Digital change in health and social care

Authors: David Maguire, Harry Evans, Matthew Honeyman and David Omojomolo
The health and social care sector is struggling to come to terms with increasing demand due to demographic and other changes and decreasing growth in funding. The arrival of new technologies offers opportunities to transform services so that they are better able to cope with these pressures. Furthermore, providers and commissioners of care are looking for ways of using digital technology to plan services better, provide more informed care at the point of delivery and keep records more secure.
There is a widely held belief that the health and social care system struggles to manage change involving digital technology. This belief is driven by events such as the National Programme for IT (NPfIT), a £10 billion-plus investment in digitising the records of every patient in the NHS, which ended up achieving a fraction of the original vision; the impact of the WannaCry cyber-attack on NHS services in May 2017; or the age of much of the software or hardware being used across England, for example. The Secretary of State for Health and Social Care, Jeremy Hunt, has emphasised that any ten-year plan will require the NHS to become ‘massively more teched up’ (Lintern 2018). However, numerous trusts and care providers around the country are already progressing towards more digitised care and record-keeping, both technically advanced organisations that form part of the Global Digital Exemplar (GDE) programme and organisations outside of it.
This report aims to support health and social care organisations that are looking to undertake large-scale digital change, no matter what their current level of technological advancement. It offers a practical understanding of the factors that contribute to successful large-scale digital change by bringing together the experiences of five case study sites that have already made significant progress towards achieving their change aims. Although we frame this report in terms of ‘digital change’, it is important to note that for many of the people we spoke to for this research, this was a clinical change process, not specifically a digital one.
When we refer to ‘large-scale digital change’ throughout this report, we mean a change process that involves a large number of staff and that requires them to significantly change how they perform their roles. One example is the implementation of an electronic patient record (EPR), which enables the way services are delivered to be changed using telemedicine or monitoring technology or introducing mobile working for staff. Our case studies have already completed such changes, and some are now completely digital across all specialties in their hospital or community settings. Smaller, in-team innovations are not covered by this report.
Attempts at large-scale digital change have often faltered for a number of reasons. First, care services are under severe pressure across the country at the moment, and putting into place new, disruptive working processes has introduced a new series of risks and challenges for trusts to deal with. Furthermore, some organisations have struggled to find the resources needed to implement digital technology, given the cost typically involved in buying the necessary hardware or software. Some organisations have found it difficult to make the cultural changes needed as they have struggled to engage their end users, while others have had problems with partner organisations both inside and outside the public sector. Organisational memory can also be an issue: some providers have not undergone large-scale change in such a long time that they no longer have that experience in‑house anymore.
We were unable to find any distinct large-scale digital change examples in the social care sector, although some of our case studies do include interviews with social care professionals and we present as much information on the sector as possible throughout the report. We therefore focus more on examples in the NHS. The case studies we present in this report faced their own unique set of challenges in making digital change happen. But they also developed their own solutions and give hope that large-scale digital change programmes can succeed in the NHS.
Section 2 examines the evidence behind digital technologies as well as lessons for successfully implementing and managing digital change. Section 3 onwards is our contribution to this evidence base, starting with a summary of our methodology and what is happening in each of the case study sites. Section 4 describes the key themes in our findings in relation to factors that can make or break digital change. Section 5 concludes the report.