In early 2020 the UK health secretary Matt Hancock reaffirmed that the appropriate use of technology would be ‘critical’ to the future of the NHS.
This is especially true if its goal of becoming the world’s first carbon net-zero national health system is to become reality. The onset of COVID-19 only served to further highlight the importance of technical solutions to deliver large-scale change at pace.
A fully digitised health service
In 2013, the then health secretary, Jeremy Hunt, promised a fully digitised health service by 2018 and a paperless organisation by 2020; yet by the end of 2018, 94% of NHS Trusts were still using handwritten notes for patient records and the paperless ambition was quietly pushed back to 2030.
Despite highly-publicised initiatives by both the National Information Board and NHS Digital, aimed at lessening the administrative burden on frontline staff, this has proven difficult to deliver in practice. There remains an urgent need for the modernisation of working practices across the healthcare system, which reduces the amount of data manually collated and which eradicates the physical input of data into disparate, non-interoperable backend systems.
Clinicians and care professionals know that technology, deployed well, is a great enabler for them to spend more time with patients and reduce their daily administrative duties.
Time to care
Even today, public sector healthcare professionals are still spending too much time on administrative-heavy tasks. The challenges of communication are extensive: both patients and staff alike constantly ask and reply to the same set of questions, the outcome of which is not just wasted time, but a process that serves to bury essential information meaning more time is spent looking for it than acting on it. The management of the data, too, is a challenge.
The NHS currently spends time collecting data that is simply irrelevant to the care of the individual just to meet a national or regional monitoring requirement. And, because this is all done manually, extracting, corroborating, and sharing information is arduous.
Taken individually each of these issues may sound trifling but combined and then scaled-up to an organisation the size of the NHS, they present a huge problem. They are absorbing caregiver and clinician time and taking healthcare professionals away from what they are fundamentally there to do: care for patients.
Superior outcomes, fewer resources
The technology exists to manage data more effectively, yet the gathering, sharing and analysis of data remain significant bottlenecks for efficient workflows. What is required is an accelerated transition to using effective and sustainable technology solutions that help organisations better manage their data and visibility of it, obtain greater levels of control and make better informed decisions around everyday operations.
There is evidence of these types of innovation today; some of which are being deployed by members of the NHS Digital Exemplars list and other innovative Trusts. Examples include innovative and secure digital data capture solutions through training to improve clinicians’ data analytics skills base. Professor Trish Greenhalgh at Oxford University, in collaboration with NHS Digital, has created a self-assessment version of her framework for non-adoption, abandonment and challenges to the scale-up, spread and sustainability of health and care technologies.
Data need not be a burden, but rather a genuine resource: one that can lead to superior outcomes using fewer resources.
Move knowledge, not people
It is the point about reducing resources that intrinsically connects the NHS drive on adopting technology to its commitment to become the world’s first carbon net zero national health system. The NHS has already made significant progress decarbonising, but as the largest employer in Britain, remains responsible for around 4% of the nation’s carbon emissions – similar in scale to the aviation industry.
Digitisation of data and the use of e-forms will play an important role in the fight against climate change through the reduced use of paper and significant reductions in travel. Aside from the micro-benefits of reductions in waste and resources, environmental costs will increasingly be reflected in the financial price paid by the NHS for energy, drugs, food, and other services. As a result, low-carbon forms of care will become increasingly cost effective in relation to carbon-intensive alternatives. In some cases, this could tip the balance when comparing the merits of different treatment options.
The reduction of waste will be a key success metric for whether the NHS can hit its target: it will push reducing waste and maximising value for patients to the top of the agenda by reducing provision of treatments that are of limited clinical value, preventing unnecessary admissions to hospital, improving communication and co-ordination between different parts of the system, and ensuring that drugs are prescribed appropriately and taken as intended. The US-based Institute for Healthcare Improvement has argued that to be fit for the 21st century, health systems should aim to ‘move knowledge, not people’.
Case study: Royal Wolverhampton
The Royal Wolverhampton NHS Trust (RWT), one of the leading NHS Trusts in the UK, is using innovative mobile technology to empower its community team to provide patient-centric care within their own homes, whilst helping to minimise the carbon footprint of the Trust.
The Trust introduced an integrated Patient Information Database (PID) to identify the application of in-the-field operational forms. This solution integrated with its existing patient record system and automatically pre-populated patient information into live e-form documents: a move that enabled district nurses to spend less time on administrative duties and creating more time to care for patients. The project was deployed across Windows and iOS tablets supporting digital data capture on any Windows device, for broader use throughout the Trust’s mobile and in-hospital teams. PID now delivers pre-populated e-forms containing key patient information reducing the time spent inputting data during patient visits, leaving more time to spend on patient care.
The PID function allows for a clinician to search for a patient name either by name, date of birth, NHS number or hospital number. Once a successful match has been returned, the clinician can choose the patient and select the desired e-form that is required. The e-form is presented with the patient demographics automatically embedded so that the clinician does not have to repeat or enter data that already exists. This provides an improvement in the validity and accuracy of data input, reducing exceptions, guaranteeing successful first-time processing of records, automatic uploads to relevant systems and saving time.
By processing on average 9,000 e-forms per month, RWT expects to use 510,600 fewer sheets of A4, reduce its annual travel by nearly 850,000 miles and lower carbon emissions by over 340 tonnes of CO2 over a 12-month period.
The digitisation of data has had a demonstrable impact on budgets. Using real-world data derived from existing customers, 100 users would save 11,000+ working hours in travel and administration, with annual cost savings estimated at £200,000+.
Time to act today
If enough progress is made in these areas, the NHS could become carbon neutral without having to undertake drastic forms of carbon rationing. There are plenty of opportunities for carbon reduction to go together with efforts to improve the health of the population and increase the efficiency of health services, but seizing these opportunities will mean taking action sooner rather than later.
As a result of the 2008 Climate Change Act, the UK has a legally binding commitment to reduce greenhouse gas emissions from the whole economy by 80% by 2050. Meeting the commitments for 2050 is a major challenge and going fully carbon neutral will be harder still. In a time of rising budget deficits and mounting pressures, climate change might appear to be a lower priority for the NHS, but the answer lies in the palms of our hands in the form of laptops, mobile phones, tablets, and wearable devices.
The desire to change is there, the need clear, the solutions accessible and the knowledge abundant. There is no reason to delay how the NHS taps into technology to reduce its carbon footprint and the impact of the administrative burden on frontline services resulting in more time to care.