Blog / Would you start from here?

David Garbutt: October 09, 2018

I met a delegation from Estonia recently, who were discussing how they’d managed to build an fantastic integrated, set of healthcare IT systems. While they undoubtedly had vision, drive and technical insight, a key factor was that they’d started from a clean slate. After the break-up of the Soviet Union, they were pretty much starting from scratch, so could build modern systems without breaking anything that was in existence already. In a funny kind of way, their difficult starting point was an advantage.

I was struck last week by the fact that we don’t have the same starting point here, and everything is several degrees more complex. We’ve got a legacy of 30 years of IT systems, developed at different times and to serve different jobs. Let’s not forget - many of them work very well as individual systems and do the jobs they were designed for. We can’t afford to damage systems that provide essential services, but we do know that there are blockages getting in the way of staff delivering the best care. That’s why we need to build a National Digital Platform to transform the way information is used and accessed across health and social care.

The occasion was the first meeting of the steering committee for the NES Digital Service, chaired by Professor Andrew Morris of Edinburgh university and Health Data Research UK. We’ve assembled not just people from NES, but also Angus McCann from NHS Lothian (and formerly IBM), and Geoff Mulgan, CEO of UK innovation foundation Nesta. The purpose of the group is to provide the oversight and scrutiny about the work of the NDS, monitor performance, agree use of public funds and develop a programme of activity that will best meet the needs of the NHS in Scotland.

We heard about the Roadmap for the development of the Platform, and it was apparent that there is complexity at every turn in the road. We’re going to have to work with partners to carefully plan what we build and replace now, and what we leave until later. The big challenge is where do we start – which route should we take through the landscape of systems?

We also can’t promise to do everything at once. That much is clear. We just don’t have the capacity to do that. The other thing that came across is that we need to spend time maintaining legacy systems. Collectively, the NHS is going to need to maintain some areas while we transform others. And as part of that, we also need to give assurance to all the public sector IT professionals out there who have done an excellent job over years to deal with immediate local demands. We’re here to help them to make their services even better in the future. To that end, we’ve also set up a Transition Group drawn from eHealth leads, clinicians and local government – that and the Roadmap are things we may come back to in a future blog.

It’s good to know that we have started on the journey – looking at the architecture around the systems and beginning work around how to pull the various data sources together. In the meeting, I was impressed by the pragmatic approach to all this, and the important and thoughtful contributions from our partners on the committee.

Getting to our destination is going to require a partnership approach. We’ve had excellent input from our NHS and social care partners, and I look forward to working with them together in the future.

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