Krittika Bhattacharya and Rory Tanner of the Health Tech Alliance explore the potential of technology to support the health sector during the COVID-19 pandemic.
Technology has long been championed as the solution to many of the long term challenges facing the NHS. But for NHS staff, both in the backrooms and on the frontline, the promise of technological solutions to lighten their burden has never fully materialised. Unsuccessful attempts at large scale technological integration into the health sector and the re-prioritisation of funding have gradually led to technology being sidelined in favour of other, more immediate issues.
But recently, the prospects of technology solutions in the NHS were becoming brighter. A new Health Secretary who made technology a cornerstone of his tenure was a welcome first step. Other moves such as the creation of NHSX, the Accelerated Access Collaborative (AAC) to drive the uptake of innovation and the establishment of digital technology pilots within NICE, amongst other initiatives, have been part of the transition that showed policymakers were finally realising the transformative power that technology could have on health and social care. Then COVID-19 complicated everything.
You will be hard pressed to find a health and social care worker who does not agree that the NHS will never be the same after COVID-19. Confronted with perhaps the single biggest challenge that the NHS has ever faced, it turned to radical solutions to ensure operational capacity. Retired doctors and nurses came back to work; calls were made for non-medical manufacturers to build ventilators; and technological solutions that had historically been overlooked were adopted with immediate effect.
With the NHS adopting technology at an unprecedented pace, it will be extremely difficult to let it go. Even after the worst of the pandemic is over, there remain several challenges facing the NHS; such as the buildup of undiagnosed medical conditions, a backlog of elective care, the structural readjustments needed to get hospitals back to normal and making the effective use of an exhausted workforce urgently in need of time to recover. It is difficult to imagine how the NHS can navigate these challenges without the support of technology – but luckily, we don’t have to.
Digital integration
Efforts to increase the uptake of digital technologies have had a transformative impact on how patients interact with health and social care landscape in the past few years. When we look at the state of primary care in particular, GP practices across the country have made the move to electronic record keeping and online appointment booking services and consultations, improving efficiency of services and workforce productivity, fostering greater independence and empowerment among patients and even promoting environmental sustainability as individuals can avoid numerous trips to the doctor.
Implementation can often be complex; and large scale centralised IT programmes have often been unsuccessful at a huge cost to the taxpayer, with the failed NHS National Programme for IT costing an eye-watering £1.5bn over seven years. Top-down over-centralisation of decision making was considered a major factor in the programme’s failure, but the NHS can also pride itself on a huge number of regional success stories, many of which have been scaled up to benefit huge numbers of patients and clinicians.
Newham Hospital has worked with the Health Foundation to expand its Skype consultation service, which has seen non-attendance at appointments among users drop from 25% to 13%, so that the service model is being used by over 15 clinical teams across Barts Health NHS Trust. The NHS Innovation Accelerator has worked with organisations such as ORCHA to support the development of health app libraries that can be integrated with local systems. A digital task management solution called Infinity is working with providers to help transform the co-ordination of over 100,000 patient transfer requests a year. These are just some examples of innovators and providers working together alongside patients, to co-design projects which tackle unmet needs and improve patient experiences. As COVID-19 continues to challenge the health sector and social care sector on a scale never seen before, programmes and products such as these, which keep people out of hospital and improve efficiencies, will be more essential than ever.
The NHS has already demonstrated a remarkable ability to adapt to the speed of the pandemic, despite a huge degree of disruption, to integrate new technologies. The 2019 Topol Review,1 a holistic review of the digital health landscape launched on behalf of Health Education England, suggested that the next 20 years will see the fusion of genomics, digital medicine, Artificial Intelligence (AI) and robotics; and the realisation of the full potential of health monitoring. Although the report was well received, the timelines provided in the review were deemed optimistic by thinktank The Nuffield Trust;2 and yet COVID-19 has seen years of adoption compressed into little over a month.
Achieving widespread uptake of health tech within the NHS is sometimes likened to turning an oil tanker: bureaucracy, a lack of patient trust and data sharing, stretched workforces and limited budgets can often inhibit uptake, despite no lack of transformative products being developed by the UK’s thriving life sciences sector. The pandemic, however, has seen a huge shift in primary and secondary care embracing technology during a time of need; and the health system is unlikely to return to the status quo. There is no better way to exemplify this than NHSX’s Techforce-19, which sought to identify and adopt digital solutions – with a focus on apps and platforms to exchange key information for target groups – to help the health sector and social care sector during COVID-19. The process was novel in that it did not use traditional NHS pathways, and instead worked like an industry innovation accelerator.
As workers across the country become increasingly reliant on video and teleconferencing and the country prepares for the rollout of 5G infrastructure, the health service is no different; but that does not mean that it will be plain sailing for innovators. Rigorous standards remain, and only those innovations which are scalable, safe and solving real challenges will survive the market access journey ahead of them. Cost effectiveness will be more crucial than ever as future NHS budgets deal with the wider economic fallout of weeks of lockdown. Successful digitial innovations are usually those that are built into existing clinical pathways and flows, not inserted as an afterthought, but this will not be easy when pathways themselves are transforming around us in response to the pandemic.
AI and machine learning for the health sector
The possibilities that AI and machine learning could offer the NHS are well known and potentially groundbreaking. The NHS has shown willingness to integrate AI solutions into its operational capacity – perhaps best exemplified by the AAC’s AI Award, announced at the Health Tech Alliance’s ‘Parliament & HealthTech’ Conference in January – but internal scepticism and the NHS’ own ill-fitting structures to adopt technological solutions have prevented AI to be fully embraced. But COVID-19 left the NHS with no choice but to give AI a chance to shine.
So far, the reports of AI integration have been positive. Examples include the COVID-19 Capacity Planning and System working to help predict the demand for equipment like ICU beds and ventilators, and the data platform developed by NHSX3 to provide a centralised source of secure, reliable and timely data to inform effective decision making. These examples show the power of AI to harness the incredible amount of data the NHS possesses and to convert this into information policymakers can use to save lives.
The potential of AI to save lives is the basic message that must be communicated to those within the NHS who remain unconvinced about AI and machine learning. The fallout from COVID-19 will provide further opportunities for these technologies to showcase their potential, as the NHS will need to consider innovative ways to utilise data to improve early detection and prevention to counteract the surge of undiagnosed and untreated conditions that will arise from patients avoiding hospitals for months.
Contact tracing
AI also provides a solution to the question of how to ease the public out of lockdown and back into some semblance of normal life. Contact tracing uses AI to analyse large data sets and location mapping of the public from their phones to alert users when someone they were recently near becomes infected. This solution, championed by policymakers such as by former Health Secretary Jeremy Hunt,4 has been used successfully in South Korea and the Oxford University’s Nuffield Department of Medicine concluded that the spread of the epidemic could be effectively halted if approximately 60% of people used the app.5 But with contact tracing, a clash arises between AI’s most promising possibilities to thwart the pandemic and its single largest obstacle: public opinion.
The wider population has become increasingly aware of its own data in recent years, and consequently has become increasingly suspicious of how it is used. Ethical concerns have already been raised about the implications of the government having unrestricted access to a public surveillance tool. Already it appears the app will need to be ‘opt-in’ to avoid public policy potholes, a concession which would significantly reduce its efficacy by drastically reducing the number of signups.
NHSX is already in discussions with Google and Apple about contact tracing solutions. Although nothing has yet been confirmed, NHSX Chief Executive Matthew Gould has published a blog post on the issue, outlining how public trust is paramount for contract tracing to be successful. While this intervention – though low on detail – was welcomed, the public has not yet been offered an explanation from a high level figure that they know – such as Hancock, the Prime Minister or one of the scientific and medical leaders at the daily press conferences – to offer an explanation about how this data could be used by the tech giants if they collaborate with the Government on this project.
Such a high profile intervention is needed to quell the reasonable fears that contact tracing could quite easily reveal personal data which could be harvested for commercial gain. There is no doubt a high willingness amongst the public to experiment with a contact tracing solution that has been proven to work in South Korea, but this needs to be delivered in a way that does not exploit the trust and data of the public.
This fits into the wider argument within the NHS that the use of AI and data can offer radical solutions to enable an end to lockdown, but their success depends on whether these technologies can be trusted. The trust of clinicians and patients will be vital to ensure that new technologies making their way into the system during this period of flux remain safely embedded in the future and it is essential that the health service learns from this experience. As the virus peaks and systems slowly adjust to the future, the NHS must ensure that a commitment to spreading innovation remains, and the efforts made in the past few weeks to fast-track technologies for the benefit of patients are formalised, evaluated and embedded to benefit generations to come.
The Health Tech Alliance is a coalition of the healthtech industry and bodies from across the health sector. Discover more about the Health Tech Alliance here: www.healthtechalliance.uk
References
1 https://topol.hee.nhs.uk/the-topol-review/
3 https://healthtech.blog.gov.uk/2020/03/28/the-power-of-data-in-a-pandemic/
4 https://www.thetimes.co.uk/article/wanted-a-big-hitter-to-get-a-grip-on-contact-tracing-hrwjpthcr
5 https://045.medsci.ox.ac.uk/mobile-app
Krittika Bhattacharya
Rory Tanner
Health Tech Alliance
www.healthtechalliance.uk
This article is from issue 13 of Health Europa. Click here to get your free subscription today.
