Stethoscope next to laptop.

Understanding the NHS structure: can we make it more connected?

1948 was an eventful year.

Tanks rolled into Czechoslovakia. Mahatma Gandhi was assassinated. The state of Israel was created. The UN founded the WHO. And the LP (yes, Long-Playing record!) was invented.

1948 was also the birth year of the NHS. It was a historic moment, when access to free healthcare became a basic human right in the UK.

Old photo of doctor and nurse leaning over patient.

The structure of the NHS today is largely informed by the mindset of that time: it is, essentially, a ‘sickcare’ system. While some aspects of healthcare have been transformed – medical diagnosis and treatment, for example – at a structural level the system is antiquated.

Think about it. If someone feels unwell, they book an appointment with their GP. This may get escalated to a hospital appointment, with tests, scans, and diagnostics and, eventually, the necessary treatment. The gaps in between these appointments can be huge, with long waiting lists and administrative procedures to overcome.

These days, patient care has become increasingly distributed between different medical domains and organisations. But we still recognise the original mindset, including disconnects between different parts of the system. 

(Dis)connected healthcare: NHS structure then and now

In 1948, and throughout the rest of the last century, such disconnects were inevitable. The system relied on letters-in-the-post and filing cabinets.

But in 2020, technology that connects people and places (GPs, nurses, consultants and medical centres) exists. And it could be seamless and secure, at least in principle.

Hospital reception.

In practice, not so. Take medical records. The Electronic Health Record (EHR) has replaced original handwritten formats. An EHR is like a digital version of a medical chart.

It contains information on things like someone’s medical history, treatment, diagnoses and test results. Oh, and home address and credit card details. A lot of information, some of it sensitive stuff. Having all this in one place makes sense.

Unfortunately, EHRs are often fragmented and poorly managed. They contain medical data in different formats across different systems. Time-pressurised medical staff struggle to manually log in every bit of information. This can lead to serious errors: duplicate medical records, misdiagnoses, delayed treatments, and even deaths.

Given the amount of personal information they contain, EHRs are valuable. They must be secure. I’m sure you wouldn’t want anyone to sell yours on the black market (neither would I). But that kind of thing does actually happen. The digital format makes EHRs a target for hackers, who sell them for hundreds of pounds. 

Laptop next to stethoscope.

So connecting the NHS structure of medical staff, GPs, health centers, hospitals and care homes sounds great in principle. Achieving it would ease many pain points in healthcare. The technology to do this already exists.

Why has this not happened yet?

The main reason is that this kind ‘interconnectivity’ has to rely on a robust and secure ‘digital architecture’ that is adopted across the entire NHS structure. But the NHS is so huge and complex that building such a digital architecture is a Challenge (with a Capital).

There has been real progress towards this in recent years, with some exciting new developments. A particularly promising development uses the concept of APIs. API stands for Application Programming Interface. That’s not exactly enlightening, I know! 

One way of thinking about APIs is that they are a bit like Lego bricks. Every brick uses the same standard for connecting to other bricks. But there are lots of ways of combining the bricks to make something new. Same but different.

That makes APIs both stable and flexible: similar components can be put together differently (spending on local needs). This opens up lots of possibilities, which is why we talk about open APIs.

Assorted pile of lego.

There are other projects to develop the large-scale digital architecture the NHS needs, including a move towards cloud-based infrastructure. A lot of those are work in progress, with mixed results. But those mixed results have generated a lot of learning, sometimes on the basis of getting it wrong.

Here are some of the key things that have emerged from trying to connect the UK health system. 

Lessons learned

  • Different NHS stakeholders must be involved from day 1, all the way through design and into implementation. A big-boom top-down approach has to be complemented by small-steps bottom-up development, or the whole thing will fail.
  • The design of health tech architecture (and associated health and services) has to be fully inclusive. That’s because the NHS is a varied landscape, just like the people who support it.
  • Physical and mental health exist in a larger socio-cultural context. Low digital literacy should not be a barrier to access. Those with the greatest health needs (including learning needs) are often those who get left behind.
Elderly man using smartphone.
  • Even when people don’t use digital services themselves, they may still benefit. For example, other people (like nurses) may be able to give them more of the time saved by digital efficiency..
  • Digital architecture in itself is not enough. It needs to go hand-in-hand with developing skills and capabilities that support NHS staff, like leadership and change management. 
  • Finally, ethical concerns need to be addressed every step of the way. An interconnected digital architecture has to prioritise patient privacy. That requires stringent regulations, and testing of proposed solutions. 

In the time of Covid-19, interconnected NHS structure is more relevant than ever. The technology to achieve this exists, but it needs to be integrated securely on a large scale.

Watch this space for more developments..