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Closing the Digital Gap Shaping the Future of UK Healthcare June 2019 Contents Closing the digital gap Shaping the future of UK healthcare June 2019 Contents Foreword 01 Executive summary 04 1. The rationale for digital transformation 08 2. The current state of digital health 14 3. Key steps to close the digital gap 19 4. SMART solutions transforming healthcare today 32 5. Shaping a predictive, preventive, and personalised future 42 Appendix 1. Timeline of reviews and policy initiatives 2013 to 2018 48 Appendix 2. Stakeholders interviewed for the report 51 Glossary of terms 52 Endnotes 56 Contacts 61 The Deloitte Centre for Health Solutions The Deloitte Centre for Health Solutions is the research arm of Deloitte LLP’s Life Sciences and Healthcare practices. Our goal is to identify emerging trends, challenges, opportunities and examples of good practice, based on primary and secondary research and rigorous analysis. The UK Centre’s team of researchers seeks to be a trusted source of relevant, timely and reliable insights that encourage collaboration across the health value chain, connecting the public and private sectors, health providers and purchasers, patients and suppliers. Our aim is to bring you unique perspectives to support you in the role you play in driving better health outcomes, sustaining a strong health economy and enhancing the reputation of our industry. In this publication, references to Deloitte are references to Deloitte LLP, the UK affiliate of Deloitte NSE LLP, a member firm of Deloitte Touche Tohmatsu Limited. Closing the digital gap | Shaping the future of UK healthcare Foreword Welcome to this new report from the Centre for Health Solutions, Shaping the future of UK healthcare, which highlights the opportunities and future potential of digital and information technologies to tackle some of healthcare’s most intractable challenges. The report highlights a number of key steps to improve the adoption of digital technologies. It acknowledges the importance of technology in bridging the gap between demand for healthcare and the capacity of healthcare services to meet that demand and provides an objective view of the current state of NHS digitalisation and what the future of healthcare might look like. Successive policy documents over the past five years have recognised the need to get the basic digital architecture right, to improve the quality of data and information flows and deliver more timely, efficient, and safe care. Staff and patients need confidence that their data is held securely and used appropriately. Guiding principles include developing open standards, having secure identity and interoperability standards, ensuring the right data gets to the right place at the right time; and that services are designed around user needs. These principles form part of the NHS Long Term Plan which aims to accelerate the redesign of patient care to future-proof the NHS for the decade ahead. It expects digitally-enabled care to go mainstream across the NHS, advancing to a core level of digitisation by 2024, helping clinicians to work more efficiently and effectively, improving the patient experience and optimising health outcomes. While a number of digital and technology systems and services are being delivered in some parts of the NHS, our research shows that technology adoption in many hospitals, primary care and community settings is slow with a gap in the digital maturity of providers. Although most providers have some form of electronic health record platform, the functionalities vary widely. The next step for digital transformation is to be able to access, share and use health information seamlessly. For healthcare to realise this will require a radical shift in the culture and mind-set of healthcare stakeholders. It will also require a review of how digital transformation is funded. The insights provided in this report are drawn from an extensive literature review; a comprehensive survey of 1,500 doctors, nurses and allied health professionals; structured interviews with 65 key stakeholders across the health ecosystem; and the experience of our colleagues across Deloitte who have worked with clients on digital transformation projects in the UK and other comparable countries. Karen Taylor Bill Hall Sara Siegel Director Partner Lead Partner Centre for Health Solutions Health Technology Public Sector Health 01 Closing the digital gap | Shaping the future of UK healthcare Healthcares digital gap The Digital Maturity of NHS trusts Survey of 1,500 front line clinical SMART digital solutions transforming healthcare today staff across UK healthcare In 2018 Trusts in England self The NHS long term plan assessed their maturity by Finding the right Cost of technologies technology 11.2% 55.7% a low of Complexity of 18/100 technology 9.8% to a high Reliant on Tailored to Every patient will have Straightforward Measurable Agile of 93/100 industry end-user the right to online GP and easy-to-use impact solutions consultations collaboration needs The average Top three score across challenges in England was implementing 66/100 digital Technology assisted Telehealth RFID-tagging of staff, From 2013 to 2017, Early detection of technologies home based urine applications in care bed based medical AHSNs leveraged acute kidney injury 020406080 100 self-testing reduces homes reduced devices enables over £330 million to via an app tailored All clinicians will be able outpatient visits hospital admissions tracking of patients improve healthcare, to staff needs to access patient records for people with due to falls and staff reduced rolled out some reduced the wherever they are Funding has been concentrated hypertensive and infections on- the- day surgical 330 innovations, workload of on only 25% of the more digitally pregnancies by 7.7% cancellations from and helped create specialist nurses mature NHS trusts by 60% 40 to 5 a day and over 500 new jobs by two hours each breeches of four day, releasing EXIT Wide variation in use of basic technologies: hour waits time to care by 70% Senior healthcare leaders top 3 challenges Outpatients will be redesigned facing the NHS’s digitalisation journey Patient apps to avoid a third of visits, by 30% in Genomics saving £1 billion a year Scotland but only 19% in Wales Future of Healthcare Leadership Interoperability Funding 22% 22% Diagnostics 4.0 Hospital of 38% the future ata platf Key steps to close the gap d or en m p s O Leadership Changing Population health the mindset I Value based care n Governance management t e R ro H perable E Interoperability Liberating the power of data Liberating Open EHR e-prescribing used by 65% of to deliver a future that is: the data respondents in England but only 19% in NI Predictive Infrastructure Preventive Personalised 02 Closing the digital gap | Shaping the future of UK healthcare Healthcares digital gap The Digital Maturity of NHS trusts Survey of 1,500 front line clinical SMART digital solutions transforming healthcare today staff across UK healthcare In 2018 Trusts in England self The NHS long term plan assessed their maturity by Finding the right Cost of technologies technology 11.2% 55.7% a low of Complexity of 18/100 technology 9.8% to a high Reliant on Tailored to Every patient will have Straightforward Measurable Agile of 93/100 industry end-user the right to online GP and easy-to-use impact solutions consultations collaboration needs The average Top three score across challenges in England was implementing 66/100 digital Technology assisted Telehealth RFID-tagging of staff, From 2013 to 2017, Early detection of technologies home based urine applications in care bed based medical AHSNs leveraged acute kidney injury 020406080 100 self-testing reduces homes reduced devices enables over £330 million to via an app tailored All clinicians will be able outpatient visits hospital admissions tracking of patients improve healthcare, to staff needs to access patient records for people with due to falls and staff reduced rolled out some reduced the wherever they are Funding has been concentrated hypertensive and infections on- the- day surgical 330 innovations, workload of on only 25% of the more digitally pregnancies by 7.7% cancellations from and helped create specialist nurses mature NHS trusts by 60% 40 to 5 a day and over 500 new jobs by two hours each breeches of four day, releasing EXIT Wide variation in use of basic technologies: hour waits time to care by 70% Senior healthcare leaders top 3 challenges Outpatients will be redesigned facing the NHS’s digitalisation journey Patient apps to avoid a third of visits, by 30% in Genomics saving £1 billion a year Scotland but only 19% in Wales Future of Healthcare Leadership Interoperability Funding 22% 22% Diagnostics 4.0 Hospital of 38% the future ata platf Key steps to close the gap d or en m p s O Leadership Changing Population health the mindset I Value based care n Governance management t e R ro H perable E Interoperability Liberating the power of data Liberating Open EHR e-prescribing used by 65% of to deliver a future that is: the data respondents in England but only 19% in NI Predictive Infrastructure Preventive Personalised 03 Closing the digital gap | Shaping the future of UK healthcare Executive summary Information and digital technologies have long been acknowledged In 2016 the independent Wachter Review, ’Making IT Work’, as key enablers in transforming the NHS, however, as yet, emphasised that implementing health IT is a complex adaptive healthcare lags behind other industries in the adoption of change and made recommendations to ensure a ‘digital NHS that technologies to improve the performance of staff and the is fit for purpose’. It concluded that the funding allocated to digital consumer experience. Whereas the hospitality, transport, retail transformation was insufficient to achieve the vision of a paperless, and banking industries are almost unrecognisable from ten years joined-up NHS. Nevertheless, it recommended that all NHS trusts ago, and despite the proliferation of digital health solutions, the should achieve a high degree of digital maturity by 2023 and that transformation of healthcare remains slow and fragmented, with a government subsidies should no longer be available after that growing digital divide.
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