Why invest in digital?

Today's NHS is wrestling with three demand side challenges:

• Capacity
  Whether in the form of land, capital, or staff there is an ongoing challenge of managing resources across these areas to find balance.
  
  
• Efficiency
  To manage capacity constraints new forms of efficiency need to be found. This may be in the form of productivity gains – doing more with less. Or load balancing where increasingly hard to find skills can be easily deployed across a wider area.
  
  
• Paths to new models of care
  Trusts also need to manage reconfiguration of local services in line with national and local policy agendas such as integrated care systems, or alongside primary care networks.

Digital can support NHS providers to meet all of these challenges. However, this can only be achieved by delivering good digital services with high levels of take-up. Without this, the NHS will neither meet the raised expectations of patients and staff or deliver the financial benefits of digital transformation.

Here are three important reasons to invest:

1. Digital can help us achieve the triple aim of better health, better care, lower cost 

2. Digital is essential to meet people's raised expectations

Patients and clinicians are not just patients and clinicians: they are consumers of many other services. The digital transformation that has revolutionised other service sectors has raised people's expectations, and increasingly they are demanding more from the NHS.

This is evident in the growing number of people downloading the NHS app, ordering repeat prescriptions online and accessing NHS 111 online. And it's been clear for some time that patients increasingly want a single place to access their own, up to date health records.

We can see raised expectations in the clinical community in the rapid adoption of consumer technologies like WhatsApp in clinical settings. The ability to communicate in a simple, instant and mobile way was seized by clinicians previously hamstrung by out-of-date systems for sharing information.

A new generation of digitally native clinicians and patients will continue to demand more from the NHS. Without investment this expectation gap will grow, and 'shadow IT' will continue to serve the needs that organisations fail to address.

3. You can't afford not to

Providing safe, integrated care without investing in digital is increasingly difficult. From prescribing systems that check for drug interactions to data analytics that enables effective demand planning, digital is a critical part of trust operations. Regulators, leaders, patients and staff alike are demanding a minimum level of digital infrastructure in trusts.

As digital becomes a bigger part of how trusts operate, costs associated with digital increase. A common argument for digital is "invest to save". However, in his 2016 report Making IT work, Bob Wachter set out the challenge of seeking short-term financial returns from digital in healthcare:

Experience has shown that the short-term return on investment is more likely to come in the form of improvements in safety and quality than in raw financial terms.

In fact, cost savings may take 10 years or more to emerge (the so-called 'productivity paradox' of IT), since the keys to these gains are improvements in the technology, reconfiguration of the workforce, local adaptation to digital technologies, and a reimagining of the work.

Dr Bob Wachter    

If you invest only in technology without also investing in changing your teams, business processes and operating model, the investment may be wasted. Salisbury Foundation Trust's digital strategy makes explicit reference to the culture shift required across the organisation.