A digital NHS demands a procurement revolution

5 Dec 18

A digitally enabled NHS promises to transform medical treatment and patient experience but needs a major cultural shift in procurement and commissioning, argues consultant Colin Cram.



Digital technology is creating a global revolution in health care. Health and social care secretary Matt Hancock wants to build  “the most advanced health and care system in the world” and digital technology is at the heart of it. The clinical and administrative efficiencies resulting will enable more money to be invested in improving existing and new services and treatments and respond to rising demand.

Digital innovations will allow people to access specialist healthcare in their own homes. Video consultations will replace many visits to surgeries and hospitals. When face-to-face consultations are still needed, patients will be able to book them online – giving them control.

Appointments will be more convenient and, when there are delays, patients can be notified by text. According to Dr Sam Shah, director of digital development at NHS England and one of the team driving this transformation, there is early evidence that some GP consultations could be carried out through online channels.

As well as the convenience for patients and increased efficiency for the NHS, health benefits will be enormous. People will be able to manage their own health in ways that were not dreamt of just a few years ago.

Digital devices will allow patients or their relatives to monitor, in real time, a range of conditions that until now have required visits to the GP or hospitals. Monitoring can alert them to potential problems, prompt them to make lifestyle changes, and indicate whether or when they should seek medical advice. Devices can transmit real-time data to a specialist centre for analysis enabling quick and responsive action and keeping serious problems at bay.

Adoption of digital technology is likely to be helped by public support, who are very much in favour of using technology for healthcare purposes.

Technology may also help the NHS manage staffing pressures. Developing economies in South East Asia, India and the Middle East could soon start to attract doctors and nursing staff from the UK, creating a health workforce brain drain. Digital technology may be the only way that the NHS will be able to cope.

Many businesses report that NHS procurement personnel and commissioners create further obstacles to the adoption of new technologies

However, the scale and complexity of the NHS appears to be a serious obstacle to digitisation. Much of its organisational structure and estate were designed in a pre-digital era. It is composed of thousands of smaller organisations (7,454 GP practices, 207 clinical commissioning groups, 152 acute hospital trusts, 54 mental health trusts and 35 community providers) with diverse degrees of digital capability. A major challenge for the NHS is to ensure that the legacy structures adapt and do not get in the way of adopting this technology and preventing or delaying the full potential benefits.

Many businesses report that NHS procurement personnel and commissioners create further obstacles to the adoption of new technologies, with unnecessarily narrow and bureaucratic interpretations of EU and UK procurement law and resistance to change. Businesses approved to be NHS suppliers frequently complain to me that they have to spend a huge amount of time visiting hospitals to try to persuade them to consider using their products – even when huge benefits have been demonstrated

Small businesses do not have the resources to do this. If Matt Hancock is to achieve his ambition, there needs to be a huge cultural change in procurement in many trusts. Procurement personnel and commissioners need to align their objectives with those of the CEO.

For example, rather than contracts for cleaning, contracts to minimise infection could encourage innovation, creating large savings that could be used to improve patient care and save lives or unnecessarily long stays in hospitals. Product and contract evaluation criteria must take into account the full benefits of innovations, of which price may be a small proportion or virtually irrelevant. Best and most cost effective solution should replace lowest price as the key criterion for letting such contracts.

The challenge for politicians and senior health and local government managers is to facilitate an agile health and social care service that responds to the opportunities created by the very fast evolving digital health world. This will require a huge cultural change in many NHS organisations. It may require that those that are unwilling or unable to adapt should be taken over by those that are.

  • Colin Cram
    Colin Cram

    Colin Cram is a public sector consultant specialising in procurement.

    He has worked in the UK public sector for over 40 years. At the Cabinet Office in the early 1980s he initiated the drive to improve public sector procurement. He set up several central procurement and contracting organisations, including in the then Department of Health and Social Security, the North Western Universities Purchasing Consortium and Research Councils.

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