Driving forward digital safety

With the shift to digital health technologies during the global pandemic, Kelsey Flott, deputy director for patient safety at NHSX, discusses the need to ensure a safe digital health system.

Effectiveness, experience and safety – these three features have long been considered the tenets of quality healthcare. Safety in particular has grown in prominence over recent decades and the NHS has been internationally recognised for its leadership in ensuring safe care.

The NHS Patient Safety Strategy was published in 2019 by NHS England and NHS Improvement. This guides the direction of our safety system, and is underpinned by national incident reporting processes and protocols for promoting openness and candour.

In the wake of the COVID-19 pandemic, safety remains at the forefront of healthcare communities’ minds. It is a critical time for safety in the NHS, not least because the events of the past 18 months have brought forward a wave of digital innovation. The pandemic saw a 38% increase in the use of NHS technology. For example, from 2019 to 2020, NHS App registrations increased 111% and then in 2021, following the release of the COVID-19 vaccine status service, registrations jumped by over 800,000 new users in one week alone. Accelerations like these have brought a new emphasis to the importance of ensuring digital health technologies are safe. They have also opened a window of opportunity to harness the power of new digital technologies to improve safety and pre-empt harm.

While recent research from the Health Foundation shows the public are enthusiastic about digital health, it also highlights the importance of safety. Of staff surveyed, 57% indicated that safety would be the most important priority for maximising the benefits of digital technologies post pandemic. It is therefore imperative to ensure we have the appropriate structures and processes to ensure a safe digital health system. This includes modernising how we capture data about safety incidents, equipping our workforce to recognise and mitigate digital safety risks, and providing easier access to digital safety guidelines and standards. It also requires a refreshed look at how digital solutions can be better applied to chronic patient safety challenges.

As the NHS embraces digital technologies, there is both an increased responsibility to ensure the safety of technologies, and an increased opportunity to innovate for safety. This intersection of safety and technology is the focus of NHSX’s digital safety team, and the object of our Digital Clinical Safety Strategy that will be published later this year.

We are currently drafting the NHS’s first Digital Clinical Safety Strategy in partnership with NHS England and NHS Improvement, NHS Digital and the MHRA. This strategy will mirror three priority areas in the existing NHS Patient Safety Strategy: Insight, Involvement and Improvement. It will consider things like:

• how we gather the best intelligence about digital safety and create feedback loops for learning
• how we can best enhance training for digital clinical safety and bridge existing academic disciplines of digital health and patient safety
• perhaps most importantly, how we surface new opportunities for digital to improve patient safety issues

The evidence for the role of digital in improving safety is already known, and it suggests technologies can support safer care - from the use of remote monitoring with COVID-19 patients to reduced errors from electronic prescribing systems. Enhancing patient safety is a foundational mission for NHSX and many of our programmes include improving patient safety as a benefit.

However, new technologies bring a set of new challenges and we need to be proactive about overcoming those. One of the top priorities relates to digital exclusion and ensuring that we develop tech that is safe for everyone. We know that technologies can support digital inclusion through programmes like remote consultations that bring care to the patient rather than requiring the patient to come to the care, but we also know not all digital solutions work for everyone.

This is why the work of digital safety needs continuous input from diverse groups. The Digital Clinical Safety Strategy will be published later in the year, but that is only the beginning. We need input to drive the programmes of work and the cross-system commitments that will be initiated within the strategy.

It is time we give dedicated consideration to digital safety in healthcare. From our perspective, we want to support the NHS to become the safest healthcare system in the world. To do this, we need to continue to ensure that our digital technologies in the NHS achieve the highest safety standards. We also need to more regularly turn to digital technology as a solution for ensuring patient safety and mitigating patient safety issues.

I hope that you will reach out to get in touch with me if you would like to feed back your priorities for digital clinical safety. Email me at kelsey.flott@nhsx.nhs.uk.