The government's Health and Care Act 2022 sets out plans to reform the NHS in a move to deliver more joined-up care. The Act introduces the requirement for all of England to be covered by an integrated care system (ICS). Legal obligations are imposed on NHS England to ensure every area in England is covered by an ICS or integrated care board, and clinical commissioning groups will be abolished.
In England, electronic patient records (EPRs) have to be implemented in at least 90% of NHS trusts by December 2023. Currently, around 80% of NHS trusts have EPR systems in place. The 45 trusts that are lacking the technology to have EPRs in place or to be processing them by the end of 2023 will need support to meet the target. By March 2024, 80% of social care providers will take on digital social care records, presently around 40% are believed to rely solely on paper records. As part of NHS reform there will be an increased role for the NHS App, with an aim to get 75% of all adults in England using the app by March 2024 (Iacobucci, 2022).
New policies aim to modernise the NHS, bringing benefits to patients and building on lessons that should have been learned during the COVID-19 pandemic, with the focus on avoiding ill health, enhancing performance and increasing patient choice, as well as modernising the legal framework with the intention of making the NHS fit for the future.
Lessons learned from the COVID-19 pandemic should be exploited, public engagement with the NHS App has demonstrated that connecting with technology in health care is a reality that can be developed further and sustained. It is acknowledged that the NHS App is not without its critics and that it, too, will need refinement. Patients can be encouraged and supported to use the technology, using their phones to book appointments, to engage with practice nurses and GPs, see results of tests and seek advice to help manage their health and wellbeing.
Although patients need to be encouraged to use the technology, healthcare staff also have to embrace the technological transformation. However, they can only do this if they have the right tools and are offered the right preparation. If the Secretary of State for Health and Social Care wants the NHS App to be ‘the new front door to the NHS,’ then he first needs to give the key to those who open that door every day – NHS staff.
Trusts will require increased support to turn this ambition into a reality. This includes securing appropriate funding and staff who are equipped with the right skills and abilities so that they can work with the myriad of commercial enterprises that provide the infrastructure.
Caution needs to be considered and attention paid to ensuring equitable access to electronic systems. It is recognised that improved and enhanced access to digital information, technology and data is beneficial for a number of patients, but there is also an inherent risk of leaving some patients behind. Data poverty is one risk, this is the inability to afford a sufficient, private and secure internet connection so as to meet essential needs (Lucas et al, 2020). This is a determinant that can prevent people accessing and benefitting from the proposed developments and reforms being put in place. Data poverty has the real potential to leave communities behind, and is a serious threat to government ambitions to level up. Plans and solutions have to be devised that counter the effects of data poverty if the government is serious about its levelling-up agenda.
This is yet another attempt to digitalise and harmonise systems within the NHS – not an easy task. In embarking on any attempts to make the NHS fit for the 21st century, this will only come about when the most fundamental aspect is addressed – dealing with the chronic workforce shortages. Staff shortages are affecting every area of care and this has to be dealt with urgently or else the drive to modernise is certain to fail.