In my 10+ years working at the intersection of technology and government, as well as briefly leading a healthcare business, I have seen first hand the triumphs and challenges that the NHS faces in embracing digitisation to improve service delivery. Meanwhile, NHS Providers have reported that the first six months of 2024 has been the “busiest year ever,” with the “busiest July in A&E for 15 years.” It’s clear, now more than ever, that while the intent to evolve is there, we need a more practical conversation about how the government can live up to its immediate priorities and deliver on a digitally-enabled health service designed by and for the NHS to improve care while safeguarding patient privacy and public trust.

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Potential and practical limitations of a data goldmine

The NHS holds the single largest health dataset in the world, an incredible asset with enormous potential for improving patient care, driving medical research, and enhancing public health strategies. Nonetheless, its true potential will never be realised if important questions aren’t addressed around the data sovereignty, security, and long-term digital strategy of the NHS.

One of the key issues we face is the historical underinvestment in key enabling capabilities. The current state of our patient data compounded by our inability to share information usefully across different domains of government mean that far too many use cases remain outside the realm of the possible. 

Consider this scenario from the early days of the pandemic: 

High-risk individuals were identified using SNOMED codes from medical records, and many of them also lived in crowded social housing. If local authorities had been able to combine data on high-risk individuals with information on high-density social housing, targeted and cost-effective interventions, such as coordinating social care check-ups or protocols to support individuals isolating, could have saved lives.  

This case is only one among many that will have fallen through the cracks, underscoring a critical gap in our current system: the inability to share data across government departments to improve decision-making and outcomes. This will also be a limiting factor in the embrace of AI, which is not a magic bullet if underlying data quality is too immature. 

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The Path Forward

Some practical steps to improve initiatives around modernising the NHS might look like:

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1. Invest in capacity

• Develop robust in-house digital and data capabilities to reduce dependence on external providers
• Build on support structures like NHS England’s frontline digitisation programme, rolling out more innovation and digital skills training programmes 
• Enable and support knowledge exchange networks where previous examples of digital transformation can be leveraged and learned from

2. Embrace data access and interoperability

• Push for API access and interoperability in all new IT systems to make best use of electronic patient records (EPRs) and digital social care records (DSCRs) 
• Create secure, interoperable data-sharing platforms across health and social care to enable the ambitions of NHS England’s 2023/24 Business Plan
• Embrace the use of Privacy Enhancing Technologies (PETs) to enable data sharing without allowing access to underlying sensitive information

3. Strong commercial functions

• Empower commercial teams to enforce the Technology Code of Practice and insist on standards such as API access and interoperability
• Include ‘Contemplation Clauses’ in the procurement documentation to demand that suppliers must keep a reasonable pace of parity with the state of the art of the market
• Engage a wide market to understand the capabilities that exist

The Power of Prevention 

Targeting waitlists is, rightfully, the central focus of the new government’s health policy. But this focus risks preventing the country from truly moving the needle in terms of population health and, ultimately - keeping people out of hospitals in the first place. As outlined in the Health and Social Care Act of 2022, for the NHS to be sustainable, we need to shift resources to primary care and community services.  To effectively serve patients, more demand and care needs to be shifted away from acute care settings and to prevention. 

The move to the Integrated Care Systems (ICS) puts the structure in a better position to approach population health from a biopsychosocial perspective. For those that are not familiar with this approach, it is the view that physical health is related to mental health, which are both also related to social health.  The Victorian, stove piped approach to health means that all of these areas are separate disciplines and do not actively talk to one another. And while digital must be a part of the solution, we have to also admit that it is part of the problem: too many individuals feel isolated and alienated from social and community activities, which has a compounding effect on mental and physical health outcomes. 

Bold ICS’s should work actively with local governments and local organisations, as many of the capabilities they provide will be critical in helping prevent hospital admissions and preventable deterioration in health conditions. Digital solutions can be a part of that process. Social prescribing, the act of prescribing social and community based activities and services in the way that a doctor would prescribe a drug, has shown promising results. A 2024 study by the Welsh government found that social prescribing led to a 28% reduction in the likelihood of a GP appointment, and a 20% decrease in emergency hospital admissions. It has been proven to be effective in short term instances but lacked the kind of stickiness required to drive real change. 

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The key to addressing social determinants of health

The move to Integrated Care Systems provides an opportunity to break down traditional silos in our health system. By working closely with local governments and organisations, ICSs can help prevent hospital admissions and health deterioration by addressing the broader social determinants of health. 

Cross-sector collaboration is crucial for addressing this, but it needs to be underpinned by secure, interoperable data-sharing platforms. By enabling data sharing agreements across different parts of government, the pandemic showed us that problems we face now and in the future will require coordination across disparate parts of government such as transport, housing, education, and health. The potential to maximise cross-sector services is enormous, but these solutions must be implemented with clear consent processes and fortified data protection measures. 

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Building trust in a digital NHS

As we push for greater data integration and technology adoption, equal attention should be focused on prioritising trust from the NHS workforce and the public. We need to see a greater crowding of user needs and solutions to produce the interventions capable of driving the change we need. If we can build highly addictive social media platforms, can we not try to build well loved community platforms that help people get and stay healthy. This will require a concerted effort on the part of ICSs and local governments to implement strong data governance frameworks to try and support these community-based solutions, but there are enormous upsides for getting this right. 

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A proactive, data-driven NHS 

To make any ‘Fit for the Future’ vision a reality, we need bold action and strategic focus. The time for incremental change has long passed. We need to push for services which are re-imagined and co-produced with service users, care workers, and local communities. To do this, a greater push is required towards commercial agreements that prioritise interoperability, enabling secure data sharing across government departments, and making prevention as important as treatment. 

The NHS has always been a source of national pride. With the right approach to public engagement, data, and technology, one that combines the compassion and expertise of our healthcare workers, it can become an NHS that leads us into the future. 

Get in touch with ryan@public.io today to find out more.