Digital Governance and the NHS

Digital Governance and the NHS

DOI: 10.4018/978-1-7998-3928-6.ch007
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The benefits of a fully-digitalised public healthcare system are significant. Digital health is an essential tool in order to improve efficiency, provide coordinated care, and make real health improvements. However, the National Health Service (NHS) has yet to provide a fully digitalised system to patients and providers despite technological advances in recent years. This chapter will thus describe the progress which has already been made in providing remote health services within the NHS. It will also explore problems arising from digitalising health services and the management of health both within the institution and through more informal networks beyond the NHS.
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Towards A New Digital Governance Framework For The Nhs

Fully-digitalising health is expected to bring benefits such as improved quality, efficiency and health of the population (Imison, Castle-Clarke, Watson & Edwards, 2016). McKinsey estimates that modernisation, notably through digitalisation, could help save between 7% and 11.5% of funds currently allocated to public healthcare. It can lead to a more active role in managing one’s health thanks to information and support provided online (Gretton & Honeyman, 2016). It helps monitor safety and care. It can contribute to making efficiency gains because information is more easily accessible. New medical techniques can help advance medical practice (analytics techniques, machine learning) (Gretton & Honeyman, 2016). It can also contribute towards integrated care.

While digitalisation in the healthcare sector, which implies leveraging digitisation to improve processes, is often seen as a slower process than in other service sectors, such as finance, there has been a digitalisation process in motion to improve the delivery of health services in the UK for many years now. However, it was not until 1992 that a clear digitalisation strategy (or IT strategy) was devised by the NHS Management Executive. Yet the most wide-reaching policy to digitalise across the UK was the National Programme for IT (NPfIT) in 2002. Significant investment, a total of £10 billion, went into this comprehensive health IT programme. The aim was to implement integrated Electronic Patient Records (EPR) systems across the NHS – which could be accessed by 30,000 general practitioners and authorised healthcare professionals in 300 hospitals (Justinia, 2017). However, the NPfIT met with a great number of difficulties and was dismantled in September 2011. The explanation for the failure of the scheme was that it was overly centralised and therefore not sensitive to regional differences or local needs, too prescriptive and offered technical solutions but failed to focus on adaptive change (Castle-Clarke & Hutchings, 2019).

Subsequently, Jeremy Hunt, the Secretary of State for Health, set the objective of a paperless NHS by 2018 (Hunt, 2013). In 2016, Hunt announced further commitments with a budget of four million pounds over the course of the parliament, specifically devoted to digital and technology projects in the NHS (Gretton & Honeyman, 2016). This was also one of the main objectives set forth in the NHS Five Year Forward View (NHS England, 2014). Despite these objectives, a paperless NHS has been pushed back time and time again. According to a FOI request carried out by Parliament Street, 94% of NHS trusts were still using handwritten notes for patient record keeping in October 2018 (Parliament Street, 2018). The Long-Term Plan, published by NHS England, has promised fully-digitalised secondary care services for the NHS by 2024 (NHS England, 2019).

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