Sam Shah has a very diverse portfolio: spanning clinical work, academic leadership, legal advice, and health tech advisory roles that see him travelling from the UK to the Middle East and back.
Shah has developed this diverse range of interests since he left NHS England and then NHSX, where he was director of digital development. So, he has excellent insight into the progress the NHS is making on digital – and he doesn’t think it’s great.
Lots of noise, very little action
“I do not think health tech has moved forward for the past five years,” he says. “There has been a lot of talk, a lot of initiatives, but very little activity. There have been five changes of leadership at NHS England on digital in the past five years, and a lack of transparency about what they have been doing.
“The digital maturity assessment [that was supposed to underpin the frontline digitisation programme to implement and expand electronic patient records] has never been published in full.
“NHS England says 90% of trusts have an EPR, but […] that statement is meaningless unless you have a definition, or can say how things have changed over time, or whether these tools are being used, or what difference they have made.
“The cost isn’t clear because it’s subject to constant reassignment. And even though the last Budget made another announcement on funding, there is no programme, no proper senior responsible officers, to spend it.”
In fact, he argues, Wales, Scotland and Northern Ireland have all made a lot more progress for a lot less noise by creating teams with clear digital responsibilities, allocating them a budget, and letting them run “small, useful” programmes in collaboration with their healthcare systems.
A three-point plan for progress
The UK is almost certain to go to the polls for a general election this year and it’s almost certain that Labour or some version of it will be voted in. Shah knows exactly what he would like shadow health and social care secretary Wes Streeting, who likes to talk about “reform” and apps, to do.
“He should establish a strategy, aligned with the system – which means industry partners as well as people working in healthcare,” he says. “He should pick three things to do well, and find the budget to do them, but delegate it so people don’t have to keep going back to the centre.”
And what three items would be on Shah’s wish list? “Number one would be to make it easier for clinicians to collaborate with other clinicians,” he says. “Not just referrals, or sending people from GP surgeries to hospitals, but the co-ordination of care across the system, or what we used to call ‘any to any’.”
This would not just smooth care pathways, he adds, but Amazonify healthcare. Just as people can use apps to track their parcels and modify their deliveries, they’d be able to see where they are in the healthcare system and make choices accordingly. Health is complex but decent platforms would make things a little easier.
“The second item on my wish list is to sort out the data environment,” Shah continues. “That doesn’t mean putting in one EPR, but making data fluid, so we can sort out data for our planning and our public health and our research colleagues.
“And the third thing would be to sort out the front end: whether that’s the frontend for clinicians or for patients.” Shah says this means modern, mobile technology that makes it easy to do basic tasks, like putting together a patient list, or viewing a series of appointments on a calendar.
Not lots of apps. “Clinicians are getting app fatigue from being told to download this and login to that,” he says, “and we don’t want to start giving our patients app fatigue as well. They are much more likely to want one login and one place to see everything, end to end as far as the NHS is concerned.”
Sort out today’s problems, then see what AI can do
Interestingly, Shah’s wish list doesn’t include AI, even though it seems to be compulsory for Streeting and other politicians to claim that it will solve all the NHS’ problems. “AI is interesting,” he says, “and everybody is interested in generative AI in particular, but we need to get the basics right.
“We need to solve today’s problems and then start layering in AI, when it’s mature enough, and we know which of tomorrow’s problems it’s going to help us with.”
Instead, he has costed his wish list – he reckons it would cost around £4.7 billion over the first three years of a five-year programme. After that, there might need to be some “top ups” – although he argues his wish list would deliver efficiency savings.
For example, a transparent and efficient referral system would reduce the need for referral administration and cut the number of GP appointments that are made by patients desperate to find out what has happened to their test or trip to outpatients.
Better data could help public health and its partners in local government to get back to addressing some of the inequalities, determinants of health, and lifestyle choices that drive demand at a fundamental level. And some nifty administrative tech could deliver significant efficiencies.
“I see in my own practice that people are in pain, so they ring a call centre for an urgent appointment but it’s made at a centre they cannot get to, at a time they can’t make, so they don’t turn up,” he says. “It really should be possible to stop that happening.”
Soundbites and spin doctors
Still, Shah is not exactly confident any of this will happen. Having seen some politicians at close hand, he feels they’re looking for soundbites to deliver to their electorate.
“They don’t want practical or costly. And this is practical and costly,” he sighs.” Those of us who have been in the system: we can say the right thing and not worry about it being the popular thing. But most politicians aren’t in that position.”
This might be an argument for following the lead of Wales and, to some extent, Scotland, and creating an arms-length body to plan and deliver NHS IT. Or, perhaps, to re-create one, as the NHS in England has tried a similar idea before, with the NHS Information Authority, and then NHS Digital, and NHSX.
Shah feels the idea has merit – but the fate of these bodies shows there are pitfalls. “There is no doubt that NHS England has got too big and there is an argument for breaking it up again,” he says. “But you should only do it if you can find the right model, and the right leaders.
“It can’t be like NHSX, where the friend of a politician was parachuted in, and created a circus before he went off to the zoo [NHSX boss Matthew Gould eventually departed for the Zoological Society of London].
“You need a good operator, who understands the NHS, but knows how to run a major programme and handle a big budget. If you can’t find one, you shouldn’t bother.”
Finding causes for optimism
And if Streeting did come knocking, would he be tempted to go back? Shah laughs. “Only if he liked my plan and could accept a dose of reality,” he says. And only if the right team was appointed, and promised the space to build, implement and deliver products.
Still, he says, there are reasons for optimism about health tech. “I think there is a commitment to improve access to healthcare for society, and I think it is recognised that inequalities have widened and there is a need to address them” he says.
“So, there is an opportunity for digital, which is to bring data together to help clinicians to do the job, and to help planners make better public health decisions. And, of course, to be more transparent with the public. I think digital and data can get into quite an interesting space, and there is an opportunity to do it.”
