Why the NHS can get the Single Patient Record right this time
An NHS Single Patient Record is difficult. But not impossible.
The UK Health Secretary, Wes Streeting outlined on 21st Oct 2024, his mission to deliver a single unified, mobile-first experience to access patient records for all UK citizens via the NHS app.
Digitally-driven change in any organisation carries a high risk of failure. Doing so in the NHS, a huge, fragmented and politicised body employing 1.5m people, might even be considered suicidal.
Of the 68 million reasons why they say it can’t be done, here are just three:
1. Fragmentation
While the NHS presents as a single, unified and recognisable “brand” to end users, its services are provided by, and delivered through, a complex network of bodies, including multiple authorities for the devolved nations. Each using unique operating models (e.g. Greater Manchester) and a complicated network of public, third sector and private organisations, not least those delivering primary care nationwide.
Simply achieving common governance standards among tens of thousands of organisations could take years – even before a single line of integration code is written.
2. Interoperability
The digital flipside of fragmentation is a lack of interoperability. This is a perennial problem in healthcare systems worldwide. Work on global standards such as FHIR has advanced in the last decade, yet vendor lock-in and data empire-building continue to hamper efforts to progress UK interoperability beyond an average of current level 2 out of 4.
The ambition to have a unified health record will run headlong into this ‘never-to-be-solved’ problem.
3. Tech legacy
Lord Darzi’s foundational report in September 2024 made official what anyone near healthcare knows; the NHS has a tech problem at all levels. Whether it’s the organisation reeling from ransomware cyber attacks, the “eye-watering” cost (says the NAO) of NHS track and trace apps or the failed NPfIT project from the 2000s – organisations and individuals have been shocked into pavlovian learned helplessness around technology.
Even a small digital initiative will be met with justified cynicism.
Evidence that an NHS Single Patient Record is possible
Yet, despite the fragmentation, interoperability, tech legacy, and previous initiatives having failed to meet targets, there are compelling reasons to think that this time the chances of success are much greater. There’s evidence inside and outside the UK health system to support that an NHS Single Patient Record is indeed possible.
- It’s been done elsewhere: Other countries (Estonia, Finland, Denmark, Sweden, Australia) have achieved a single patient record view, while UAE and Saudia Arabia are making rapid strides as part of their overall government and health system digitalisation. Yes, these nations have smaller, less diverse populations and different styles of government, yet there are still lessons to be learned. A starting point for change must build on insights from other countries.
- It’s been done outside of health: As an industry, healthcare carries undeniable unique, life-or-death risks. But that doesn’t mean it can’t learn about integration from other sectors. UK Banking had a similar interoperability problem as it entered the new millennium; the industry was unsustainable, dominated by legacy proprietary systems and was customer un-friendly. This was addressed by successive European payment services directives leading to common standards and Open Banking, now positioning the UK as a leader in interoperability and innovation. Any change must make reference to transferable learnings from other UK industries.
- The journey has already started: There’s no question about whether an app will be used. As of December 2023, the NHS App reached 33.6 million registered users (75% of adults) in England. So, the front end is already built and has traffic. On the back end, NHS Exemplars are massively over indexing in their ability to deliver against interoperability. There has also been significant work done by the standards and interoperability teams at the NHS Transformation Directorate. The time is now right to co-opt this success, and to empower (and promote) those who have achieved this change.
3 Critical Success Factors
As politicians, NHS leaders and individuals now gear up to addressing the challenge of delivering a unified patient record and access, there are three key factors which will make a difference to this – or any – transformation journey.
1. Purpose
Digitally transforming the NHS is no longer a ‘nice to have’; the Darzi report has placed it as critical to averting the existential crisis facing the NHS. Plus, despite political changes, successive governments have continued to support healthcare delivered free at the point of consumption, and this continues to align it to the national interest in a unique way.
This is a compelling and powerful “why” which will be a powerful catalyst for change in years to come.
2. Vision and Commitment
Boiling down the changes which the health system needs into three easily digestible concepts has taken time. The new 10-year plan for the NHS embeds three clear, understandable principles of change which everyone should be able to line up to:
- Hospital to community
- Analogue to digital
- Sickness to prevention
These changes will require leadership from everyone in the thousands of organisations involved, and not just from politicians.
3. Customer Vision
Permanent, lasting change only comes if services meet or exceed the needs of the users. Faced with an urgent need to change, current consultation can seem like a distraction. However, engaging with all users and stakeholders in a meaningful way is the only way to ensure this project can deliver lasting change and value – this has been a key recommendation for some time.
Delivering on this vision will call for consistent and thorough incorporation of customer and user voices into ongoing customer experience evolution.
This is a once in a generation opportunity to digitally transform health. The challenges are immense. And like anything worth doing, it’s difficult.
But, now, more than at any other time before, it’s more than possible.