julia manning, chief executive, 2020health

Integrated Digital Care: An Information Revolution Can the NHS meet the digital challenge?

Julia Manning BSc(Hons) MCOptom FRSA

Chief Executive, 2020health

About 2020health

Mission 2020health is an independent, social enterprise think tank whose mission is to “Make Health Personal”. Through research, evaluation, campaigning and relationships we aim to both improve individual health and create the conditions for a healthy society.

Vision Making Health Personal means:

Sustainability – individuals and their communities are essential foundations of and participants in maintaining affordable healthcare.

Sharing – empowering people through technology to build confidence and knowledge, and participate in managing their health and networking within communities.

Shaping – designing healthcare that reflects the needs of the individual and enables them to function within their environment.

Can the NHS meet the digital challenge?

2020health’s track record...


November 2014, ‘Personalised Health and Care 2020’ sets out a framework for action around the exploitation and adoption of digital healthcare.The document has been prepared by the National Information Board, which now represents all the major national stakeholders in the English health and care system.

We particularly noted these recommendations...

• NHS Choices as a single point of access to common digital transactions, integrated with 111.• National accreditation and kite-marking of apps (one hopes this does not stifle innovation).• Piloting digital care accounts for patients with a personal budget.• National ‘experiment’ of a mobile care record under the control of patients.• Use of the Digital Maturity Index to track effective use of IT in the acute sector and beyond.• Dame Fiona Caldicott as National Data Guardian of health and care.• A new National Tariff that supports and rewards new models of care, enabled by technology.• Leadership support to exec and non-exec directors in the development of digital strategies.

Dame Fiona Caldicott as National Data Guardian of health and care.Independent Information Governance Oversight Panel (est 2013; NDG Nov 2014)

“the recent establishment of the National Information Board and the development by the Department of Health of structures to address the challenges around it, not least the greater awareness by the public of these issues, can give some optimism that the next year will see much improvement.”

The IIGOP report concludes that a basic condition for building public trust is a commitment to more transparency about how data is collected, stored and used. Individuals must also be able to opt out of data sharing arrangements and be confident that their wishes are being respected consistently across the system.

‘Personalised Health and Care 2020’ challenges

• How is the document expected to be used? Would a Trust CEO or indeed an ICT Director know what to do next?

• Throughout 2013, the promise was the NHS would be ‘paperless by 2018’. Although laudable, this was a false promise in that the aim should be more streamlined care not the removal of paper. And it was not remotely deliverable. The ‘paperless’ term has been quietly dropped in this paper, with a new commitment ‘all patient and care records being digital by 2020’. Why ‘all’ and how is this deliverable?

View from the frontline:

“It concerns me, and I'm sure I'm not alone, that the focus appears solely on the ability to provide the technology to go paperless as though that is the only obstacle.

For me there is also the issue of a major cultural shift with related issues of confidence amongst end users. There are still many staff who are reluctant to use IT systems because they are, frankly, scared or intimidated. Even those who see the benefits of electronic records feel they can hand write a note in a tenth of the time it takes to type it so they stick with what they know works for them.

When training is provided there are three problems. Crucially it ignores the problems above and starts from an assumption that everyone is comfortable with computers. It addresses the new system in isolation rather than in context of the user's role. And it is detached in time too far from the actual roll-out so staff have forgotten things which exacerbates their confidence problems.

Without addressing these cultural factors it doesn't matter which system is in place, people will struggle to accept and use it properly. In my opinion this is more than a 5 year project so even if Mr Hunt's plans were on schedule there is no way 2018 was ever feasible.”


• The commitment to greater standardisation is welcome but this is a familiar theme – ten years ago, the mantra of NPfIT was ‘ruthless standardisation’. What’s different this time?

• What is the national technology architecture within which national infrastructure and systems will operate? Who is responsible for developing it?

“It is the view of IIGOP that progress in achieving appropriate sharing of information for direct care will not be satisfactory until core building blocks are in place at national level.”

Guidance did come from NIGB (abolished); some activities transferred to CAG and HRA. “The Care Quality Commission has made significant progress in fulfilling its new statutory duty to monitor the information governance practices of registered health and social care providers.”

• How will the hints on funding policy (e.g. around future Tech Funds) be developed to give longer term clarity about national investment policies? Nothing was mentioned in the Autumn Statement about funding this essential infrastructure.


• In our opinion, some element of systems coordination around the common development of digital and health records are essential to corral health communities to deliver joined up care to their local population.

“The public’s main concerns about the use of information about them were suspicions around usage creep, lack of personal benefits and loss of data.”• How will this report enable this to be achieved,

particularly with NHS England rationalising its local informatics support?

HSJ Jan 26th survey 70% thought “lack of technological expertise and resources would undermine the NHS’s drive to integrate health and social care.”


• Finally, many NHS organisations around the country (and particularly those in the north, midlands and east) face a cliff edge in July 2016 when their NPfITpatient record contracts will expire and national funding for their systems cease.

The NIB paper is entirely silent on this. Can local commissioners and providers afford the new arrangements, do they have robust plans in place, and how will patients be assured that their care will not be put at risk?


No clear deliverables, roles and responsibilities despite a specific timeline.

For example, it is widely known that one of the reasons for inaction has been the lack of clarity of roles between the Department of Health, NHS England and the Health & Social Care Information Centre (HSCIC) around digital, and where funding and accountability lies.

Around 30 innovation funds accessible to LAs – how many in health?!


Recommendation 1 Caldicott 2 “People must have the fullest possible access to all the electronic care records about them, across the whole health and social care system, without charge.”

It called for an audit trail that details anyone and everyone who has accessed a patient’s record to be made available in a suitable form to patients via their personal health and social care records.

Integrated Digital Care: An Information Revolution Can the NHS meet the digital challenge?

What about us?

“lack of personal benefits”

Before the NHS, DH or any other body asks for consent, people need to know why it matters.

Making Health Personal

Information: confidence - Sustainable

Involvement: interdependence - Sharing

In charge: personal - Shaping

Can the NHS meet the digital challenge? The benefits....

• Home Telehealth (HT)

Monitors patients and manages diseases through the use of mobile devices for acute and chronic care management and health promotion/disease prevention.

• Teleconferencing

Real-time videoconferencing between different hospital sites and community, care home or prison sites. It replicates face-to-face consultations between patient and provider, or provider to provider.

• Telehealth

Acquisition, storage, and forwarding of clinical images to experts for review. Currently used for teleretinal imaging and teledermatology (VHA); Cardiac care (Southampton)

• Secure Messaging

Enables timely and secure text-based communication with patients via mobile phones (Flo)

• Mobile Health

Smart phone applications for self management of health conditions 24/7

Secure messaging: Flo/ Annie

• HypertensionAsthmaMental HealthCOPDPulseBlood GlucoseBlood PressureBlood OxygenPeak FlowWeight

• ConstipationDaily Medication RemindersExercise RemindersAppointment RemindersCatheter Bag Empty ConfirmationsPre-eclampsiaSmoking CessationBody Temperature

Thank you

www.2020health.orgwww.healthtechandyou.com

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077 2020 6910

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julia manning, chief executive, 2020health

Healthcare