A tremendous amount of work went into the development of the NHS’s Long-Term Plan, launched in January 2019. It sets out our vision of a fully integrated digital health and care system, supported by high-quality digital tools, data and technology. The plan was well received by both the public and the system. We now need to deliver it.
The ability to join up patient information from multiple settings, with its meaning intact, is at the heart of the digital transformation we want to achieve. Whether you are a patient with a long-term condition or a clinician treating someone in A&E, the inability to get hold of all the right information is incredibly frustrating. Worse than that, a lack of information can endanger people’s health through poor coordination or inappropriate treatment. The NHS Long Term Plan makes crystal clear that we want local and health and care record systems to provide a single joined up view of a person’s heath record in every area of the country in the next five years.
To achieve this there are seven issues that I remain focussed on resolving. These are:
- Citizen ID
- Staff ID
- Dates and scheduling
- Clinical observations
- Basic pathology
- Diagnostic codes
Progress has been made in each of these areas but none have yet been fixed. I’ll take the first two as examples (Citizen ID and Staff ID).
We need to link records and we need to link them reliably, being sure that we are talking about the same individual each time. The NHS number is simply not offering this level of certainty. Hospitals use their own numbers and add the NHS number in retrospect. And diagnostic systems (radiology/ audiology) use a Radiology Information System number in turn linked to the hospital number, in turn linked to the NHS number. A drunk or unconscious patient in A&E may need a temporary number. Over time we are aiming to allow citizens to hold copies of their whole record through the NHS App, so we absolutely must have an assured NHS Identity that links to their device.
The traditional alternative to the NHS number is a three-part identity (name, date of birth and postcode). But for some demographics and some areas of the country these three elements does not reliably provide a unique identity. So we must do better. A team are now working on making the NHS number work for emergency departments, out of hours GP, citizens and users themselves.
A single Staff ID is equally important for two reasons. 1) to know who has created each data entry in a record and to know who has viewed an individual record. We need a single electronic identity for staff that will always be associated with their actions in NHS systems, just like leaving an electronic fingerprint. 2) staff have a right to expect IT to save them time and make their lives easier. This doesn’t happen now because staff have multiple NHS log-ins – I have 12! And they are slow and cumbersome to use. The pilot for linking the different databases that hold Staff ID is running up in Blackpool at the moment and I am expecting the national solution to be developed in 2019 (a single national identity). Modern smartphones allow staff to associate their electronic ID with their own biometrics, so I hope it will one day be possible to securely open all of your clinical applications by simply looking at your phone.
These are just two examples that illustrate the scale of the challenge in front of us. However, the Secretary of State for Health and Care’s recent announcement about NHS X reaffirms his commitment to overcome all obstacles in our way and achieve both the ambitions set out in both the NHS Long Term Plan and his personal technology vision. NHSX, as a joint unit between NHS England, NHS Improvement and the Department of Health and Social Care, will bring together the policy, strategic skills and expertise needed to put the digital transformation agenda in a stronger position than ever before, and I for one welcome this great opportunity.
Dr. Simon Eccles is the Chief Clinical Information Officer for Health and Care. His role spans the Department of Health and Social Care, NHS England, NHS Improvement and the arms-length bodies. He is accountable for delivery of the Digital Transformation portfolio, and the whole of the central NHS IT expenditure.
Simon still practices one day a week as a consultant in Emergency Medicine at St Thomas’ Hospital.