The NHS needs sustained investment if it is to become a technology driven service
02 December 2020
When we spoke to junior doctors about how they thought technology could change how they cared for patients in the future, their answers highlighted the investment that needs to be done to get the basics right. They weren’t asking for robots, or AI, or remote monitoring. They told us that the things that would make the biggest difference were secure methods of communication; computers that reliably turned on; interoperable patient records.
Over the years, the NHS has underspent on technology in relation to its peers. We see this in the amount that trusts spend - on average 2% of expenditure per year - and in the OECD’s benchmarking of scanners per head. We heard it when we spoke to finance directors who were forced to make decisions about capital spend on IT infrastructure or on backlog maintenance. And we saw it when we analysed job adverts to understand whether investment was being made in technological roles through pay costs.
When the NHS does set aside substantial sums for digital transformation, there is often underspending on technology and funds too often get redirected elsewhere. Complex processes surrounding large scale investment can be a barrier, and business case development and due diligence can slow spending down.
Coronavirus (COVID-19) has shown what can be done with what’s currently available - the pivot to remote care has been rapid and extraordinary - but there is a real need for sustainable investment to ensure that the gains that have been made stick, and that they act as a catalyst for an improved patient pathway, rather than simply replicating existing processes but other the phone.
There will be tough decisions to be made about funding as the country moves forward from COVID-19. As the NHS moves towards recovery, the Government must resist the temptation to divert technology funding to meet other demands and instead see bringing technology up to standard as part of the solution.
Good technology is expensive, but not as expensive as bad technology
Our research showed the public wants more spending on technology - 59% felt it important for people using the NHS to have access to new technologies, and 40% would be happy to see tax rises to pay for this. However, people value the human aspect - over half felt they needed to speak face-to-face to get quality care.
In interviews, we repeatedly heard that it was difficult to commit to investing in technology at an
organisational level, due to limited sustainable funding mechanisms, a complex capital regime, and too many more immediate concerns.
There is a need for both simplified processes and a more creative approach to funding. A centrally held fund could help here. Systems could bid to borrow from it, to invest in technologies that would help them make back-office efficiencies. They would pay back the loan - with a gain share arrangement - over the period set out in their business case.
The experience of the NHS during COVID-19 has shown the extraordinary things that the service can achieve when conversations about money stop being a constant sticking point. While we don’t argue for a blank cheque for technological innovation in the NHS, it’s clear that underspending on technology, or short term piecemeal solutions, will prevent the NHS from moving forward as a world class health service.
You can find out more about our recommendations to address this in our ‘Getting the money right’ essay.