Back to the Future of Digital Health?

The Prime Minister has called a General Election and finally we can stop guessing when the UK might go to the polls!  Many, like me had settled on an October or November General Election not least because Sunak had indicated his preference was for an election later in the year.  And with little expectation of a victory, why not string things out as long as possible?  Rumours suggest that the Chair of the 1922 Committee was in receipt of a number of letters not far short of the number required to call a vote of no confidence in the Prime Minister.  In these circumstances…why not hit the self-destruct button?  A farcical election announcement, held in the pouring rain and with New Labour anthem ‘Things Can Only Get Better’ by D-REAM playing in the background, was perhaps a fitting metaphor for much of this government’s interventions into public policy, including health.

The NHS’s problems -  underfunding, staff shortages, surging demand; were not made by this government but they certainly haven’t been helped by it either. Yet as Digital Health has reported; there’s lots to be positive about - West Hertfordshire NHS Trust, which has invested £2.5 million in surgical robots this year whilst NHS Lanarkshire is trialling Patientrack, a digital observation system for ED. Entia, is deploying its ‘Liberty’ at-home full blood count analysers for cancer patients, eliminating the need for clinic visits.

If we cast ourselves back five years – Theresa May was still PM and many of us thought having someone in 10 Downing Street who had a chronic health condition might make the NHS more of a focus. And for a time it seemed that might be the case with the creation of the NHS Long Term Plan – an expansive vision but at least a starting point for a more strategic approach to digital health.  What none of us bet on, was the arrival of a global pandemic, only a little more than six months after Boris Johnson had become Prime Minister, securing a whopping majority of over 80 seats in the December 2019 General Election.

The COVID Inquiry will hopefully tell us what we want to know about the conduct of the government during this time.  Although the what was going on at 10 Downing Street has been the subject of press scrutiny and even TV drama, in the NHS; barriers to digital technology were actually breaking down.  The cliché that ‘necessity is the mother of invention’ became more of a mantra.  The procurement and deployment of telehealth platform  ‘Attend Anywhere’ by NHSX, demonstrated that digital health could be sourced and deployed rapidly and at scale if the need arose.  Yet since, we perhaps seem to have gone backwards.

The pandemic exacerbated a number of existing challenges in the NHS – staff shortages, backlogs and an outdated IT estate that hampers adoption of new technology.  Nor was their time for upskilling staff to harness the potential of technology, something the NHS Long Term Workforce Plan is intended to address.  And with its focus on leveraging digital and technological, it certainly seemed like the government was moving in the right direction.  Yet the NHS’s biggest problem – constrained finances, is likely to stifle these ambitions as the funding to train clinicians and other staff (and dare I say it, patients) is arguably, not there. 

The same issue applies to the NHS Digital Health and Care Plan, launched by Sajid Javid.  Another plan that seemed ambitious in scale, in reality it promised little new money.  While the improvements to the NHS App it funded were welcome, these were arguably pretty mundane.

Disruption in the centre of the NHS hasn’t helped either.  Seemingly almost as quickly as he arrived, Tim Ferriss; hired to great fanfare as Chief Transformation Officer to the NHS, departed.  Ferriss managed to energise a programme of EHR implementations before departing.  Many of these programmes seem to have gone awry – in some cases creating extensive patient safety issues.  Hardly a ringing endorsement for major players EPIC and Oracle Cerner.

Yet, on the plus side but not without extensive controversy, the Federated Data Platform (FDP) got off the ground.  There were no surprises that the contract to deliver FDP went to CIA backed data giant, Palantir.  Whilst Palantir’s track record as a defence and intelligence provider and concerns over data privacy, has attracted considerable criticism; on a more pragmatic note, others have questioned the use of a ‘platform’ that excludes GP data.

Extensive cuts at NHSE driven by a ‘transformation’ and the merger of NHSD into NHSE, have perhaps exacerbated some of the – understandable; post-COVID inertia.

The most recent tranche of funding for the NHS, came in the Spring Budget 2024.  With a chunky £3.4 billion in funding for NHS technology and transformation announced over three years starting from April 2025, this seemed more generous at the time than it appeared in retrospect given in reality it was a real terms funding cut.

The real indicator for how the government has prioritised health can be seen in who’s been in charge.  Not only have we had six Health Secretaries in four and a half years but most have courted controversy in some way.

The last four and a half years haven’t been great for the NHS or for digital health.  If, as we all expect, Sir Keir Starmer arrives in 10 Downing Street on 5th July and Wes Streeting becomes Secretary of State for Health, what can we expect?  It’s been said that Streeting has been taking advice from a range of health policy luminaries – including Alan Milburn and Lord Simon Stevens.  And the NHS brand is irrevocably associated with Labour.  Labour’s Nye Bevan created and nurtured the NHS.  So can we assume that a new Labour government will put the NHS at the centre of its programme?

Streeting has been tight-lipped about his plans, only more recently using carefully orchestrated opportunities in the press to focus on key pre-election messages.  We know that Streeting confesses himself an advocate for digital health so can we expect more investment?  With fiscal conditions tight, it’s unlikely there’ll be new money.  The one exception to this will possibly be for the elective backlog.  Streeting has indicated he wants to use private sector capacity to reduce this at pace.

What does this have to do with digital health?  Well, a significant part of the backlog is people waiting for diagnostics.  It’s conceivable that Streeting may seek smart ways to harness digital health to ‘triage’ those waiting.  We know that Streeting has professed admiration for the ‘family GP’ model that exists in Singapore and for bring technological innovation into the NHS faster.  Close observers of Singapore’s health system will know that the level of technological enablement is extensive. For Streeting to realise his ambitions, some creative thinking will be needed – create routes for digital health interventions to be brought forward at pace and scale. In reality, this probably means rebadging existing funding as there won't be new money until the economy starts to grow again - 'back to the future', if you will.

We have a month or so of campaigning to go.  I’m sure we’ll be hearing more about all the parties plans for health.