There’s a whole lot of hype around the big digital trends that people expect to see gain traction in the NHS. I find myself disagreeing with a lot of these, asking where are the circumstances, funding routes and drivers in the systems and wider service actually driving this? Often it’s not clear, and I can only conclude it’s based on enthusiasm, progress in that field of technology or erm… hopeful PR (which I have no beef with).
An obvious example of over-exuberant predictions is of AI finally getting broader application in 2023. However, the accessibility of data, the details, guidance, policies, trust and willingness around governance with private sector organisations isn’t there yet. Additionally, wider workforce education has not really progressed on this topic. With so many challenges in the NHS I cannot see how initiatives that feel ‘safer’ will be superseded by the complexities of the above, and think that whilst wider society is going to have a big educational year around AI, predictive forms of ML in clinical contexts will remain limited, focused on test-beds and pilots. Maybe next year.
The NHS demand cycle
Fundamentally nothing moves in healthcare without demand from public sector, and demand is driven by a few key factors: immediate circumstances, strategic operating guidance (ideally with associated funding, metrics or targets), and targeted funding. There is a final one, which is emergent models from the higher profile awards (such as the HSJ) based on successful implementations – however many of these often, but not exclusively, relate to the three above. Understandably, many of the operating plans (such as the one for 23/24) relate to the immediate circumstances and pressures that we see on BBC News every day:
- ambulance response and A&E waiting times
- wider elective long waits and cancer backlogs
- quicker diagnosis, tests and early identification of health problems, especially cancer
- access primary care and community services, but particularly GPs
- workforce – kind of – since the plan remains pretty vague
Arguably efficiency targets is going to be another big potato, but that’s probably more indirect. Also whilst there are a few other lines, note that social care continues to not be on that list, regardless of the noise.
What this means for digital – my five big hitters that I expect to see progress
Since I’m totally addicted to Midjourney AI right now, I’m going to sexy up my 5 predictions up with some lovely AI art and silly taglines. Because you, my reader, deserve nothing less!
In all of the examples below I have outlined not what I want to see happen, or see happen for my lovely clients, but areas based on where I believe the system will see furtherance based on the realities and dynamics above.
The remote monitoring curve continues
We’ve had two phases in the remote monitoring journey since COVID – scattergun reactive application in a pandemic (no judgement), and then targeted application in discharge from acute scenarios, with the latter being formalised by NHS EI around 13 months ago, with an ongoing stream of funding. From an optics perspective we’re seeing examples emerge, more sharing and the stakes being high with hospital capacity.
However, whilst there is a long way to go with digital discharge pathways developing, I think we’re going to see that learning spread into other areas, particularly for prevention and some waiting list support within primary and community care.
The road is going to be long and keep evolving for remote monitoring as we progress into the age of AI, but I think this next year we’ll start to see a broader range of shoots across more health contexts, and for a happier and more sustainably funded group of virtual monitoring providers.
Asynchronised interactions, especially for triage.
Right now time is the biggest scarcity in the NHS, regardless of the current spin from the Cabinet leadership, and this will continue to shape our furtherance of thinking around shifting how we interact with patients, and how this is supported by tech. This relatively un-fixable workforce scarcity and waiting lists are already driving services I know and work with to start being more creative around how they can save minutes and hours, and the already ubiquitous shift to video and content out there in the real world is starting to penetrate thinking in health. Good, it’s about time, I’m seeing come good solutions come to market and think it will be well received in those seeking to redesign services and pathways in an overloaded NHS.
The only blip on this, which could set us back, is the growing ire around GP booking front-ends (not naming names) but I think the response will be to push for bettering these rather than regressing.
National emphasis on supported self management, and the ongoing, albeit slow, development of the NHS App functionality means we do have a bit of a hiatus in widespread interactions through portals, (along with wrecking the portal market) but new and better tools for more safe encrypted communication, and the continuance of primary care digital communication tools, will hopefully mean we see more examples come through in care logistics, data collection and two-way multimedia interaction. That should set us up for a much needed big bang in 2024.
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Automation in clinical scenarios
I’m picking this for a few reasons, firstly this is logically adjacent to the above, and likely that the workforce challenges will lead to providers seeking to automate interactions wherever possible. Secondly, whilst we’re having a bit of a stumble in robot process automation not meeting the expectations that were sold, capability, particularly in acute trusts, has really grown, interoperability is slowly getting better, and the RPA technology is too, especially with Microsoft doing what it does in racing up the pack in the market, and then dominating (I call this happening in 2025).
Nationally advocated initiatives such as Patient Initiated Follow Ups (the acronym of which Healthtech Pigeon perfectly associated with a scandi yoghurt drink), again supported self management, diagnostic improvement targets, more support for waiting lists, and so on, should start to see good suppliers start to get their foot in the door and make a name for themselves.
The continuing growth of workforce solutions and virtualisation of care
Have I mentioned workforce yet? Over the last few years we’ve seen the transition to locums, virtual GP services bolting on to general practice, and then mental health provision, and of course a pandemic that normalised the phrase ‘you’re on mute’. Since the workforce vacancy situation is getting worse and not better, I can only see that the two obvious forms of digital service will continue to play a big role:
Workforce infrastructure and matching tech services – very popular but also not really healthtech if we’re honest. So I won’t dwell, but those companies will continue to get headlines for their performance IMHO.
Virtual clinician provision – I think we’ll see these grow and into new areas too. One really interesting indicator is where a few cash strapped local authorities went out to consultation around the child services they commission in community health, and I think we’ll see a few areas put out tenders with these requested, and that could start to spread to other areas once contracts come up (like happened in sexual health).
This is a double edged sword – in one sense this is a zero sum game that is contributing to financially crippling the NHS and needs to be brought more under control. However, optimistically on the latter I think there is a lot of room for innovation and we’re only scratching the surface on the future benefits of virtual service provision (such as what pass-through data can offer to the care experience).
Population health management begins to come together for the emerging integrated systems
Finally, and not exclusive to some of the others, most ICS leaders I talk to know that the only way out of this mess is to find a way to intervene early and that a population level this needs a data-driven approach. Whilst future risk stratification and AI risk scoring will come once the big incumbent EPRs stop faffing around and holding progress up in their efforts to dominate the market and squeeze every ounce of cash from the system (but clearly I’m not taking a view on this – promise), this isn’t happening in 2023/24 and local systems seeking to be ambitious and explore new integratey (sic) ideas this year, will right now be very frustrated that their supporting data is really not cutting the mustard.
I have a high degree of confidence that they’ll push for better systems that offer better decision-making data, and funding will be apportioned to systems that can help with this purpose and also new solutions that 1. do micro-population health management (i.e. practice integrated) and 2. improve, augment and possibly even workaround, the existing systems to offer better data, and 3. to better improve understanding of where they sit against the national picture. Whether the national efforts to push these data platforms will massively help push this or whether those initiatives will be a huge monster truck collision – well – should be left to observers more informed and more intelligent than me.
Final words
As always I hope that this article has been informative, and whilst I don’t know what’s going to happen in this weird volatile world, that it has offered enough of my logic from being in and around the system. If you’re left with positive and warm feelings, do give the article a like, a comment or a re-share, the network effect really helps me meet interesting and like-minded future clients. If you fundamentally disagreed with everything I said, then please give me a curious face, heckle me in comments, and re-share with an explanation of why you disagree and think I’m a massive fraud 😉.
I know the NHS doesn’t move as fast as we like, or even as fast as the system, staff and patients need, but I do think that if we get progress in these areas then they won’t be insignificant in their impact, and will set us up for the bigger things to come in the long term.
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Liam Cahill is a trusted adviser to frontline providers and national bodies on all things digital, and has mentored and advised some of the best known names in healthtech, and he’s been there and bought the t-shirt in building a nationally impactful digital social enterprise that developed medicines pathways. He regularly posts content, ideas and advice on LinkedIn. Check out his other numerous articles and videos here, LinkedIn newsletter here and his viral dance videos on Tiktok here.
