Jane Rendall - Digitising the NHS
Why does it take so long?
When it comes to going digital, few would see the NHS as a pace-setter. Its major IT projects have often been costly disasters, the organisation relied for far too long on ancient technology such as fax machines and Windows XP, and until recently as a patient I’ve looked on with amazement and frustration as my doctor paged through a bulging paper file trying to find some note or scan that should have been available online.
A new paper on productivity in the NHS by the brilliant economist Professor Diane Coyle* puts part of the blame on the constant reforms in the health service. She writes that they have sought to promote competition at the expense of collaboration:
“The desire to introduce digitisation to improve services and productivity, requiring collaborative efforts to standardise and interoperate systems and data, has been hampered by the organisational changes.”
But according to Jane Rendall, who’s seen the NHS from both sides of the fence, first as a practitioner then as a technology supplier, the pandemic has brought a great leap forward in digitisation:
“I've never seen things happen so fast in my entire career, as they did during the pandemic. Projects that would have taken maybe months and years were taking weeks and days. It was incredible.”
Jane was a radiographer for many years but is now the UK MD of Sectra, a Swedish medical technology company. I was speaking to her about Sectra’s role in a major programme to digitise NHS pathology - that’s taking things like biopsy results and making them available online rather than just to be viewed through a microscope on a slide.
Sectra seems to have been chosen because Sweden went down the digitisation path some years ago after a study found that waiting for pathology results was a big obstacle to improving cancer treatment: “Sweden is a huge geographical area and so the distances are vast. And so we needed to have a way of delivering levels of efficiency in terms of moving data around so that we could get specialists to look at different images.”,” she explains. “It was born out of necessity to be able to reduce the time it took for a biopsy to be taken and to have a diagnosis.”
Rather than having slides moved around between laboratories and hospitals, the answer was to digitise them and make them available online. It sounds obvious, but Jane Rendall says there was a major technical challenge. “Digital pathology is really, really big images, they're just huge,” she says. “And we need to be able to move those about about really efficiently, we need to be able to have the clinicians to be able to immediately look at those images wherever they are.”
The advantages for the NHS are clear. “It's opening up a lot of efficiency and productivity gains.” She gives an example where there may be only one paediatric cancer specialist in a region. “Before we would have to physically move the glass slides and pop them in a taxi or with a courier and actually take them to that individual who could then look at those images. Whereas now they can look at them immediately that they are available.”
How far down this road are we then in the UK? “It's been used in the research field for many years but now it's becoming mainstream,” Rendall explains. “And I don't think it'll be very long before the entire NHS will be fully digital.”
I get the point that handling such large images is technically challenging but if this has been possible in research labs for years it strikes me that the pace of digitisation across the NHS is still pretty glacial. There’s just a hint from Jane Rendall that one issue may be the conservatism of some pathologists. She says a digital system had to be good enough to provide “the visualisation that the pathologist has always expected and enjoyed looking through the microscope, which is obviously the gold standard.”
And given the track record of many NHS IT projects one can forgive pathologists for being reluctant to give up a system that works for one that doesn’t. “Fail fast, fail often” might be a mantra for some edgy Silicon Valley startups but it doesn’t work for a system where failure can cost lives.
Still, the opposite approach where health service managers are so risk-averse that they won’t even try a new system unless it has already been rolled out successfully elsewhere also has its costs. Whatever the great leaps forward in innovation during the pandemic, Professor Coyle’s paper points out that NHS output and productivity actually fell as so much of its limited capacity was given over to Covid.
As a result, there is a huge backlog of treatment for other conditions to be treated, something which might be easier to tackle if the efficiency gains from digitisation described by Jane Rendall could be realised.
History shows that new technologies only lead to big increases in productivity when companies realise that organisational structures need to change - the template for a factory in the steam age had to be torn up when electricity came along.
A fully digital NHS might mean, for instance, that you needed fewer pathology labs or that staff had to be located in different places. But in the short term, pushing through the kind of revolution that digital pathology entails costs a lot of money, so expect plenty more clashes between the Health Secretary Sajid Javid and the man who holds the purse-strings, Rishi Sunak.
*Full disclosure - I am married to Diane Coyle.
The NHS is not one entity. The hospitals are run by 100 Trusts. Each has its own management structure. NHS Digital cannot mandate that all trusts use the same IT system - so each has its own mix of software systems, some of which talk to each other and some which don't. Only when one gets data from different trusts does this become apparent. We've done this with ophthalmology audits.
I'm fully in favour of this, it's been far too long coming. The speed with which the Government Digital services were able to set up Covid reporting and ordering of LF Tests shows what can be achieved if the will and budget is there.