The pace of change in public services and in healthcare is more rapid than ever before. Much of the latest wave of change was driven in part by necessity – from the programme of austerity that was introduced by the coalition government and that was then renewed by the Conservatives, meaning that we all needed to find ways of “doing more with less”. More recently Brexit has served to distract and distort the government – potentially threatening how the NHS is resourced and possibly also impacting investment in patient services.
This coincided with a wave of digital technologies that meant that it might just be possible to “do more with less”. Technologies are emerging and maturing that promise to disrupt how patient care is delivered – wearables, precision medicine, preventative measures, medical research, etc.
The NHS is however often slow to change and adopt new technologies. Many technology entrepreneurs trying to drive innovative and disruptive technologies find it difficult to disrupt the status-quo and persuade customers to take a different approach and to try something different. But this is exactly what’s needed across the NHS and social care communities.
Patients and vulnerable citizens depend on our NHS. They depend on our welfare systems and our social care – organisations that are under immense pressure to reduce costs and improve patient outcomes.
We need to have strategic vision in order to look beyond the immediate challenges and find ways to support the creation and adoption of specialist solutions that interoperate based on open standards. These solutions, especially IoT solutions, are generating a wealth of new and enriched data, that further inspires yet more specialist solutions that will deliver new insights and will help reduce costs and improve outcomes. There are a number of factors that need to be considered here:
- Security and trust – Patients and citizens have a right and an expectation of privacy – especially from governments and big businesses that might seek to abuse these datasets.
- Standards and interoperability – devices and applications need to be integrated to deliver real value, providing seamless access to whatever data and insights are needed wherever, whenever and however.
- Data analytics and intelligence – Big data analytics can examine massive datasets of genomic and patient data to identify trends, provide insights and derive intelligence.
- Data gravity – pooling valuable data on a secure, trusted and connected platform that is harnessed by a vibrant ecosystem of specialist solutions.
- Cloud Computing – Underpinning all of this is cloud computing. IoT devices feed data to the cloud, where the capacity exists to store and process it all. It is in the cloud where the data is pooled for analytical application to mine for insights to turn into intelligence which can then be accessed remotely by mobile devices to empower both clinicians and patients.
In the UK we are also seeing more collaboration between public services and private services which is particularly exciting, through institutions like Precision Medicine (Oxford Biomedical Research Centre) and the Northern Health Science Alliance.
So what’s stopping us? As ever there is inertia, partly because some fear change and have concerns about the new technology and the cloud in particular, but largely because all their time and energy is exhausted simply keeping what they have working. They have little time for vision and transformation.
There is a lesson to learn here from central government. It was once blighted by slow, expensive and poor IT with 80% of public sector IT spend being allocated to an oligopoly of just 8 multi-national service providers. This lead to a lack of competition and choice and indeed to situations of lock-in – which we’re still paying for today.
Like the NHS, central government departments were driven by the austerity to “do more with less.” Government policies such as Cloud First, Digital by Default and Disaggregation were the catalyst for a dramatic wave of transformation. Pooling workloads to the cloud enabled the UK government to generate savings of £600 million, earning it recognition from the UN as the most digitally advanced government in the world. It has also provided a platform for reinvestment and a further wave of transformation moving to cloud native applications and shared services.
The contrast with the NHS is stark. While in central government 10% of workloads have already moved to the cloud, in the NHS it is as low as 1 or 2%. With an antiquated and fragmented computing estate, the NHS struggled to maintain, patch and secure its systems, falling prey to the recent global malware attack. With workloads in the cloud where they are easier to maintain and secure, central government departments were hardly hit at all.
As a result of the cloud first policy, we’ve not seen an RFP for a new government data centre in some time. In the NHS we saw one issued by a northern NHS trust only a couple of months ago. When asked why they were looking to build a new data centre rather than move their workloads to the cloud, the response was that they were not interested. Hopefully lessons learned more recently will prompt a rethink.
There is a compelling rationale for NHS Trusts to consider which workloads they can move directly to the cloud (quick wins can be achieved by moving virtualised workloads directly to the cloud). Savings from initial transition can then fund the transition and transformation of subsequent workloads – it quickly becomes a virtuous circle.
Further savings and service improvements can be achieved with edge devices – using chrome books and smartphones instead of laptops that are more expensive to buy and maintain.