The prominence of digital transformation initiatives within the Welsh health sector has no doubt been accelerated by the COVID-19 pandemic, and its effect on the way people and organisations access critical services.
The fast-moving and complex nature of the digital transformation landscape raises some interesting questions for Wales as a nation, including where its digital healthcare offering sits in comparison to other countries, how the pandemic has influenced service provision, and where next for Wales – questions that I’ll be exploring in this article.
(For a recent discussion about digital healthcare in Wales with representatives from the sector itself see this article, “Streamlining Public Services: Focus on Health”.)
Firstly, a brief look at what the term ‘digital transformation’ actually means. There are many definitions for digital transformation, and Wikipedia is probably not a bad starting point:
“Digital transformation is the adoption of digital technology to transform services or businesses, through replacing non-digital or manual processes with digital processes or replacing older digital technology with newer digital technology.”
Across both the private and public sectors, within the world of digital transformation there will be bleeding edge organisations that are leading the way, laggards and followers, as well as those unable to keep up who will eventually fall behind.
Usually when referring to digital transformation, it can be broken down into three areas:
In order for any digital transformation to be effective and to deliver lasting change, it must be successful across these three areas. In this article then, I’ll explore how Wales (and specifically the public health services provided by the NHS) might be deemed to be performing across these core areas in its digital transformation journey.
Any digital change is driven by people. The NHS in Wales employs close to 78,000 staff, making it Wales’ biggest employer, and due to the current labour-intensive nature of the NHS, staffing costs account for 75% of its total annual cost. In order to transform and to adopt new digital practices at scale, this workforce needs the appropriate digital skills and knowledge.
NHS Wales has been through a period of major change in the last decade to cater for the health needs of a 21st-century population, restructuring to deliver services through seven Health Boards and three NHS Trusts. At Box UK we’ve seen elements of this process first-hand, having worked to redesign and consolidate the outward-facing web presence of the previously-disparate health board and trust websites.
This provided a natural structure to centrally coach content leaders from within each region, who could share modern digital practices with each of their respective teams. Having this structure in place is certainly beneficial for Wales, in being able to centrally roll out digital transformation initiatives more quickly than before.
In addition, there is an opportunity to benefit from initiatives such as the work being driven by the newly-formed Centre for Digital Public Services in Wales (CDPS Wales). Set up to provide guidance, training, standards and hands-on practical help around upskilling public sector organisations in the latest digital practices, leaning on bodies such as CDPS Wales could help significantly accelerate digital transformation across many parts of the public health sector in Wales.
By way of comparison, many other nations do not have a centrally managed healthcare system; take the USA for example, in which healthcare is provided by many distinct organisations, largely owned and operated by private sector businesses. Within this model, rolling out initiatives such as the ‘Once for Wales’ programme – which looks to avoid duplication of effort and roll out centrally-managed healthcare technology – is just not feasible.
The lack of centralisation does provide additional flexibility however, and drives competition among private sector organisations to implement the best technologies, which the NHS in Wales may find more challenging. There are some strides being taken here though – for example exploring Open Architecture and other collaborations that I’ll be touching on later in this article – that can help mitigate some of the restrictions of a centralised approach.
The NHS is a 70 year-old organisation, traditionally focused around delivering hospital-based care which has shaped its processes over time. Like many other developed nations (with ageing populations) the NHS in Wales is looking to become less reliant on this model, and move from providing a ‘sickness’ service towards delivering a ‘wellness service’ – providing more self-care programmes, and care closer to people’s homes, to support greater independence and better quality-of-life.
To take forward the digital transformation needed for better health and care in Wales, NHS Wales has recently created Digital Health and Care Wales (DHCW), a Special Health Authority. DHCW has an ambitious programme of integration and innovation that includes expansion of the digital patient record, and the creation of a world-leading national data resource which will improve the way data is collected, shared and used.
In driving forward digital change, having well-organised, accessible data and the foundations for an interoperable system really are going to be key. It is very encouraging to see that Wales has recognised this and is putting emphasis on the patient record – a drive that Europe is also avidly pursuing – but are there initiatives being seen in other countries that Wales may also want to emulate?
One potential example is the Electronic Health Record (EHR) being advanced in the USA, where 94% of hospitals are thought to have adopted EHRs (source: Hitech). Particular success has been experienced both in improved patient outcomes, and cost savings through being able to reduce the number of office visits and lab tests. Closing this gap would certainly require some effort from NHS Wales, but they are already moving in the right direction by building the appropriate data foundations that are key for effective digitisation.
The final component in digital transformation is technology. As with much of the NHS, it is not uncommon for large swathes of NHS Wales’ digital estate to be tied up in long-term and ageing software contracts. Due to the nature of such contracts, and the way in which data and access to this have been historically managed, the system has largely been a closed loop – with limited opportunity for competition, and the innovation this brings.
The NHS in Wales is taking a modern approach to tackling this challenge, as new generations of software are implemented. Through collaborations such as the Digital Health Ecosystem Wales (DHEW), industry, clinicians, policy makers, academics, innovators and funders are brought together to create an environment of digital innovation in Welsh healthcare, making it easier and faster to adopt new digital healthcare technologies in Wales.
This particular collaboration is between the Life Sciences Hub Wales and Digital Health and Care Wales, funded through the Welsh Government’s Digital Priorities Investment Fund. The aim of the initiative is to open up NHS Wales’ systems and data to developers through a platform of APIs, and bring together stakeholders to tackle barriers and challenges to adoption and rollout. This is a hugely positive move forward for Wales, and should help lead to faster software innovation and a quicker time to market for new digital healthcare services.
Innovation has been further spurred on as a result of the pandemic, with an extra £25m being allocated to help the NHS and social services adapt new technologies to improve services. While aiming to accelerate strategic transformation projects, the specific intention for this particular funding is to help NHS Wales invest in mobile devices, remote working and video consultation, which have clearly seen an increased demand due to the changing ways in which healthcare is being accessed as a result of the pandemic.
The provision of effective primary care access to users via mobile devices is indeed an area where Wales may possibly lag behind other nations. For example, in England the NHS has made a head start in this area by creating an app that gives users registered to a GP surgery the ability to book GP appointments, order repeat prescriptions, and access to other features such as viewing medical records, health information and advice.
There are additionally other nations that offer a rounded mobile healthcare experience to users, for example in Eastern Europe where mobile healthcare penetration is strong. At Box UK we’ve worked with a major healthcare provider in this region to design a mobile app allowing citizens to book appointments with preferred doctors, receive medical services without queuing, search for medicines, receive electronic prescriptions, referrals, diagnoses and letters of guarantee, all through one integrated mobile application.
This application has further opened access and convenience to users across the nation (many of whom live in rural areas), and like the efforts by NHS England, is helping save time for the end-user and drive efficiency for healthcare providers by minimising unnecessary direct practice interactions.
Of course, with any technology initiative the question of inclusion must be addressed, to ensure that modern digital healthcare services are as accessible to as many citizens as possible. Wales has a real opportunity to take learnings from other nations here, to design and shape new digital services that are truly inclusive and accessible by users that need them most.
Wales has well and truly started its digital transformation journey, and the additional funding released as a result of the pandemic has certainly helped to speed up this process. There are some good organisational structures in place that, if used effectively, can help disseminate information quickly, and which will be needed to ensure the appropriate training, coaching and upskilling of staff is in place to smooth the adoption of new technology and processes.
Wales is possibly slightly behind other nations when it comes to areas such as the electronic health record, but it again is encouraging to see the funding and focus being put towards a drive to create a world-leading national data resource, powered forward by the new Special Health Authority, Digital Health and Care Wales. Technologically too, Wales probably couldn’t be classed as a leader at the moment, but the collaborations that are being set up to enable open architecture and minimise the barriers to adoption and rollout should open the door to a more competitive landscape, and greater choice and reach of digital services in the future.
At Box UK we’re proud to play a role in helping drive Wales’ digital health ambitions forward, having worked with organisations including the former NHS Wales Informatics Service and GP Wales to streamline vital services and processes. Our healthcare experience also extends beyond Wales, including a long-term partnership with BMJ Best Practice to make clinical information quickly and easily accessible to medical practitioners. Get in touch today to learn more, and discover how we can help deliver your digital vision.