The long-awaited Wachter Review (Review) was published on 7th September 2016. The Review was carried out by the American professor Robert Wachter and commissioned by the Department of Health (DH) to provide an assessment of the digitisation of secondary care (hospitals) in the UK and issue recommendations on the way forward. It follows a number of policy and funding announcements – including the £4.2bn funding to support the digitisation of the NHS – as well as several publications and initiatives identifying technology as a critical lever to address the multiple challenges the NHS is facing. The Five Year Forward View made a commitment that, by 2020, there would be “fully interoperable electronic health records so that patient’s records are paperless”.
At present, commissioners and providers are working on Sustainability and Transformation Plans (STPs), including a Local Digital Roadmap (LDR), which will identify how local health and care systems will deploy and optimise digitally-enabled capabilities to improve and transform practice, workflows and pathways. The publication of the Review, therefore, takes place in a context of high national and local policy interest in leveraging the potential of technology to transform healthcare services.
The digitisation of healthcare in England remains a varied picture, with different health and social care bodies at different stages of digital maturity. It is generally acknowledged that after years of under investment in technology in secondary care for example, many NHS provider organisations still have more to do.
The Marwood Group and DAC Beachcroft LLP have prepared this note focussing on the next steps for secondary care digitisation. It aims to make sense of the several announcements, reviews and plans, and to clarify how they will be implemented and what their impact will be on NHS commissioners, NHS providers (Trusts/Foundation Trusts) and the private sector (suppliers and investors).
Watcher Review: Key Takeaways
The 10 high-level recommendations are broadly in line with previous policy announcements and assessments of NHS digitisation progress. The notable exception within this listing is the amount of funding needed and the timeline to realise the transformation.
Additional Funding Needed and New Implementation Deadline
Other Levers: Workforce, Strategy, Interoperability
Despite the momentum and quick policy response to the Review, providers and investors will need to keep an eye on how funding allocations will play out and the articulation between national drivers and local implementation plans. This is particularly relevant in view of the delays in publishing STPs and LDRs (the publication of the Review itself was delayed by 3 months). As such, implementation is likely to be slow.
Responding to the Review last week, the Secretary of State for Health announced that 12 Trusts will lead the way in transforming secondary care services through technology and will receive funding. Twenty other Trusts will also benefit from support and early funding. This is in line with the Review's recommendations, though it only gives funding certainty to 14% of the Trusts in England. Further announcements should be expected by the end of the year or in early 2017, to clarify which Trusts will be part of the first phase and how the funding will be distributed. Given the multispeed approach, funding is likely to be an issue in the longer term. The success of phase 1 will give an indication of the likelihood of funding being continued post-2020.
The Review and the government are both careful that the digitisation of secondary care is not a top-down process, imposed on Trusts. Policy-makers are cautious not to reproduce the mistakes of previous national IT strategies, mainly those of the National Programme for Information Technology (NPfIT). As noted earlier, the Trusts will start implementing their plans at different stages. As such, there may be a degree of variation across the country, cautioning suppliers and investors, in particular, to pay attention to local specificities. This includes looking into STPs/LDRs, new models of care, and Trusts’ strategies. Initial outcomes from the Vanguard Sites will give a good idea of what can be done and how implementation works. However, there will also be some national elements to take into account - in particular - national framework contracts, which are negotiated centrally and allow a swifter route to market for those capable suppliers that can meet the framework requirements.
Impact on Commissioners, Providers and Private Sector
Commissioners are likely to have the broadest overview of the various IT arrangements (in both primary and secondary care) where they are responsible for commissioning services (and potentially along emerging STP areas). Given the trajectory towards commissioning accountable care systems in the future, commissioners will need to engage with providers - interoperability is critical to the success of an accountable care system.
When procuring IT, providers should consider their long term ambitions in relation to the policy initiatives set out in the NHS Five Year Forward View, particularly around collaborations of different providers in a local health system holding a capitated budget and providing services based on population need, rather than service type. There are framework contracts for the procurement of clinical systems that can be utilised by providers, and whilst this allows for a swift route to market for IT suppliers, the Review rightly makes it clear that “going live” is the beginning, and not the end for the implementation of health IT, and building a successful digital platform in a local area. In light of the recommendations of the Carter Report, providers may also wish to consider jointly procuring IT systems, as a collaborative approach to commissioning may not only ensure a joined up approach to IT systems in an area, but may also help achieve efficiency savings.
Healthcare digitisation is likely to be less controversial for private involvement in the NHS than service delivery and it is clear that Trusts will need external support to realise digitisation and promote the transformation of services. The Review specifically makes several references to the role of vendors and suppliers. Several Vanguard Sites are already working with private technology suppliers, and the LDRs which have been made publicly available have been drafted in consultation with suppliers and partners.
On the investor side, the large scale of transformation needed and the funding certainty until 2020 are both positive. In many respects, the market for secondary care technology is younger and more fragmented than the primary care technology market (especially in regard to suppliers of electronic health record systems). The Review recommendations favour the development of a diverse, competitive market with small and large suppliers for Trusts to choose from. However, the centralisation of contract negotiation is likely to bring some consolidation in the medium to long term.