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May 24, 2018
Getting the UK health system to the moon is about giant leaps, not small steps—Part II
By: Dan West

In my last blog we covered the importance of re-imagining how health can be managed for better outcomes, rather than maintaining perverse, volume-based incentives to treat people who are already unwell, and how incremental changes in efficiency are not going to be sufficient to sustain the UK health system in the long term.

There are many challenges when it comes to taking a Lunar Leap, but I’d like to narrow them down to two main categories, if you’ll bear with me: financial, and transformation capacity and capital funding.

About the money…

On the financial side, health CEOs and CIOs are wrestling with several issues. First, IT budgets (as a proportion of annual budget / turnover) in the UK health organisations are lower than almost any other industry—resulting in systematic underinvestment in technology. Then, in the current climate, aggressive cost improvement targets result in growing pressure on all spending, including IT, which exacerbates the problem. Trust boards struggle to justify investing in replacement, or in the evolution of IT systems that are adequate for current operations (if it ain’t broke, don’t fix it). This sometimes implies accepting risks by continuing to operate, or failing to fully maintain, unsupported technology, which can result in increasing security vulnerabilities (see WannaCry for more details).

Then, despite a growing volume of anecdotal evidence and advocacy, there’s still a lack of validated, empirical evidence that IT investment (digital?) can be an enabler of significant efficiencies in organisations and regions. At times, when faced with the inevitable “do we do A, or do we do B?” business case and budget decisions, there is an understandable unwillingness among Trust boards to make a big, strategic commitment in the face of this uncertainty. Added to this is the historic absence of a macro-economic model at a regional level, or the ability to address wider regional spending, that allows reductions in one area to be offset against benefits in another (recognising that the new wave of ICSs may begin to address this). There is also little clarity on the availability of longer term external capital for the purposes of future planning (the need for right-and-proper discipline being applied in business cases and applications for funding is understandable, but results in lack of ability to forecast effectively).

In terms of transformation capacity and capital funding…

While public healthcare eco-systems can often create a vision about how they want to deliver services in the future, they often find it difficult to create the buy-in across the different leadership teams and organisations that allows them to take the journey, and the experience to know how and where to start. They are in desperate need of the capacity to break down big transformations into small, deliverable chunks and accelerate delivery and benefits across multiple organisations as well as the resources that can foster collaborative leadership to create alignment and break down silos. At the same time, they require the agility to define requirements and quickly procure new services and information systems from the market. Often, the eco-systems also lack the discipline to fully realise the benefits of each change, and the funding to be able to deliver the transformation at scale.

Where there is national investment cascading to the end delivery organisations, it is often enough to "get to the start line" but seldom sufficient to fund the full organisational transformation that is needed to realise the potential that Digital has delivered in other industries.

If you’re struggling to take the Lunar Leap, whether the obstacle is more financial or more to do with transformation capacity, and you’d like to bounce some ideas off us, please feel free to get in touch.

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