The Download: It’s not the tech plan, but there’s a lot of tech in it

One virtual ward to rule them all

The 10-Year Health Plan answered one big question: how are staff in integrated neighbourhood teams going to look after patients at home?

After all, integrated care boards are being hollowed-out, so who is going to buy the tech systems required?

The 10YP’s answer is the centre, and once for everyone.

It says: “We will undertake national procurement for a new platform available to all NHS provider organisations. This will include the ability to remotely monitor patients, with data flowing through to the NHS App and single patient record – enabling proactive management of patients to become the new normal.”

The remote monitoring of patients (a virtual ward) with plugged in wearables (available to all on the NHS by 2035) is a big job. But it’s probably the best bet in the 10YP of shifting the centre of gravity in the NHS.

The single patient record and the data citadel

Is Wes Streeting rowing back on patients owning their data?

In a speech in October, the health and social care secretary said the single patient record would be “owned by the patient, shared across the system”.

The 10YP only mentions “giving patients real control” of the SPR.

True patient ownership would be a genuinely transformative change in how the rich data (mostly from GP records at the moment) gets used. Properly connected, patient-owned data could be shared with clinical researchers very easily, and the patient could make their own decision about who else they gave it to (for example: “Researchers doing a trial into a condition I have?”, “yes sure”. “Insurance company?”, “no”.)

Where this ends up is important for UK PLC.

The 10YP has high hopes for the SPR and integrating it with the NHS App but the timescale is curiously unambitious.

The document promises legislation that “places a duty on every health and care provider to make the information they record about a patient, available to that patient”.

Great! When? “From 2028”. Oh. “Subject to parliamentary time”. Ah.

A healthtech leader said: “This is them giving themselves as much time as possible. But 2028? It will take even longer.”

The tendency of governments is to try and retain the data and strike the deals themselves. But the “citadel” approach has foundered in the face of public suspicion a few times now.

Perhaps the NHS App will make possible a lot of the progress Mr Streeting is counting on before 2028.

The NHS App

We’ve heard the NHS App described as the “front door of the NHS” before, but the 10YP lays it on thick with detail about a wide range of functions to be added. 

This will include clinical advice, a virtual 111, “My Choices” which will carry detail on services including heart surgery outcome scores, direct booking for diagnostics, medicines management, and new access for carers.

This and the plethora of “my” features of the app are a big ask but again “by 2028” looks unambitious. (Meanwhile, how the NHS App interacts with another important “My”, Epic’s “MyChart” is an unresolved issue.)

The NHS App has had around £200m in public money since 2018 and the teams have done well to get it where it is (a fifth stage of procurement for the App is currently out with incumbents IBM, BJSS, Kainos or Accenture among the likely winners).

But the Financial Times last month quoted a “government official” saying “there is no question the app is crap at the moment”, reporting that the previous government had cut £200m from its budget, something this administration might reverse. (By the way, £200m is what the NHS spends on letters and text messages at the moment, things the app could replace).

This would be quite a small amount of the “up to” £10bn for health tech announced in comprehensive spending review. In practice, and subject to all the usual caveats about keeping the Treasury happy, this will see the health tech budget go from around £2bn a year for the next three years to around £3bn for the next three years.

So if the reversal of the Conservative NHS App budget raid is £200m, where is the rest going?

Asked yesterday by HSJ what the top priorities were for new tech spend, NHS CEO Sir Jim Mackey said the App was top of the list, but also cited making EPRs work better, partly by improving basic tech infrastructure.

EPRs

But electronic patient records were notable largely by their absence in the document.

The minister responsible, Karin Smyth, said in her first speech that she would prioritise investments that made working life easier for staff, so it’s worth quoting the only real mention of EPRs from the 10YP in full: “Clinical systems often provide a poor and inefficient user experience requiring multiple clicks to set the next step in the care process.

“Many of the systems in use in the NHS today were originally designed for the US healthcare system to capture as many care delivery steps as possible to maximise the opportunity for private healthcare providers to bill private healthcare insurers. Their purpose was to maximise revenues rather than productivity or patient outcomes. It is unsurprising that most clinicians find the data entry squeezes out the joy from their work.”

Sir Jim told HSJ yesterday: ”We’ve heard loud and clear that people need the functionality of EPRs, but it’s got to do what you paid for. It’s got to make things easier and more productive…

“In my time in Newcastle before I came down here, the infrastructure just wasn’t there. I had one of the best EPRs you can get but the infrastructure wouldn’t support it. So I think we need to get very very focused about that.”

Since 2020, NHS trusts have spent roughly £576m with Oracle Cerner, and £430m with Epic.

Senior officials have said a priority for this period is getting the sunk costs of hospital EPRs used more effectively and getting staff to use the systems they’ve already bought more efficiently.

It’s not clear at the moment whether remote consultation technology built into these systems are what the NHS is depending on to do away with two-thirds of face-to-face outpatient consultations. This will be the main plank of the “bricks to clicks” shift that planners are praying for. But like most things, it relies on some significant changes in working practices.

AI and AVT

AI appears in most sections of the 10YP but its sub-category ambient voice technology is the bit that might make the most difference on the staff welfare challenge.

The document notes that AVT is already out there and that “the problem is not one of adoption but of scale”.

Er… to judge by the recent cease-and-desist-using-non-compliant-AVT-products letter sent out by the CCIO, the problem is scale and adoption. There is evidence that the market for these products is very competitive and trusts get a lot of approaches from salespeople.

This is why the 10YP’s plan to “accelerate” adoption promises a new procurement framework from 2026 to 2027 “so they can adopt this technology safely”. There is already a framework and there’s already had to be a warning letter about the functioning of a market the NHS itself values at £400m.

At least one big EPR provider has asked NHS management not to buy an AVT system because they’ll sort one out and ship it over at some point. That sounded to me like it might miss the boat – but on a 2027 delivery for the framework, maybe it will be here in time.

The 10YP quotes from an as-yet unpublished study in London on how much time AVT saved clinicians. The Great Ormond Street Hospital research found a “51.7 per cent saving on paperwork” allowing each doctor to “treat 13.4 per cent more patients during a shift”.

The Download has heard that the biggest improvement was in accident and emergency (the specialist, alerted sooner by quicker note-taking in A&E, comes down sooner to see the patient). Improvements in other settings were not as profound.

Some companies offering AI services are venture capital-backed and are under pressure to start yielding returns sooner rather than later.

I’m not saying it’s easy, but in that light the 10YP’s commitment to “review regulations, and in 2026 publish a new regulatory framework for medical devices including AI” could seem a little slow.

Missing in action

Considering the government committed £370m to the Federated Data Platform it seems strange it is only mentioned twice in the plan – perhaps because it was introduced by the previous administration.

Both mentions are in relation to AI or “AI-led” tools, one for monitoring complaints data and another helping the Care Quality Commission with alerts. Important stuff no doubt, but you could have bought the current “crap” NHS app nearly twice over for this sum.

Cyber security was also notable by its absence in the document. HSJ revealed last year’s cyber attack has now been linked to at least one death. Cyber security budgets were also hit in the last government. Considering how big of a potential target the single patient record and NHS App could become, the silence is puzzling. It is a silence unlikely to endure.