Baroness Blackwood on NHS tech transformation

Nicola Blackwood is the minister responsible for life sciences, NHS innovation, and technology. She talked to Susan Venables and Lyn Whitfield about the government’s developing IT strategy, and her conviction that IT will not just support but transform the health service over the next five years.

For much of the past decade, Nicola Blackwood has been described by political commentators as a “rising star of the Conservative party.” Elected MP for North Oxford in 2010, she soon attracted attention as chair of the science and technology committee.

She became a junior health minister when Theresa May took over from David Cameron; before suffering a set-back when the prime minister called a snap general election to try and bolster her Brexit negotiating position. May lost her majority, and Blackwood lost her seat to the Lib Dems.

Blackwood was not out of government for long, however. When Lord O’Shaughnessy resigned for family reasons in December 2018, she was invited to become a parliamentary under secretary of state in the Lords, and to take on the NHS research, innovation and tech brief. Asked how she feels about her return to the Department of Health and Social Care she says: “It is a real pleasure; it feels like coming home.”

Although it is a home in which a good deal has changed. Over the past two years, the NHS Long Term Plan has been published, Jeremy Hunt has been replaced as health and social care secretary by Matt Hancock, a shake-up of central and regional organisations has started, and Hancock has published a tech vision that focuses on cloud-based, internet-first technology and open, interoperable systems.

“The really interesting thing about coming back to this job for the second time is being able to see the momentum that has been built up,” Blackwood says.

“There has been technological progress, we have got some key arrangements in place, there is more capacity – and we have a health and social care secretary completely committed to health technology and transformation in a way that is fully integrated into the agenda of the NHS. It is a real step change.”

Strategies for the future of medicine

In her maiden speech to the Lords, Blackwood spoke about her “great sadness” over losing her seat in the city where her father, a cardiologist, met her mother, a scrub nurse, and where she both grew up and studied music at the university. She joked that it had been “a joy to represent a research-intensive seat” – even though she had to be constantly ready for “impromptu tutorials from world-experts” looking for support.

She has also spoken about her diagnosis with Ehlers-Danlos syndrome, a condition that affects the joints and muscles, after suffering joint pain, migraines and asthma. So, it is, perhaps, no surprise that in the first few months she has focused on the research and personalised medicine aspects of her brief.

In February, she used rare disease day to preview the government’s national genomic healthcare strategy, which will be launched this autumn with the joint aims of “making the UK a global leader in genomic healthcare” and to improving services for people with rare conditions.

Subsequently, she has given an important speech on AI and digital health that discussed how regulation, training, and funding will need to change to harness the benefits, and backed the creation of digital innovation hubs to give scientists and innovators controlled access to NHS data.

And, the day before Highland Marketing went to the Lords to meet her, she announced improvements to the Accelerated Access Collaborative, first set up in 2018, to drive the “most promising medicines, diagnostic tools and digital services” into the NHS”.

Asked why she has given such high-profile support to genomics and personalised medicine, she says it is because “we are world leaders in these areas; genuinely ahead of the pack” and also because there is a clear role for government.

For example, she says the genomic healthcare strategy sends clear signals on key issues like regulation and consent “so suppliers know where we are going, and clinicians and patients can see where we are going, and everybody can have confidence in that.”

While the Accelerated Access Collaborative will look to speed up testing and regulation and “make it easier for the NHS to buy innovations” by “sorting out procurement” and amending the ‘cost neutrality’ rules that stop the NHS adopting ideas that cost it more; even if they should deliver savings in the long-term.

Tackling enterprise IT  

There are other barriers to the NHS using digital technologies and moving into the new world of AI-supported medicine and advanced analytics. For one, many hospitals and community services have yet to complete the roll-out of electronic patient records that are still needed to connect into new, clinician and patient-facing services and to feed those machine learning programmes and population health management algorithms.

At the same time, some of the mental health and primary care services that made more progress a decade ago are now struggling to maintain their systems and infrastructure. Since the Wachter Review of NHS IT, the global digital exemplar and local health and care record exemplar programmes set-up by NHS England have been the main vehicle for addressing the first of these problems.

However, the GDE programme’s enterprise-IT approach has not been easy to align with Hancock’s tech vision, and it has not been clear what would happen to it with the arrival of NHSX, the new unit being set-up to coordinate policy, streamline decision making and take on a host of other IT-related activities.

Blackwood recognises the need to complete the EPR agenda, but shortly after Highland Marketing met her, the departure of Matthew Swindells, the deputy chief executive of NHS England who has been closely associated with the GDE programme, was announced. With his departure, it became clear that the programme was, indeed, under review.

Her office says now: “We are currently reviewing all our major tech transformation programmes. We want to co-ordinate them in a way that brings them into line with our tech vision, takes advantage of new technology, and delivers the results that we all want to see for patients and staff.”

The results of the “re-prioritisation programme” that is now under way will be announced “in the coming weeks.” Meanwhile, in her interview, Blackwood also hints that some kind of support is being planned for the so-called laggards; the trusts furthest behind on IT, that have so far failed to benefit from the GDE programme, despite its declared aim of providing support for fast follower organisations and blueprinting.

Unfortunately, she can’t bring herself to say more for the moment. “Watch this space,” she says, “because we have to raise the standard and improve overall. That is why we have brought in the focus on interoperability. But I can’t say more… just watch this space.”

Creating clarity, NHSX

The announcement of NHSX has attracted huge attention, with the health tech community speculating on what it will mean not just for some of the big tech programmes underway in the NHS, but for the other bodies that have health and care IT responsibilities.

Blackwood is keen to squash speculation that it will replace NHS Digital, the agency for which she has ministerial responsibility as part of the data, digital, technology and cyber security part of her brief.

“NHS Digital has deep expertise in the management of large-scale, complex IT systems. It will continue its statutory functions of delivering data and statistics and managing national programmes, such as the NHS Spine,” she says. “The creation of NHSX will mean that NHS Digital can focus on these core responsibilities using its unique skill-set to build and run the infrastructure on which NHS technology depends.”

Still, she confirms, NHSX will have a wide range of responsibilities, some of which do sit with bodies including NHS Digital at the moment. “It will set standards, because the core requirement is to make sure that ‘systems can talk to each other’,” she says.

“It will make sure systems are user focused, and that they deliver what clinicians say they need. Instead of pushing innovations to the NHS, it will pull in ideas and do the things required. It will also develop NHS prototyping capacity; it will work alongside the accelerators on that.

“It will address issues of duplication and make sure common technology and services can be used without having to reinvent the wheel. Also, the secretary of state is keen on open source and reforming procurement through spending controls and new procurement frameworks that support standards.”

If there is a theme to come out of all that, it is probably the idea of clarifying the environment in which innovators and adopters operate that also came through in Blackwood’s comments about the genomics strategy and innovation hubs.

For instance, she argues that the focus on standards and on common technology and services will help developers “because they will know what they are building for.” While changes to procurement rules might help purchasers, by giving them more guidance on what to buy.

A true believer in the NHS and IT’s future

Clearly, though, it is new ways of doing medicine and delivering services that excite Blackwood. One of the jobs that she took on after leaving Parliament in 2017 was as an advisor with Push Doctor, one of the new breed of online GP services that have sprung up over the past five years or so.

She enthuses about the role that online services could play in the future. “As somebody who has had lots of engagement with the NHS, I think that technology will play a big role in managing demand and improving quality of life for patients,” she says.

“We will need to make sure that we can make it available, free, to patients, and we are only at the beginning of what works and how different patient groups interact with technology. But it looks like some patients may want to switch to an entirely digital GP service, some will want a mix of digital and face to face, and some will just want face to face – and I can’t believe we can’t design a service that accommodates that.”

She is also enthusiastic about the NHS and the importance of technology to its future. “I am a true believer,” she says with real warmth. “We are going through a period of uncertainty at the moment, but I have belief that the work we are doing on the prevention agenda, and the long-term plan, and the tech agenda and in life sciences will make a real difference.

“We will not just protect and improve the system that we have, but create one of the most exciting innovation ecosystems in the world. There is no doubt that people in the NHS do face challenging situations, and we can only be grateful to them for the work they do to meet them.

“But behind the scenes, the transformation we are starting to see is incredible, and we could witness something really remarkable over the next five years. I truly believe that.”