Does government report on digital health in NHS go far enough?

Dr Lloyd Humphreys, managing director at ORCHA and an NHS Innovation Accelerator alumnus, analyses a report published by the Department of Health and Social Care, and asks if it goes far enough in its advocacy of digital health use in the NHS. 

Laura Wade-Gery’s independent review, Putting Data, Digital and Tech at the Heart of Transforming the NHS, gets to the heart of the issue but falls short on delivering some fundamental building blocks for digital health.

The language of the report is welcome, with its clarity and sense of purpose. Wade-Gery, chair of NHS Digital, rightly says: “The time for action is now. The need is enormous. The NHS faces unprecedented demand and severe operational pressure as we emerge from the pandemic.”

ORCHA’s experience of the pandemic absolutely dovetails with this. Views of our digital health libraries by healthcare staff increased 6500% in the first months of the pandemic. The time for action is, indeed, now.

By recommending wholesale organisational change the report shakes up NHS strategy so that digital, considered by many to be a bolt-on to health and care services, becomes integral. Particularly inspiring is the integration of technology teams across the NHS into NHSEI.

But, in the author’s eye, this organisational change is just a start. At the very heart of the report is a passionate call for the ‘NHS to be bolder in stating that the health and care system should empower citizens to manage their health and well-being and give them the tools to take ownership.’

A noble sentiment, but is this more easily said than done? Self-management of health and well-being and a recognition of personal responsibility would be a massive step change, not just for the NHS, but for society as a whole. Digital tools can make this happen, but all stakeholders need to be determined to drive the change – strategists, front line health and care staff and citizens themselves. 

We know from our own research that there’s a real appetite for digital amongst the population. Consumer research in 2021 revealed that two thirds of the public would be willing to use more technology, such as health apps, as part of a fresh approach to help the NHS. Strikingly, of the four in ten people who had already used a digital health tool, nearly 90% were satisfied or strongly satisfied with the experience.

The report does give reassurance on two key points.

• The recognition that digital exclusion is, in fact, a health inequality. The expansion of the Health Inequalities Team is welcome. 
• Equally, that if the NHS is to demand broad digital literacy, training needs to be provided. The proposed mix of on-the-job training, peer support and formal training is most welcome. Our experience has been that whilst patients are often open to using digital tools, healthcare staff are not always recommending them. 

On a tactical level, our great hope is that this re-imagined NHS moves away from identifying point solutions from different tech suppliers to a system-wide approach to technology. This will enable technology to scale and achieve greater impact. A fantastic example of this is our partnership with seven ICSs across the South West of England. Working together, they have appointed ORCHA to provide tailored digital health libraries for communities from Dorset to Cornwall. The cost savings to the public purse have been significant. 

We had hoped such a visionary report would have taken the bold step of paving the way for key infrastructure developments such as the support for digital formularies and reimbursement models. 

To understand the grave importance of infrastructure, let’s put this in context. For prescription medications there are approximately 20,000 licenced products and they have – in the UK – the MHRA to approve and licence products, NICE to evaluate the effectiveness and impact, the BNF to collate these products along with indications and contra-indications, and we now have electronic prescribing. 

Yet none of this infrastructure exists for 365,000 digital health technologies, with 250 new products coming on to the market daily, and only 20% reaching quality thresholds (based on ORCHA thresholds). One could argue that medication carries greater risk of adverse events, but is this true when we think about apps that address suicide, addictions, eating disorders, self-monitoring of long-term conditions or advice for treatment?

Overall, whilst the language and intent of the report is most welcome, there does not appear to be timescales applied for the major structural changes. How long will they take? If we lose momentum on digital health, we could stall.