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NHS England needs to get into the hearts and minds of the NHS workforce to bring about digital revolution

By Alex Kafetz

Digitalisation, participation and transparency, realising cash savings that can be used to improve services at the weekend. You might, at first glance, think I’m referring to NHS England’s ambitious plans to modernise the NHS, but I’m not, I’m talking about the tube strike.

Over the last few years London Underground has introduced many of the innovations that NHS England is striving for. I can buy my oyster credit online, I have digital access to my information and I can even transfer this data onto my new oyster card if I lose my old one. And there is transparency – oyster data is available through an API helping to manage demand. Oh, and it also tells us that only four regular commuters use the Emirates Air Cable Car. Only three percent of people now buy their tickets from ticket offices in the conventional way. London Underground is going to close all ticket offices and reinvest the cash to give us a 24-hour service at the weekends.


Spread of London’s population swiping in and out with their oyster cards

So digitalisation works then? We have a better service without it costing any more money and that’s good right? Wrong. Well partly wrong. As a result of this modernisation London Underground staff went on strike this week, London ground to a halt, there was a £200m cost to the economy and Jeremy Hunt had to walk from Oxford Circus to Chancery Lane to speak to the Cambridge Health Network.

This all sounds familiar when we think about digitalisation in the NHS. NHS England is investing millions in a strategy of digitalisation, transparency and participation. In two years we will be able to access our data, book appointments online and be ‘remembered’ from visiting any NHS hospital we happen to end up in. It all sounds brilliant, with an ambition that in five years time we won’t believe the NHS in January 2014 basically functioned by moving pieces of paper from one building to another. We do our banking online, so let’s do our health online.

But it seems not everyone is so excited. Last week I visited a hospital to talk to some community nurses. They go and see about six patients a day and after each visit they drive to a GP surgery and input the data about that visit. This can be one of 20 practices and they have 20 passwords for 20 data systems, a different system at each practice.

I was talking to these nurses about digitalisation. I said: “Wouldn’t it be great if you had an iPad, input information from the patient’s home, it was stored in “the cloud” and all GPs and hospitals could access this patient’s information as it “talked” to their systems? And wouldn’t it be even better if patients could access the part of this information relevant to them such as revisiting advice they’d been given about when to take their medications?”

I’m sure they were convinced it was a good idea, but they seemed dubious at the same time. The first problem was that they didn’t really believe me. They couldn’t conceive that their employer – the NHS – would give them iPads. One nurse laughingly showed me her NHS-issued Nokia, which probably looked state-of-the-art in 2006. Secondly, it turns out they quite like their life. They see patients, they pop in and chat to the GP staff and then they see other patients. What I was proposing would transform their (and the patients) lives, but I wasn’t sure they wanted to be transformed.

And then there is the bigger picture. Digitalisation means changing human behaviours – shifting patterns, working practices, tasks and responsibilities, and this, as Boris Johnson has found, is when the unions get involved.

If NHS England really wants the digital revolution to work they need to get into the hearts and minds of the NHS workforce, they can release all the tech funds in the world and swamp the NHS with iPads, but if staff don’t use them or don’t accept the changes required, the pad, paper and petrol bill will continue.

Let’s hope that the softer side of change is also managed well. If Tim Kelsey is the Boris of the NHS digital revolution, I’ll leave you to insert the punch line of who might be Bob Crow.