital tools such as artificial intelligence (AI) can help improve diagnosis and treatment, underlying software and connectivity issues need to be addressed.

“We cannot afford to overlook the barriers presented by the clunky, outdated infrastructure that still underpins much of the NHS’s digital systems,” he argues. “These systems are often slow, require significant amounts of manual input and cannot ‘speak’ to one another, creating siloes which make tools difficult for clinicians to use and inhibit genuine collaboration between different services.”

Fabien Rech, SVP and general manager for EMEA at cybersecurity vendor Trellix, says the report shows how a reliance on legacy systems presents significant security challenges: “It limits threat visibility and contributes to the increasing attack surface for threat delivery,” Rech says. “While some threat actor groups may have moral qualms around attacking the healthcare industry, it’s no secret that the data held by institutions such as the NHS is rich and highly sensitive – this makes them a prime target for less discerning threat groups.”

Trade unions have also waded in on the conversation, due to the publication of the NHS workforce plan. Sara Gorton, UNISON head of health, commented that pay needed to lie at the heart of any solution for NHS workers.

“Action on retention is key,” Gorton says. “There are simply too few staff across all jobs and services. That makes it difficult for the NHS to function as a modern health system.” She believes that “finding a fix for pay” must lie at the heart of any solution, adding: “The pay review body process no longer works.”

This piece was originally published by TechMonitor on 30 June.

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