Since the outbreak of the coronavirus pandemic two years ago, almost every healthcare service in the world has come under pressure, struggling to balance traditional patient care with the highly contagious (and deadly) COVID-19 virus.
The UK’s National Health Service (NHS) is no exception, and throughout the pandemic, technology has played a vital role in its coronavirus response. The successes include temporary “Nightingale” hospitals opened in 2020 to deal with the sheer volume of patients, the online infrastructure that allowed thousands of UK residents to order free COVID-19 tests or book vaccinations, and the rise of video consultations. Best forgotten are the multiple failed attempts to build a comprehensive track-and-trace mobile app.
Most of the world is still in the grips of the pandemic, and the rise of the Omicron variant seems to have pushed the finish line over the horizon. But healthcare leaders are already eyeing the future of UK health services and what recent adaptation and innovation might mean long term.
The current state of healthcare tech in the UK
Since it was founded in 1948, the NHS has provided healthcare to all legal UK residents, offering most healthcare services free. It is currently the second largest single-payer healthcare system in the world, with planned spending for the Department of Health and Social Care in England totalling £212.1 billion in 2020-21, up from £150.4 billion in 2019-20.
“… We’ve always been at the cutting edge of many different medical technologies,” said Dr. Annabelle Painter, a GP registrar who also holds a fellowship role for Health Education England and NHSX focused on AI and workforce. “But at the same time, the hardware infrastructure within the NHS has been really bad.”
Painter, who is also a clinical advisor to healthcare tech firms such as Medsii, said that despite campaigns by former health secretary Matt Hancock to “purge the pager” and “axe the fax,” legacy technology is still pervasive in the NHS.
“As a millennial growing up with a mobile in my hand from a very young age, going into the NHS and suddenly being asked to use a pager and a fax machine was overwhelming in many ways,” Painter said. “Firstly, how is the NHS still using this technology that I’ve literally never ever seen before? But also, I didn’t know how to use that technology.”
The lack of modern technology and inefficiencies in the system hampered good care, she said. “That was quite frustrating for me and … part of the reason I wanted to move into the digital health space was to try and help improve all of this.”
Despite the billions of pounds poured into the NHS, experts said years of underfunding left the health service in a vulnerable position that was only made worse by the pandemic. This year, NHS hospitals, mental health services, and community providers reported a shortage of 90,000 full-time staffers and as many as 39,000 nursing vacancies, or 1 in 10 posts. And as of October 2021, the British Medical Association reported that the NHS waiting list was at a record high 5.98 million — and still growing.
The role of legacy systems
The NHS has long been plagued by issues relating to legacy technology. The 2017 WannaCry ransomware attack, which infected devices running unpatched versions of Windows XP, affected at least 80 of 236 NHS trusts, forcing the cancellation of around 20,000 hospital appointments and operations and prompting five accident and emergency departments to divert their patients to other hospitals.
In April 2018, after the attack, the Department for Health and Social Care announced an agreement with Microsoft that saw NHS devices upgraded to Windows 10 for free. But as recently as February 2020, a month after Microsoft stopped patching Windows 7, around 500,000 NHS devices were still running on the outdated OS.
That said, the NHS is one of the strongest in tech investment compared to other countries in Western Europe, according to Silvia Piai, Research Director for IDC Health Insights in Europe. And the pandemic accelerated plans already being discussed.
“…I think that prior to COVID, we were in a bit of… [a] moment of reflection on how to use the technology,” she said, noting there was a lot of talk about digital transformation in healthcare. “[Covid-19] has accelerated many of those processes.”
She pointed to advances in remote care provisioning and clinical decision support and believes the experience of the pandemic will help the NHS better understand how to deploy emerging technologies and roll out new integrated care delivery models.
“For instance, everything we have learnt about telemedicine and virtual care could be really handy when it comes to deciding what is the level of access to services you want to offer and what kind of which segment of the population should we target with telemedicine. I think that’s the key takeaway from the pandemic,” she said.
“We know that healthcare is still a priority area in the UK, and they will need to make sure that lessons we’ve learnt are put it into practise.”
The technological needs
The push for leveraging technology in the NHS is not new. In 2013, the Department for Health and Social Care founded NHS Digital to provide digital services and social care, including the management of large health informatics programmes by both in-house teams and private suppliers. In 2019, the department launched NHSX, a unit responsible for setting national policy and developing best practice for NHS technology, digital and data, including data sharing and transparency.
(In November, Sajid Javid, the Secretary of State for Health and Social Care, announced that NHSX and NHS Digital would merge into NHS England and NHS Improvement to accelerate the digital transformation of the NHS.)
Not every technology investment necessarily has to be pioneering. Video gained serious traction during the pandemic, particularly since it had been viewed as a grudge purchase, said Neil Killick, EMEA Leader, Strategic Business, at video tech firm Milestone.
“I think the pandemic has changed that previous attitude into the realisation that actually, the kind of good it can do, and how it can support the public, has been one of the big changes we’ve seen when we’ve spoken to our end customers or partners, he said. “Video is no longer that suspicious technology which we view with contempt.”
An IDC/Milestone white paper released in November found that 78% of UK healthcare providers plan to adopt video and sensor solutions during the next two years to underpin smart surgery and diagnostics. And 64% plan to roll out video and sensor solutions during the same time frame to help patients navigate around hospitals.
Video technology has come far in the last 24 months, Killick said, with cameras now being used to manage queuing systems in hospitals to determine whether someone’s wearing a face mask. Data about face mask use, coupled with diagnostic and analytics tools, can be extrapolated and used in other areas. And the integration of artificial intelligence and machine learning can be used by companies like Milestone to provide patient monitoring, heatmapping, temperature control, breathing control, or simple observation.
“All these kinds of technologies are spinning up because programmers and developers have realised there’s a need for it,” Killick said. “And … there’s [now] an acceptance of that. There’s a realisation that patients are actually quite happy and often happier to be monitored remotely.”
Microsoft UK plays a big role
When it comes to deploying technology in healthcare, Microsoft UK is a major player for both cutting-edge and day-to-day tech, according to Jacob West, director, Healthcare & Life Sciences. In May 2020, for example, staff at Imperial College Healthcare NHS Trust were wearing Microsoft HoloLens headsets as they worked in the most high-risk area of some of London’s busiest hospitals.
Using HoloLens cut the amount of time staffers spent in high-risk areas by up to 83% and reduced the use of personal protective equipment (PPE), Imperial College Healthcare Trust said. (By using Hololens, a single doctor could work with COVID-19 patients while colleagues were able to observe from a safe distance, and without wearing PPE.) The use of Hololens saved an estimated 700 items of PPE per ward, per week.
One of the things West said he’s most proud of is the rollout of Microsoft 365 to 1.2 million healthcare staff during the pandemic. In June 2020, NHSX, NHS Digital, and Microsoft agreed to enable all eligible organisations in England to access Microsoft 365 digital tools — at a considerable cost saving for the NHS.
“That is practical technology in the hands of GPs, nurses, doctors, administrators that can save time and improve efficiency,” he said.
West also cited a recent study that found 3 million hours during a six-month period were freed up by using Microsoft Teams, instead of staffers having to make phone calls or hold in-person meetings.
“That’s not AI technology, that’s just a quite simple collaboration tool,” West said.
The biggest digital transformation for healthcare during the pandemic was the almost overnight shift to virtual care regarding GP appointments. As a result, the UK has now built the physical — and to some extent, the digital — infrastructure that could be used in other diagnostic areas.
While technology is not a panacea, it can greatly augment what healthcare professionals are doing: streamline administration, automate tasks, and ease the demands of data entry.
“I think we’ve seen this huge digital transformation,” West said. “I think some of the lazy cliches about the pace at which the NHS innovate have been put to bed.”
The question now, he said, is how the NHS can innovate in ways that are better for patients and give time back to front-line workers.
Looking to the future
One issue still facing the NHS is an ongoing labor shortage, Piai said. It’s not just vacancies in front-line positions; like the rest of the country, the NHS also suffers from a digital skills shortage.
Sarah Boyd, an NHS employee, recently tweeted about her frustrations hiring for digital roles in the health sector: “Sooo, I can’t hire perm people, I can’t entice people on 1 fixed term contracts (a lot of money is only in year*) as people need more stability for mortgages etc and now getting contractors is ridiculously hard too. Can someone tell me how we are supposed to do anything please?”
“If you want to modernise infrastructure, you need skills like DevOps, for example,” said Piai. “However, it’s not a traditional IT skill and, let’s be honest, the NHS probably doesn’t pay as well as the private sector, so lots of these skilled individuals will go get a job in something like finance.
“This is part also of the work that NHS Digital and NHSX are coming together to try and do — looking at how to make sure that when you have a best practice, the blueprint of this is shared so that you can somehow reskill the IT staff that you have already in place,” Piai said.
When it comes to education and re-skilling, the NHS’ digital offshoots are focused on improving the digital literacy of current and future healthcare workers. One area getting attention is AI, Painter said.
When it comes to education and reskilling, the NHS’ digital offshoots are focused on improving the digital literacy of current and future healthcare workers. One area getting attention is AI, Painter said.
“There’s a ‘DAR’ tech programme [within the NHSX] which is focused on digital, AI, and robotics technology education, and that’s looking at the whole of digital education across the workforce,” she said.
As for AI that’s already been rolled out, Painter said it’s concentrated in administrative areas that don’t directly relate to clinical outcomes or directly affect patients. Elsewhere in the world, healthcare workers have access to some of the most innovative AI products available — largely because in many third-world countries, healthcare workers have to rely on smartphones.
“There’s a good example where people have retinal imaging scanner cameras that you can attach to a smartphone, take a picture of the back of someone’s eye, and then an AI triages that,” she said. “Just because you don’t have the technological infrastructure or hardware, it doesn’t need to stop you introducing innovative technology.”
For patients, more empowerment
Another trend moving through healthcare is an effort to give people more say over how they monitor their own health. Since relatively early in the pandemic in the UK, people have been able to order COVID-19 tests online and take them at home, eliminating the need to involve healthcare professionals.
A growing number of people bought devices such as home blood pressure monitoring kits, allowing them to regularly check their own well-being from home. And there’s been growth in the number of people using wearables to track health data, according to a Mintel report in November 2020.
“…People want to be able to take care of themselves, but they don’t necessarily have the knowledge or information to do that,” Painter said. “By giving people the tools that can help them give them personalised health advice, through things like remote wearables and symptom checkers, you can really empower people to look after their own health….”
“We have seen a new generation of patients that are much more involved and attentive when it comes to their health,” Piai said.
Even so, Piai said, it’s important that patients trust doctors when it comes turning this data into action — because consumer-level technology may not be as accurate as what medical professionals offers.
“That’s why it’s important to measure the outcomes, what worked and what didn’t work. Virtual care can work for certain segments, but for others [it] can be a matter of exclusion because they are not very digitally skilled, or they don’t have access to the necessary technology,” Piai said. “Ultimately, the question should be, ‘How can I embed these new tools that will benefit the most people, whilst taking the burden off GPs?’”