A new beginning and the latest technologies provide fresh opportunities for healthcare

As the new UK government settles in and turns its manifesto pledges into actual policies for the next 5 years and beyond, Ian Hogan, CIO for Leeds & York Partnership NHS Foundation Trust, discusses how this period of change, coinciding with the availability of new technologies, provides an opportunity to look at healthcare in a different way. 

How do we actually want to change and improve healthcare provision?

A change of government provides the opportunity to look afresh at the provision of healthcare in England and across the UK. The sector is in an unprecedented position with extreme workforce pressures and tight budgets. The NHS is still fighting to return to pre-pandemic performance levels and waiting list numbers. Ministers want to be seen to act and rapidly show some signs of positive change.

Beyond the push for overall improvement, the incoming Secretary of State has signalled a welcome renewed focus on particular areas such as cancer treatment and mental health provision. The proof of the depth of these commitments will only be seen by action. It will be hard to stay focused and easy to be deflected by the turn of events and short term demands. The political honeymoon period for the new government will be fleeting and expectations high, and then it will take strong nerve to avoid being buffeted into new directions.

Managing for targets and headlines

In healthcare the public and the media will focus on simple to understand metrics and deliverables such as the length of waiting lists; number of new hospitals; A&E wait times; number of GP appointments available etc. There will even be added numerical pressure from the government’s drive for economic growth and how the health of the nation might be perceived to be holding back our ability to increase productivity.

It will be hard enough to reduce waiting lists for elective surgery but the way to do so is relatively straightforward. Hip and knee replacements, for example, are well understood and straightforward. The real challenge is to increase patient flow through the processes. Reducing a patient’s time in hospital benefits their recovery, saves money and allows more people to come off waiting lists faster which will make for great headlines.

In mental health, my own area of specialisation, the answers are not so simple. There’s not a formula that doing more of x will lead to a guaranteed improvement of y. Diagnosing and treating mental health issues requires much more face to face time with patients and results are not as predictable. My concern is that it will be easy to shift focus and move resources to more predictable and deterministic areas.

How can new solutions change mental health provision?

The mental health community can feel left behind by the understandable focus on primary and secondary care. The reality of mental health care provision is that it needs to be more personalised, specialised and delivered over the long term. The level of support beyond direct care can be far reaching and the broader impact on family, friends, community, other services such as the police and even the economy needs to be taken into account.

At my Trust digital has been a key enabler for improving the way we work. We are in the fortunate position that we now have a mature implementation of EPR which is well used throughout our organisation. Through electronic document management we are now almost 100% paperless in our processes. However, as a CIO I still feel that technology can do even more for us. AI may provide the answers but are we even sure of the questions yet?

Harnessing the power of Artificial Intelligence

The discussion in the sector has now moved on to be about what AI can deliver but there are currently not enough concrete use cases and success stories to show a clear way forward. Is AI a solution in need of a problem to fix, rather than the other way round?

I was interested to read the recent Imprivata guest blog on AI by Cindy Fedell, the Regional CIO, Northwestern Ontario Hospitals in Canada. It seems that the whole world is struggling with the same challenges. As Cindy points out, Ambient AI could be very useful for the provision of mental health services. AI scribes can be used to capture the face-to-face interactions between clinicians and patients which are integral to mental healthcare. AI generates written notes in real time based on conversations – and machine learning improves the accuracy of the transcriptions over time. In this way AI could reduce the daily growing documentation burden on clinicians.

It is probable, but yet to be proved, that AI can do more. In mental health could it be used to automatically highlight exacerbations and show emerging trends? Could AI identify trigger points for patients that could lead to downward spirals? Will it enable clinicians to proactively predict likely outcomes so that we can move to preventative rather than reactive treatments?

AI solutions will need to be advanced and thoroughly tested as mental health issues are not as straightforward as physical conditions. Situations can be very different for each patient. Creativity and care will be needed to implement and tailor solutions to meet a variety of patient needs, the requirements of clinicians, and the resources and objectives of different organisations.

We need more from IT and our solution providers

With 25 years in the industry, I’m old enough to remember when developing your own website from scratch was a big thing. The mantra then was to minimise the number of clicks needed for a visitor to get to what they needed. I think this thought process is something we need to revive.

As the health sector workforce interacts with more systems, digital devices and AI as part of their daily workflows, ease of access and ease of use become key once more. We need to prioritise this demand to our IT solution providers, especially as more care is moved into community settings.

When a clinician is outside hospital walls looking after a patient there cannot be multiple onerous steps just to get into the systems and to access the patient information which is readily accessible when inhouse. Alerts and notifications need to be available too. All this needs to work on the full range of mobile devices including smartphones and tablets. Yet we need to ensure security and auditability.

Ease of access and usability is also needed for patients. For example, to make, change and cancel appointments easily. This would help reduce the approximate 5% figure for no-shows to GP and outpatient appointments – or to put it another way, rapidly increase the number of appointments available to help meet NHS targets.

Final thoughts

A change of government does give an opportunity to take breath and look at different objectives, solutions, and ways of working. Whatever good intentions there are will soon collide with existing pressures and sky high expectations. What lens will the government look through? Will they be highly focused and target-driven or take a wider perspective?

As a CIO I obviously have a technology focus, but if I had a magic wand to help fix the NHS the one thing I would change would be to increase the number of clinicians, especially in the mental health workforce. To help do this we need to make the discipline more attractive and show it is valued so that we retain more staff. IT has a role to play by making day to day jobs easier to perform and less stressful. As ever, I’m hopeful for what the future holds.