A welcome plan, but delivery is key
In quick succession in recent days, the Government published two strategies for digital transformation and use of people’s data for health and care planning and research (A Plan for Digital Health and Social Care and Data Saves Lives). The digital agenda is central to plans for the future of the NHS and social care, and standards are a critical part of that narrative, finally gaining the traction they deserve.
The lessons from the pandemic have made digital transformation unstoppable: witness the massive public uptake in use of the NHS App, remote consultations and virtual wards increasingly the norm and the development of federated data platforms to support care planning, research, the life sciences and economic recovery.
Standards are key to so much of the change and improvement envisaged in these plans. The health and care system is poised to see a huge shift as more and more success stories emerge of organisations that transform care and efficiency by embracing standards and digitisation, so much so that others will want to copy them. But bringing all parts of the system up to a passing grade, let alone best in class, demands that we understand why we’ve failed in the past and how we learn for the future.
A Plan for Digital Health and Social Care contains a clear analysis of many of the challenges that have bedevilled the digital transformation of services: the poor deployment of purchasing power, no clear route map for standards that suppliers can rely upon, a lack of vision for aligning levers and incentives across the system to support digitisation at a professional and organisational level backed up by enforcement of standards and little support for social care.
As the authority on record standards and the body representing the front-line users of standards, PRSB believes that standards could be a catalyst for radical, transformational change and improvement but that will only happen if change is looked at in the round and we don’t make the mistake AGAIN of treating this as solely a technical problem. Reviews from Wachter to Topol to Heifetz and the National Audit Office have drawn this conclusion repeatedly. PRSB was created for precisely this reason – not only to develop the standards that have wide support from professionals and people but also, with our members, to play an important role in getting them successfully landed in routine practice.
We welcome the greater clarity, consistency and de-duplication promised by the creation of the NHS Transformation Directorate. Our members and key stakeholders tell us that it has been extremely difficult to untangle the threads and work out what they need to do to implement standards and interoperability so this should make things easier.
We also welcome the focus on digitally immature organisations where the capacity for improvement might be greatest. Provider organisations will need a lot of practical advice and support – much of it at the very basic level. The plan’s focus on funding for IT systems and training to support professional staff are absolutely the right direction of travel.
With care spread across different teams, settings and services, sharing vital information about the people who are accessing services is not simply a record-keeping task or afterthought of care. In today’s world, information is care. It is great to note the attention on upskilling all professionals. Too often, people talk about standards in purely technical terms which is far from the reality of the several million front-line professionals and people who use them daily to document care, and work closely with PRSB to define them.
At the same time, strengthening the enforcement of standards through meaningful independent assessment of supplier conformance will drive positive change. PRSB’s own experience of assessing supplier conformance with record standards through our Standards Partnership Scheme has helped suppliers differentiate themselves in the market based on quality, and let providers know unequivocally what they are getting. Our partner suppliers tell us that aligning their systems to PRSB standards is an essential step toward interoperability and more importantly to better quality care, and they value our developmental approach to conformance assessment.
There is a growing recognition of the importance of engaging and activating people in their care through tools such as the NHS App and PRSB is actively promoting widespread use of the About Me standard to enhance personalised care. Our #CareAboutMe campaign is supporting people, professionals and suppliers to adopt its use and we would like to see it taken up by the NHS App.
I am also pleased to see that the role of system-wide levers and incentives is recognised as critical to driving transformation. Getting everyone to do the basics well, like sharing structured, coded transfers of care using PRSB standards, may seem pedestrian but from a safety and quality perspective, this would be game changing.
Regulation by NHS England and the Care Quality Commission are rightly identified as key to signalling that digitisation is a must and certain standards are non-negotiable. If we are to realise the potential of digital transformation, embedding it in the regulatory framework is fundamental. There has long been consensus that it is desirable and we would plead that it is given the priority it requires to see it through this time as one of the most potentially impactful changes in the journey to standardisation.
PRSB welcomes the funding announcements in the plan, but social care remains the poor relation to health care when it comes to finance. The reality is that there is no integrated care without social care. If we are to achieve genuine integration within Integrated Care Systems, we need to address the digital challenges in social care with as much rigour as those in the NHS.