In 2014, following the introduction of the governments ‘Cloud-First’ policy, the NHS set out to achieve a ‘paperless NHS’ by 2018. However, due to legacy technological infrastructure, a lack of digital skills, complex governance arrangements and limited budget, the NHS missed its target. The goal was reset in the NHS Long Term Plan 2019, then, in 2020, the NHS faced a crisis like never before as the pandemic pushed it to the limit.
However, for all its negative consequences, the pandemic introduced a renewed sense of urgency around the need for digital transformation, and fostered a fresh innovation culture, giving healthcare technologists the autonomy to implement technology and complete digital projects in a matter of weeks.
The NHS now aims to deliver a “core level of digitisation” by 2024, but this will come at a significant cost with the NHSEI estimating over £8.1billion of investment is required to deliver against this goal. This sheds light on the sheer scale of transformation required to alleviate healthcare’s’ current digital challenges.
Progress towards the NHS Long Term Plan has improved over the past two years, but it is vital that technologists within healthcare do not lose sight of the overarching challenges faced across the sector and seek to address them in the most appropriate way.
Legacy technology
Healthcare’s most prevalent digital challenge is widely accepted as legacy technology. The NHS relies heavily on aging IT applications and paper-based systems. These systems have formed the technological backbone of the NHS since its creation. But such prevalent use makes digital transformation and cloud adoption complex, or impossible in the case of implementing emerging technologies like AI.
Legacy technology should not automatically be dismissed because it isn’t ‘fit for cloud’, especially as these systems have often been heavily invested in. However, healthcare technologists need to understand that their reliance on systems that cannot support the interoperability of data may hamper the NHS’ ability to reach its digital transformation goals.
A ‘cloud strategy’ FOI request found that more than 40% of healthcare respondents cite legacy technology as a significant challenge, and noted that they intend to keep approximately 70% of their apps, data, and workloads on-premises. In addition to this, more than 69% of NHS trusts report they do not have a cloud strategy, with just 11% of NHS trusts forecasting a plan to have more than half of their infrastructure in the public cloud within 12 months.
This number is in stark contrast to the 67% of organisations in central government who intend to move to public cloud, highlighting the disparity between central governments’ expectations, and the reality within healthcare.
Interoperability of IT systems and data
Interoperability is a key aim for the NHS. It can mean powerful analysis of national data, leading to earlier diagnosis, treatment, and development of preventative medications, ultimately improving patient care. The data exists, but better unification is where the true power lies.
However health data remains difficult to access and share in a secure manner. The sensitive nature of the data, public consent, and the need for immediate access in life-threatening circumstances mean achieving interoperability is complicated. It would require large-scale implementation of cloud technologies to facilitate this.
However, the ‘cloud strategy’ FOI request found that many NHS Trusts highlighted data security as a key concern with using cloud technologies - 48.8% reported data privacy concerns, 39.87% reported offshoring and data residency as an issue and 21% reported data classification as a key challenge.
With NHS Trusts opting to keep 70% data on-premises, planning for interoperability will require substantial change to policies and procedures to implement a UK-wide government data fabric.
Consistent governance standards
A sprawling array of applications is a governance nightmare for any organisation, but especially when those systems are vital to delivering patient care. Of the NHS Trusts who responded to the Solar Winds FOI request in 2018, 61% cited security and compliance as the biggest barrier to the adoption of new technologies such as cloud.
However, there is a disparity between the NHS national plans and the expectations that organisations such as NHSX have on local trusts to implement them.
In its 2020 report the NAO states there is “currently no governance mechanism to make existing data and technology compatible with national plans” across NHS Trusts. Whilst the NHSX has outlined approaches that trusts can take to develop systems in-line with national ambitions, it fails to provide transparent cost information. This “hands-off” approach has contributed to the proliferation of inefficient legacy systems, lack of governance and leaves local and national strategies out of sync.
Digital skills gap
Finally, one of the most significant challenges for NHS trusts at a local level is the vast spectrum of digital skills available within healthcare. Disparate systems, nuanced trust requirements and the monetary draw of the private sector are impacting the availability and dissimilarity of skills across the NHS.
In the ‘cloud strategy’ FOI request, 41.53% of more than 400 respondents reported a lack of in-house skills as a barrier to public cloud adoption. When the NAO asked digital and technology leaders why this skills gap exists 78% blamed ‘external market conditions’, 67% limited supply, 58% procurement constraints and 50% organisational culture.
NHS trusts who have started their cloud migration journey have predominantly moved applications to cloud-based versions of their existing software, suggesting that technology professionals feel most confident migrating the tools which have a lower impact on vital health services. For example, 88% of healthcare organisation respondents have moved ‘Office productivity’ tools such as Microsoft to the cloud-based Microsoft 365, followed by their public website (63%).
The skills gap is recognised by the Government as a significant challenge. Its Digital, Data and Technology (DDaT) function was launched to help cross-government professionalisation of technology roles and drive consistency.
The NHS path to conscious transformation
For NHS trusts to accelerate their digital transformation and address the issues of legacy technology, lack of governance, data interoperability and digital skills challenges, we believe it’s time to critically review digital estates, infrastructure and strategies.
There is a growing movement for the public sector to become conscious of their cloud transformation and we’re here to guide them. The pandemic has been a huge catalyst for digital transformation in the NHS, but now is the time to maintain momentum and join a conscious transformation revolution that drives the nation's digital ambition.
To hear experiences from public sector technologists across the sector, watch the original documentary film ‘Consciously Hybrid’.
Russell Macdonald (@russell) is Contributing Editor for ConsciouslyTech.com and Chief Technologist for Hewlett Packard Enterprise.
This article was previously published in the May 2022 edition of PharmaTimes magazine.
