UK pins hopes on 'latest technology' to whittle down massive National Health Service waiting lists

£500m tech consultancy procurement in the offing

The UK health secretary has invoked "the latest technology" to clear a 6-million-strong waiting list in England as the National Health Service struggles with a patient backlog caused by the COVID-19 pandemic.

The Department of Health and Social Care (DHSC) and its quango NHS England have at the same time awarded millions of pounds' worth of technology consultancy contracts while launching a new £500m procurement for more of the above.

Announcing NHS's Delivery Plan for tackling the backlog yesterday, Sajid Javid said 300,000 people had now waited longer than a year for elective care – non-urgent but necessary treatment or operations – while 6 million were now waiting for care, up from 4.4 million before the pandemic.

On top of that people have held off presenting conditions to the NHS. Estimates suggest that there are around 10 million "lost" patients with little known about their conditions and how severe they may be. Javid was forced to admit it would be 2024 before those waiting lists numbers fall.

The health secretary's plan is to launch a new online platform called My Planned Care. Set to go live in February, it promises to give patients and their carers "tailored information ahead of their planned surgery." As well as letting them know how long they're likely to wait, the platform is supposed to "link patients to the most appropriate personalised support ahead of their surgery" in a bid to reduce on-the-day cancellations due to people not being clinically ready for treatment.

In the foreword to NHS England's document on the elective care recovery plan, NHS England chief executive Amanda Pritchard said the body hopes to "harness the potential of data and technology."

Under the heading "Using digital technology and data systems to free up capacity," it reads: "Digital technology and data systems provide us with the opportunity to release capacity… by allowing us to deliver services in new ways that more efficiently meet the needs of both patients and staff.

"Our ambition is to improve core digital and data services in hospitals to ensure we have the basics right, as well as harness and scale innovations that have shown high impact in some areas of the country. We also want to use national digital tools such as the NHS App to provide a personalised route into NHS services for patients, making care more convenient and driven by patients' needs."

Part of the reason for the strong emphasis on technology is because the NHS has little room for manoeuvre when trying to increase capacity. There are already 40,000 unfilled registered nursing vacancies in England while the proportion of unfilled medical consultant posts is the highest in a decade.

Dr Chaand Nagpaul, chairman of doctors' union the BMA, said: "The biggest limiting factor will be workforce shortages, given that there are currently 100,000 unfilled vacancies across the NHS."

Management membership organisation the NHS Confederation also criticised the plan for lacking a "a fully costed workforce strategy."

The way to do more with fewer staff is to be more efficient, hence the continuing allure of "the latest technology."

The elective care delivery plan details examples of where IT has helped. Robotic Process Automation was used to streamline patient registration "enabling effective data upload and transfer to Electronic Patient Records," saving admin time. It also offers the example of a data platform to "dynamically optimise theatre capacity to reduce the burden on staff."

The recovery document commits £2.1bn to "modernise digital technology on the frontline, improve cyber security and the NHS's use of data and redesign care pathways." The money was announced last year by chancellor Rishi Sunak in the autumn spending review.

Recent procurements offer a clue about where the money is going, though. Contracts worth between £21m and £42m have been awarded to a group of management consultancies to boost integrated care analytical and planning capacity with support for the Elective Recovery Programme on a regional basis.

Familiar names Deloitte, Ernst & Young, KPMG, McKinsey & Company, and PwC are joined by Bramble Hub and Newton Europe.

Meanwhile, a separate procurement run by NHS Shared Business Services – a joint venture between the DHSC and French outsourcer Sopra Steria – aims to offer NHS organisations "access to short and long term skilled resource, people and services to enable the authority to develop and implement IT projects and solutions where they may have a skills gap or shortfall in personnel and resources," according to a tender document.

The "prior information notice" marks an early market engagement with the official competition set for a later date.

MPs have already slammed the health service's over-reliance on consultants in the Test and Trace COVID-19 response organisation, which at one time employed 1,230 consultants on an average day rate of £1,100.

According to a report by Parliament's Public Accounts Committee (PAC) released in October, the DHSC had assured MPs that it planned to reduce the Test and Trace service's use of external consultants, "but that this was dependent on the availability of civil service recruits to fill posts and on future demand for test and trace services."

Following the report, Test and Trace continued to sign new contracts for consultants.

While the NHS is looking for IT consultants to fill its technology skills shortage, its own strategic IT organisations are in flux. NHSX and NHS Digital are being rolled into the Transformation Directorate of NHS England and Improvement under plans announced by Javid last November.

The move followed criticism from spending watchdog the National Audit Office (NAO) which in May 2020 said governance arrangements for digital transformation were "confused, despite attempts to clarify them."

The criticism followed the missed target to go "paperless" by 2018. The NAO said the NHS was failing to learn the lessons from the National Programme for IT. Dating back to 2003, the NPfIT, which was at times estimated to cost £12bn, was stopped early in 2011 and "did not deliver key benefits," the NAO said.

The new plan to use the "latest technology" to get the NHS out of a staffing tight spot is a reminder of the punchline to an old joke: you wouldn't want to start from here. But if you have no choice, it might pay to be honest about the past. ®

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