Technology is advancing at a fast pace and holds significant promise for the future of healthcare and the NHS, with the potential to enhance productivity through cost, resource and time efficiencies. Yet there is a gap in practical guidance for healthcare stakeholders on how best to take this agenda forward, and what key roles are required.
Systems are now in a place where people can take a large-scale view and make connections across the system to advance the technology agenda. To support them, the NHS Confederation and Google Health have developed this guide.
Supported by:
About this guide
Who this guide is for
Intended for NHS leaders and those leading on the technology and transformation agenda within their organisation, this guide will support you to:
- review transformation plans against five key components for unlocking the future of patient-facing technology in healthcare
- stimulate conversations with team and board members, using our actions framework
- bring external stakeholders and partners together to assess priorities for patient-facing technology.
The NHS Confederation and Google Health are committed to making a contribution to support digital innovation being fully adopted across the NHS.
How this guide can help
This guide:
- Showcases what the future of healthcare could look like and challenges your own, and our, assumptions about what is possible for the NHS.
- Demonstrates the future is already happening, and that developments can be harnessed to support high-quality, effective healthcare.
- Highlights the potential actions technology leaders can take in the short and medium to long term to support reaching the ideal future state.
- Builds on a 2023 NHS Confederation report, supported by Google Health, based on findings from an Ipsos survey.
- Elaborates on the report’s finding that people want more control over their health but would prefer healthcare professional endorsement.
- Reflects the report’s finding that people felt there is a role for health technology but lacked confidence in using it.
How we developed the guide
Exploring the here and now
The technology leader experience in 2024: meet digital leader, Amelia Davies
Context
Amelia leads her organisation’s technology strategy and implementation. She is experienced in this field and has been involved in impactful projects, including supporting her organisation to transition to electronic patient records, thanks to an influx of funding that made the project possible. However, Amelia feels as though she is continually fighting to balance access to capital and revenue funding in the NHS. A lack of revenue funding is resulting in insufficient resource to support the effective implementation of technology.
Amelia is continually frustrated by the absence of an aligned strategic view and short-term thinking surrounding technology infrastructure. With growing elective waiting lists and industrial action, Amelia’s to-do list is growing bigger and leaving her limited headspace to think about doing things differently or in a more strategic way. When she gets a moment, she is limited with what she can do because of non-recurrent and / or small funding pots which cannot fund a full project from design through to implementation and monitoring. She looks forward to a time where her role can be more clearly defined and have access to sufficient project management support to enable a consistent and effective approach to change.
Opportunities to collaborate
Like many of her colleagues, Amelia is passionate about ensuring access to technology for the entire community, not only those who can afford it or have confidence. She is keen to find solutions to reduce health inequalities. She acknowledges that technology can widen the inequality gap and tries to avoid this, but feels as though she needs support in this area. Amelia recognises that she has an important convening role as a leader, but feels as though she would benefit from guidance on who else to engage and for what reasons. She is working to navigate the variation in roles and responsibilities of her peers in similar roles in other organisations, but the picture can sometimes feel muddled and confusing.
Culture and purpose
A key challenge Amelia has faced when trying to implement something new is a cultural resistance to new ways of working among colleagues, partially driven by how busy the current system is and organisational siloes. She acknowledges that the system is on a hamster wheel and is continually trying to support colleagues with adopting new technology that will make their lives easier. However, the appetite to learn new systems or how to operate new technology is variable, and the pace of implementation can be frustratingly slow. Amelia is clear in her mindset that technology can help bring about positive change in healthcare, and that the change itself is what matters. She tries to focus minds on opportunities to free up staff, provide assurance that accurate information and data are readily available, and align the correct capacity to deliver high-quality care.
Envisioning the patient journey of the future
The patient experience in 2027: meet Javier Rodriguez
Using technology
Javier uses technology as part of his management for his diabetes. He was keen to understand how the technology would work but had some concerns at first. Staff at his the GP practice walked him through how to use the apps and wearable device he was prescribed. This gave him greater confidence and reassurance. The practice team also explained the security of Javier’s personal data as part of this discussion. He was signposted to resources through his GP practice and local patient group and now has a greater understanding of the ways in which using technology can be helpful and how it is used by patients and healthcare staff. He also knows that should he need to see a medical professional, this will still be part of his care, and is not being replaced by the technology he uses.
Experience
Javier has noticed the benefits of using technology, including more control over his condition, fewer trips to GP and hospital and the ability to manage his diabetes at home. He has noticed a positive change when he does need an appointment in that staff already know about his condition, and he doesn’t have to repeat his history. When he experiences an incident with his diabetes, Javier appreciates being proactively contacted by his GP via text message and app messaging, and having the ability to proactively contact the team with his own concerns when needed. Javier finds it reassuring that the data he is collecting is being monitored to prevent his condition deteriorating too far.
Feedback and improvement
Javier was invited by a local patient group, along with a mix of community members, to provide feedback about his experience using technology as part of his care. This was part of a conversation in his local area about deciding which solutions were required and how technology might work in the future to support people’s health. Javier thinks this patient involvement has meant that the solutions have a better chance of working well, and he was pleased to see doctors involved in the discussion about using technology.
Javier is now a huge supporter of technology, but his uncle Jim has arthritis and is unable to use apps and wearable devices because of his condition. Javier is grateful that his uncle is able to access healthcare through the traditional way and that, despite a shift towards use of apps and wearables, his uncle hasn’t been excluded from receiving the care he needs. Javier has spent time with his uncle to show him how the technology has worked well in his care. Jim has been sent educational materials and invited to join a peer support group to help support him using technology if he wants to.
Envisioning the healthcare system of the future
The healthcare worker experience in 2027: meet Dr Malik Ibrahim
Context
A large proportion of Dr Ibrahim’s patients regularly use technology as part of their care. In his training, Dr Ibrahim and other patient-facing members of staff in his organisation were shown the use of a range of technologies in healthcare. This included receiving training in the use of core digital administration tools, as well as innovative patient-facing technology helping to drive prevention and population health management. He also received training in how to best discuss and explain technology with patients in ways they understand and is confident in linking patients to peer support resources which aid their journey in using technology in their care.
Implementation and integrated working
Increased flexibility in budgets, and better collaboration across organisational boundaries, has allowed Dr Ibrahim’s local healthcare system to be more strategic with the technology they purchase and implement, and he and his patients are starting to feel this difference. There has also been an effective change management process running alongside the digitisation which has helped people adopt a new way of working and make improvements in an organised way.
Dr Ibrahim also appreciates that there is a robust process for evaluating technology, and stopping or amending technology that is evaluated as having a negative impact on health inequalities. When new technology is being implemented, Dr Ibrahim has been informed of the learning from evaluation projects in other regions spearheading these new approaches. These clear data outputs have allowed him to understand the impact of the planned change and has meant that implementation in his region has learned from elsewhere.
Confidence and impact
One of the biggest changes Dr Ibrahim has noticed is the connectivity between datasets within and between organisations. When a patient comes into his office, he can see their medical history even if their last appointment was in a different setting of care, and if they have a wearable, he can see their recent health and wellbeing data. This has made his appointments more impactful as baseline details are available about the patient before they even sit down, and he can be more productive as a doctor. Artificial intelligence is integrated into some of the digital tools Dr Ibrahim uses, and this saves him time and supports him in delivering high-quality patient care with greater productivity. He is confident in his communication with patients, and in their communication with him both using digital tools and in face-to-face interactions, as these are informed by accurate and timely information.
Because many of his patients are able and supported to self-manage at home, Dr Ibrahim has more time to focus on patients who may be harder to engage in the healthcare system, or who prefer not to or cannot use technology.
Turning vision into reality
Several key components were needed to turn Javier Rodriguez and Dr Malik Ibrahim’s experiences into reality:
Integrated IT infrastructure
Patient-facing tech fed into existing workstreams, meaning Dr Ibrahim could access data from primary and secondary care and Javier didn’t have to repeat his story. The solutions fitted into the existing IT infrastructure, meaning Dr Ibrahim had a streamlined experience.
Innovative finance models
Multi-year budgets allowed Dr Ibrahim’s system to invest in capital investments and revenue for implementation. Dr Ibrahim also felt the benefits of strategic deal-making at regional level.
Implementation and access
Javier had access to technology and was supported in using it, leading to adherence and sustained adoption. Appropriate change management processes were in place to support staff and technology was evaluated to ensure it was meeting its objectives.
Education and awareness
Staff and patient organisations were trained to explain to Javier how to use technologies. Javier was aware of why he was using technology and bought into the idea.
Collaboration
Co-design with patients meant that apps and wearables were fit for purpose. Including implementers in discussions meant there was a smooth roll out. Continuation of traditional mechanisms of patient care helped to ensure no one was left behind
Making the future a reality
1. Integrated IT infrastructure
What can you start today to progress this agenda within your organisation? The actions below are based on insights from interviews and an interactive workshop with NHS stakeholders and patient organisations working in this space.
Actions that can take less than 1 year to implement and see impact
Conduct a diagnostic to identify gaps: Undertake a strategic needs assessment and diagnostic of the existing digital infrastructure on a regular basis, in line with your organisation’s digital strategy, to identify any gaps or areas for optimisation related to patient-facing technology.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? IT, clinicians, patient organisations / patients
Check functionality of existing technologies: Ensure that any data from existing patient-facing technology is being monitored, stored and actioned appropriately.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? IT, clinicians
Confirm population technology accessibility needs: Analyse if there are areas of your community that have different technology accessibility and if there is a way to design technology systems to ensure these groups do not get left behind.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, patient organisations, VCSE, patients
Collaboratively design solutions that solve a genuine problem: When a solution is required to address a problem identified during the diagnostic phase, co-design and shape the solution with all relevant parties in the room to ensure transformation achieves the desired end result.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, patient groups, VCSE, patients, local authority
Determine if new technology is needed and, if so, what the interoperability requirements are: Assess whether existing infrastructure has the capability to add developments or add-ons to meet future needs, and critically assess the interoperability of new solutions and how they connect to existing infrastructure before selecting a new piece of technology to implement.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? IT, clinical leads
Actions that can take 1-3 years to implement and see impact
Think about how to connect with organisations outside of your own: Explore how to increase data sharing across organisational boundaries, such as between primary and secondary care, and with social care. Leads: Transformation / technology leads
Who needs to be consulted/engaged? Transformation/ technology leads in other organisations
Identify synergies that could be achieved through shared services: Assess whether there is the potential to streamline services between organisations for example an IT helpdesk across a system or at regional level.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Transformation/ technology leads in other organisations
Learn from peers: Understand what other organisations have done on the patient-facing technology agenda, and what lessons can be learned.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Transformation/ technology leads in other organisations
Advocate to government and NHS England for more capital investment: Appeal to government and NHSE for adequate investment in capital to enable upgrading of obsolete IT systems over a longer period of time.
Leads: Chief executive / chair via NHS Confederation
Who needs to be consulted/engaged? IT, clinicians
Keep integration on the agenda at a national level: Make the case for better integration systems between organisations such as prioritisation of API integration across providers in primary care, expanding GP connection to optometry and dentistry in addition to community pharmacy.
Leads: Transformation / technology leads via NHS Confederation
Who needs to be consulted/engaged? Regional leads, leaders from other organisations
2. Education and awareness
Actions that can take less than 1 year to implement and see impact
Understand the patient experience of using patient-facing technology: Regularly collate patient feedback and adherence data to identify how effectively patients can use prescribed patient-facing technology, and determine if there are knowledge gaps or areas for support. Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, patients, patient organisations, VCSE
Understand the staff experience of showing patients how to use patient-facing technology: Regularly gather insights on the staff experience of explaining patient-facing technology to patients, and determine whether there are knowledge gaps or areas where they feel they could use more support.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, any staff member who is involved in implementation of technology
Design training programmes to upskill on areas of need: Based on the knowledge gaps identified, seek out our design training programmes to support patient and staff with the areas where they could use support.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, any staff member who is involved in implementation of technology, NHS England
Raise awareness of what is available and potential benefits: Work together with local organisations in the community to raise awareness of the choices for patients available from your organisation, including traditional and digital options, indicating for whom digital options may be appropriate for and the benefits of using it for self-management for both the NHS and patients.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Local authority, patients, patient organisations, VCSE
Actions that can take 1-3 years to implement and see impact
Assess the environment of potential partner organisations: Understand if there are existing groups who your organisation could build relationships with to support raising awareness of options available for patients within underserved communities.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? VCSE, patient groups, local authority
Advocate to government and NHSE for technology training for patient-facing staff: Advocate for improved training on both the use of technology in healthcare and the effective communication with patients on this topic, to be part of the curriculum for relevant patient-facing staff.
Leads: Chief executive / chair via NHS Confederation
Who needs to be consulted/engaged? IT, patient-facing staff
Support patient awareness and knowledge: Campaign to ensure the public rights surrounding their data are clear in the NHS Constitution as this helps with promoting self-empowerment among the public.
Leads: Information governance leads
Who needs to be consulted/engaged? Transformation / technology leads, patient organisations
3. Implementation and access
Actions that can take less than 1 year to implement and see impact
Support the change, not just the technology: Develop change management programmes alongside any technology implementation to help staff adjust to new ways of working.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, any staff member who is involved in implementation of technology
Design patient-centric processes: Devise robust standardised operating procedures and key performance indicators (KPIs) for patient-facing technology projects with a focus on patient and staff outcomes and experience, rather than only the technology implementation.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Patient organisations, clinicians, any staff member who is involved in implementation of technology
Promote equitable access: Signposting and reassure those who struggle or prefer not to use technology that traditional methods of care are also available.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, patient organisations
Actions that can take 1-3 years to implement and see impact
Design with improvement in mind: Build continuous improvement methodology into implementation plans to help ensure technology is relevant and usable.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, any staff member who is involved in implementation of technology
Track KPIs and processes to stop inappropriate technology: Monitor the impact of patient-facing technology against agreed KPIs and have a process in place for stopping or adapting technology that does not meet KPIs.
Leads: Transformation / technology leads
Who needs to be consulted/engaged?Clinicians, any staff member who is involved in implementation of technology
Pre-empt stakeholder concerns and proactively design support: Look ahead to what technologies are in the pipeline and begin collecting any staff or patient concerns early so adequate support is in place at time of roll out.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Clinicians, patients
Ensure implementation costs are not forgotten: Campaign to ensure capital projects have associated revenue to ensure the implementation is conducted in an effective and streamlined way and so that future technology iterations are factored in.
Leads: Chief executive / chair via NHS Confederation
Who needs to be consulted/engaged? Clinicians, and other roles involved in implementation
Prevent digital exclusion becoming a barrier to access: Ensure investment into traditional services remain, even if this is for a minority of patients, to ensure no one is left behind.
Leads: Chief executive / chair via NHS Confederation
Who needs to be consulted/engaged? Transformation / technology leads, patient organisations
4. Innovative finance models
Actions that can take less than 1 year to implement and see impact
Set up contracts with a population health view: Consider using outcomes-based contracts for technology that put emphasis on reducing health inequalities.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Regional leads, leaders from other organisations
Actions that can take 1-3 years to implement and see impact
Assess if there are economies of scale through partnering: Identify if there are areas where cross-organisational alignment would be beneficial to take advantage of greater purchasing power.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Peers
Advocate for greater budget flexibility: Make the case for a shift towards multi-year budgets, budgets with longer time horizons and greater flexibility to enable more strategic purchases and investment in patient-facing technology.
Leads: Chief executive / chair via NHS Confederation
Who needs to be consulted/engaged? Clinicians, and other roles involved in implementation
5. Collaboration
Actions that can take less than 1 year to implement and see impact
Engage a broad set of stakeholders: Involve relevant end users and implementers in design, implementation and roll out, genuinely committing to co-designing services.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Patients, patient organisations, local authority, clinicians, any staff member who is involved in implementation of technology
Consult with communities that do not traditionally engage with patient-facing technology: Ensure diverse voices are considered and that underserved communities are consulted to understand how to broaden access to patient-facing technology.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Patients, patient organisations, local authority
Actions that can take 1-3 years to implement and see impact
Identify opportunities to collaborate at scale: Explore system-wide and regional opportunities to collaborate at scale, building and implementing innovative investment partnerships (see Case Study 2: South Yorkshire Digital Health Hub).
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Regional leads, leaders from other organisations
Reach out into other sectors: Identify relevant stakeholders across sectors, to ensure open lines of communication and ease of working throughout a project.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? NHS England, local authority
Signal key problems to industry: Articulate the needs of the healthcare system to technology providers to ensure future technology solves genuine problems.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? Technology companies, clinicians, patient organisations
Advocate for strategic pilot coordination: Consider how to design pilot programmes so they focus on quality rather than quantity, and can produce clear and usable data other areas can use to determine whether or not to implement technology.
Leads: Transformation / technology leads
Who needs to be consulted/engaged? NHS England, technology companies
Case studies
Warrington Innovation Network PCN and Etc Health: proactive care for Hypertension and COPD*
Context
- Warrington Innovation Network is made up of seven GP practices which cover a combined population of around 57,090 people.
- COPD exacerbations are the largest driver of A&E attendances, with 47 per cent of COPD patients experiencing at least one exacerbation per year.
- Poor blood pressure control is a national issue and a ticking time bomb for poor cardiovascular outcomes.
Opportunity
- Hypertension is a direct risk factor for heart attack and stroke. Blood pressure control nationally needs improvement.
- There are hundreds of excess heart attack and stroke risks to the integrated care system (ICS)** , resulting in millions of healthcare costs.
- Proactively managing long-term conditions and promoting health represents an effective way to support system and patients.
Intervention
- Proof of concept using HealthyYou app for patients to upload clinical data that can be viewed by clinical teams, but also provide opportunity to self-manage.
- Managed by Warrington Innovation Network PCN and supported by Etc Health (Part of BT Group).
- Patients who need .greater intervention are identified through risk stratification tools, and offered the HealthyYou App.
- Patients are supported with a dedicated clinical team, to guide through the process and achieve lifestyle changes.
Lessons learned
- Lifestyle intervention alone was the outcome for 80 per cent of consultations, resulting in a positive drop in blood pressure.
- Effective monitoring and support reduce the number of unplanned attendances and vastly increase patient satisfaction.
Impact
- Remote monitoring is efficient, offering patients intensive management with micro-interventions.
- Achieved average 12mmHg drop in systolic BP across the cohort, which equates to prevention of 10 heart attacks and 20 strokes in the 1,000 patients. The recent addition of AF (irregular heartbeat) case finding will further increase these numbers.
- Confirmed funding from the ICS to expand across the whole of Warrington (220,000 people) from April 2024, enabling the spread of innovation from one PCN to an entire place.
*How this PCN... set up proactive care for hypertension and COPD - Pulse Today
** Helping the NHS to prevent heart attacks and strokes at scale
South Yorkshire Digital Health Hub and Google Health tech research and training - tackling inequalities and driving economic growth***
Context
- The South Yorkshire Digital Health Hub (SYDHH) is a partnership between University of Sheffield and Sheffield Hallam University, the South Yorkshire health and social care system, the South Yorkshire Combined Mayoral Authority, patient and community groups, and industry partners.
- Initially funded by a £4 million grant from Engineering and Physical Sciences Research Council (EPSRC), the ambition of the SYDHH is to tackle healthcare inequalities and transform how patients are treated in South Yorkshire through faster and more effective digital innovation and improving digital skills across the local health and care workforce.
Opportunity
- The hub serves the population of the South Yorkshire region, comprising around 1.4 million people. There is marked socio-economic deprivation in large parts of the region, with an associated high burden of disease and marked health inequalities.
- Given this, the ambition of the SYDHH is to transform the health of the local population, working in partnership across academia, local public services and industry. Intervention
- Google is working with the Digital Health Hub to support this ambition in a number of ways.
- It is supporting upskilling the local population through digital skills training scholarships and digital apprenticeships.
- It is also supporting research looking at how wearables can be used to improve care pathways, as well as funding innovative AI research. The first research project aims to understand whether smartphone sensors that detect light, radar and electrical signals from the heart could aid the detection of common conditions such as hypertension, high cholesterol and chronic kidney disease.
Lessons learned
- The SYDHH is still in its early stages; but it is already clear that bringing together a wide range of partners into the collaboration has been really important. Focusing on upskilling local health and care workers and local businesses will prove as important as the technology itself.
Impact
- The first citizen’s jury identified principles and priorities for digital health innovation that embed the public voice in all work.
- As the projects develop, the use of new types of data (such as from phones, wearables and other devices) linked with NHS data will provide new insights to improve prediction, prevention, diagnosis and treatment of diseases in South Yorkshire and across the UK.
*** South Yorkshire to be focus for smartphone illness prevention study; South Yorkshire Digital Health Hub unveils Google investment to tackle health inequalities and drive economic growth
Current developments supporting this agenda
Policy developments are supporting a positive direction of travel for the patient-facing technology agenda:
Call to action
We're all in this together. The NHS Confederation and Google Health are supporting with making this a reality.
NHS Confederation
There is a lot of optimism in this field and some positive examples showing we are not starting from scratch.
Our workshop showed that several of the enabling actions to move this agenda forward are feasible, and some of the unlocking actions can be adopted today with minimal effort, including effective co-design and greater collaboration across organisational boundaries.
We are encouraged with continued advocacy for this agenda, we can make some of the feasible actions a reality.
Google Health
We have been delighted to partner with the NHS Confederation on this work around digital empowerment. Both our prior report and this practical guide demonstrate there is a willingness for individuals to make better use of technology and steps health systems can take today to meet this demand.
We remain positive about the opportunities to harness technology and change the way individuals access and receive healthcare.
As an industry partner to the NHS, our role is to collaborate with local and regional technology leaders to bring this to life. We look forward to continuing this journey with you. We’re all in this together, The NHS Confederation and Google Health are supporting with making this a reality.
