A lack of skills and knowledge coupled with work pressure on clinicians is preventing widespread and cost-effective IT modernisation across NHS hospitals, according to experts at Cambridge University Hospitals (CUH) NHS Foundation Trust.
Fran Cousins, chief operating officer at CUH, and Dr Afzal Chaudhry, chief medical information officer at CUH, both have instrumental roles in the trust's 10-year IT overhaul plan being carried out in partnership with HP.
Now two-and-a-half years into the programme, both have an insight into what's needed to remove the legacy systems and networks found in many NHS hospitals, and replace them with modern cloud-based infrastructure and technology.
During an event discussing the project held at the Academy of Medical Sciences in London, V3 asked Cousins what barriers exist to prevent more hospitals from following the example set by CUH, given the cost-benefits and improved care delivery such an undertaking can yield.
"I would say the first barrier is a lack of knowledge and understanding [of technology implementation], particularly at board level," she said. "You find in most NHS organisations they don't have a director of operations.
"Everything is transferred and communicated through someone with a bigger portfolio," she added, noting this approach often means there is no single individual who can focus on a complex IT transformation project.
Cousins said there is a serious lack of IT infrastructure knowledge within the NHS.
"We brought in a team of 10 people to actually provide the systems integration and programme management for ourselves," she said, explaining how with CUH's IT project, the trust tapped into the expertise from HP and medical software firm Epic.
But even with external help, Cousins said NHS hospitals still face the problem of a general lack of specialist IT skills and expertise in the UK.
"There just aren't enough people with the capability, competence and knowledge to implement and digitise 250 hospitals across the country," she said.
In an interview with V3, Chaudhry said the clinicians in other, and likely smaller, hospitals are under too much pressure to find the time or resources to think through a major reworking of their IT systems.
"Not every hospital is willing to give up the time to follow that thought," he said. "Many of them just don't have the bandwidth, either in time or money."
Chaudhry said strong leadership is needed to see a hospital through such a change, and that requires freeing up the time of clinical staff.
"Part of the [IT] implementation has to be some sort of process that allows clinicians to step back just a little bit, and start to think about what they might do," he said.
This room to think is important as Chaudhry said hospital leaders need to be able to understand the benefits a major undertaking will have in the long term against potentially steep upfront and interim costs.
Despite these challenges, Chaudhry said that as large NHS trusts like CUH push ahead with digitalisation projects they will build up a knowledge base that smaller hospitals can tap into.
"As a number of the bigger hospitals do it, there will be more learning and people will start to recognise what needs to be done," he said.
Furthermore, Chaudhry thinks the smaller hospitals can share some of the resources and IT strategies established by the bigger organisations.
"I think there needs to be a process where the smaller hospitals make use of the capabilities the bigger hospitals have," he said.
Chaudhry noted that a number of local councils share back-office systems and argued there could be a scheme that allows hospitals to do something similar.
This would mean taking an approach reminiscent of the government-as-a-platform proposed by the Government Digital Service, whereby pubic services are created from common shared components across the public sector in order to reduce the number of bespoke and costly systems.
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