Tag Archives: NHS

SPI Digital Health: Can New £150M NHS Framework be RPM’s Golden Ticket in England?

At the end of March, NHS Shared Business Services (NHS SBS) announced a new £150M framework to develop new remote patient monitoring (RPM) initiatives across England’s health system. 

The Technology Enabled Care Services 2 framework is arranged into six lots covering Remote Clinical Monitoring (allocated £36M in funding), Alarm Receiving Centre Platforms (£14M), Digital Alarm Solutions and Peripherals (£36M), Intelligent Activity Monitoring (£24M), Patient Controlled Personalised Healthcare Records ($14M) and One Stop Shop / Combined Solutions (£26M). 

Overall, the Framework aims to free up hospital beds, reduce appointment backlogs, accelerate patient hospital discharge, and alleviate pressure on social care. An estimated 14,000 hospital beds are occupied by a patient who is clinically fit to leave, but has no appropriate care setting to be discharged to, and so creating new ‘virtual wards’ should go some way to relieving this costly bottleneck. 

The Signify View 

One of the most potentially impactful lots in Technology Enabled Care Services 2 is the £36M being allocated to Remote Clinical Monitoring solutions to expand England’s virtual ward capacity. These virtual wards had their origins during COVID, when transitioning patients out of hospital was a matter of crisis management rather than cost consideration. Even as the pandemic eased, hospital bed capacity in England remains under intense pressure, and staff shortages make care delivery more difficult than ever. 

The Framework gives England’s 42 Integrated Care Systems (ICSs) the ability to rapidly procure RPM technologies from shortlisted vendors to build virtual ward capacities and support health and care professionals in delivering clinical care. The NHS intends for these virtual wards to care for people with chronic conditions such as diabetes, stroke and heart failure, as well as providing post-operative surveillance.  

ICSs therefore have a central role to play in linking up health and care functions beyond the hospital. Whether they can deliver on the UK government’s goals to have 50,000 virtual beds in place in England by March 2024 (from 10,000 at present), is another matter, however. 

Centralised Approach 

NHS SBS is responsible for providing the funding and shortlisting vendors to carry out contracts in each of the six lots within Technology Enabled Care Services 2. It is then up to the individual provider organisation (e g the ICS) to select the vendor and manage the contract budget.  

In terms of the Remote Clinical Monitoring lot, £36M won’t go far given that it must be spread across 42 ICSs in England. The fact that it is a one-off funding stream is also less than ideal, because it prevents RPM adoption from really scaling and delivering longer-term benefits. A consistent funding supply would nurture RPM technology adoption by giving providers the ability to develop long-term plans based on ‘guaranteed’ budgets. 

Reimbursement Riddle 

As Signify Research regularly reports in its Insights, the lack of reimbursement or ongoing funding structures in most countries, including England, also restricts progress in ‘hospital-at-home’ programmes, and RPM adoption, in a big way.  

Even in the US, which is more advanced than in any other country in this respect, only around 200 hospitals have to date taken advantage of reimbursement for ‘hospital-at-home’ care (‘hospital-at-home’ being the US equivalent, to all intents and purposes, of England’s virtual wards), and only a small number of patients have actually been managed at home. Ongoing uncertainty over the renewal of specific ‘hospital-at-home’ reimbursement codes beyond May 2025 continues to play on the minds of providers in the US, and this is seriously dampening the RPM market potential. 

A lack of clear long-term funding structures in England (and the UK), parts of Scandinavia and elsewhere means that the appetite to build virtual ward capacity and ‘hospital-at-home’ programmes depends almost entirely on more unpredictable, one-off funding streams. This  funding, like Technology Enabled Care Services 2, is not tied to the number of patients being monitored at home (as would be the case in a reimbursement model). Instead, it is good for putting in place the service and workflow, but there is then no specific mechanism for providers to fund schemes on a long-term basis. It is no wonder that providers are reluctant to invest in RPM solutions. 

Big Picture View 

Despite the above, it is a positive that ICSs are responsible for how the £36M is spent on Remote Clinical Monitoring in England. The siloed nature of the healthcare system in England (as in many other countries) has traditionally meant different organisations in the system providing, for example, acute care and care at home, operate under siloed, individual budgets. It is not uncommon for a community healthcare organisation to invest in RPM technology but derive little real benefit from it because it’s the acute providers that benefit the most from them in terms of keeping patients out of hospital or being able to move patients out of acute settings quickly. For these community providers, RPM is largely just a cost burden. 

So again, this stunts RPM adoption. While it will still be the hospitals, individual primary care networks, GP practices and social care systems who do the ‘legwork’ to expand virtual ward capacities, ICSs have the unique oversight of every different care setting. It is the ICS that can co-ordinate the various players in the system, and hopefully dismantle the silos that prevent RPM adoption from reaching its true potential.  

In such a scenario, the shortlisted vendors competing for a slice of the £36M pie – Aseptika, Baywater, BT, Doccla, Docobo, Huma, Immedicare, InHealthCare, Prescribing Services, Solcom, Specialist Computer Centres, Spirit Healthcare and Vcare – will view this as one of many opportunities in this space going forward.  

Of these vendors, Doccla, Docobo, Huma, InHealthCare and Vcare have already had success implementing virtual wards for the NHS on initiatives such as the COVID-led £65M NHS Spark Dynamic Purchasing System and COVID Oximetry at Home projects in 2020, and the NHS National Innovation Collaborative. They will be in pole position to benefit from the latest funding initiative. 

Internationally, structures are also being put in place in France, Saudi Arabia, parts of the Nordics and Australia where big health systems (the equivalents of the ICSs) will also be in a better position to break down barriers and provide that big picture view on patient care management. 

A Case of Myopia?  

The Technology Enabled Care Services 2 framework nudges virtual care in England another step along the road. However, while undoubtedly helpful, the £36M one-off funding to expand virtual ward capacity in England is a short-term solution, when what is really needed is a long-term vision. Providers need a long-term spending commitment around which they can plan, deliver the number of virtual wards required in the future and enable RPM adoption to scale in the country. 

While the desire for change is clear as hospitals and their staff creak under unrelenting pressure, joined up thinking and long-term strategy are essential to have a lasting impact. 

Signify Premium Insight: Palantir in Pole Position for NHS Deal, but Uncertainty Reigns

Some time after 9 February, the winner of a £360M contract to supply NHS England with a new national data aggregation platform will be announced. For many in the industry, the result is a foregone conclusion. US data analytics firm Palantir, which has a deep (and not without controversy) footprint in the NHS, is widely tipped to clinch the five-year Federated Data Platform (FDP) deal.  

But it is not just controversy around Palantir which triggers questions about the FDP. Notably, there are striking parallels with a major regional platform roll out by Integrated Care Systems (ICSs) over the last two years. On the face of it, the FDP smacks of duplication, albeit offering aggregated data at national level.  

The Signify View 

The FDP will aggregate and interrogate anonymised and non-anonymised data from different EHRs and IT systems within ICSs, Acute Trusts, Primary Care and other providers in England. It will replace the NHS COVID-19 Data Store (run on Palantir’s Foundry software), which was delivered in 2022. The NHS claims the FDP, a national platform, will reduce the time NHS staff spend chasing referrals, scheduling appointments and waiting for test results. 

But, far from being a pioneering project with potentially transformative impacts, the FDP is an almost identical system to one that ICSs have been procuring at regional level over the last two years, often referred to as Shared Care Records. The below diagram outlines the main building blocks set out in the new FDP tender and compares them with the building blocks for the ICS tenders. The similarities are clear.  

Vendors supporting that $480M roll out include Oracle Cerner, InterSystems, Orion, Patients Know Best, Graphnet, Kainos and Black Pear (the table below summarises these contracts by number of ICS contracts each has). These platforms are aggregating data from acute trusts, GP practices, mental health and social care, and offer a population health analytics tool very similar to that envisaged for the FDP, but at a localised ICS level.  

A Question of Duplication? 

The FDP tender document states that these platforms being rolled out in the ICSs will be able to integrate into the FDP. This implies that the FDP platform will essentially be a duplicate, and this potentially undermines the ICSs, or at least introduces confusion on IT strategy for ICSs. 

A look at the use cases for the platform in the FDP tender document reinforces the duplication argument. The document specifies five use cases. Three of them (population health and ‘person insight’, elective recovery and care co-ordination) are already intended when the ICS solutions were procured. The other two are vaccination (where Palantir’s experience with the NHS COVID-19 Data Store is a clear advantage going forward) and supply chain. 

While the FDP will offer the key advantage that it provides a national system, it also indicates that solutions procured by ICSs are not living up to expectations.   

The Horse has Bolted  

The FDP will not be compulsory. NHS Trusts and ICSs will be encouraged to use it to support their own use cases, however, it is difficult to see how many will actually do so. ICSs are already spending nearly half a billion dollars on the rollout, and have had challenges implementing Shared Care Record systems. They might justifiably wonder what would be gained from the FDP that they will not reap from their own projects. 

They might also justifiably ask NHS England Director of Transformation Dr Timothy Ferriss for his answer on this. The FDP has his stamp all over it. Just last week he authored an article, published on the NHS website, promoting the FDP and the scale and benefits he says it will offer. 

Dr Ferris is known as a champion of large, national-scale projects. The American is frustrated with the fragmented nature of NHS IT systems. There were rumours circulating around a year ago that he wanted every NHS hospital to migrate to a national Epic-based EHR. It was only a rumour (and it is hard to see such a scenario ever playing out), but Dr Ferris’ reputation clearly precedes him. And in the FDP, he will at least get his wish for that national system. 

That said, the ICS Shared Care Record rollout has not been particularly smooth. To date the vast majority put in place are only being used to provide healthcare providers within the ICS a summarised view of each patient. Few ICSs have yet leveraged their full potential from a more strategic Population Health Management perspective. Only a small number employ analytics solutions on top of the aggregated dataset that they offer.  

Therefore, there is still pent-up demand for ‘better’ solutions, and a sense of frustration with the solutions put in place in terms of the original promise and vision. However, technology is not always the barrier. Leveraging the full potential of these solutions is more down to changes in workflow and structure within providers. Putting in place a national system on top of the local ICS solution will not address this.  

Rough Ride 

If Palantir are, indeed, chosen to deliver the FDP, they can be sure of a lukewarm reception (at best!) from many different stakeholders.  

Its critics point to its alleged poor record on data management and procurement policy on other NHS deployments. The company can expect a rough ride from the media, too. The ICS Shared Care Record initiative has not escaped media scrutiny, with many questions around why patient data was being shared for research. On a national-level project the stakes will be even higher. The idea that a large American tech firm has access to NHS patient healthcare record data and will be sharing it at national level will cause unease. 

That is one reason why the FDP tender document clearly emphasises the use of anonymised data.  

A Line of Other Suitors 

The fact that such a large NHS contract will likely be awarded to a non-UK vendor who will then have access to huge amounts of patient data from England is a moot point. Palantir may not be everyone’s cup of tea, but Oracle Cerner, InterSystems and Orion all have good track records with the ICSs, and may have a competitive chance of winning the FDP contract. Last June, Oracle Cerner stated its ambition to develop a solution for a US national EHR database (which we analyse in this Insight). It may want to extend its ambitions across the Atlantic. Epic, which is only number six in the UK in terms of number of hospitals using its EHR, will also feel it has a solution that fits the FDP bill. InterSystems has a strong footprint in the UK via its HealthShare product, as does Orion.  

Big Tech will also be circling around this opportunity. Amazon’s HealthLake aggregator is, for example, a natural fit for the FDP, as is Google Cloud’s Healthcare Data Engine (HDE). 

Market Opportunity 

The FDP contract will also have provision for the creation of a marketplace where vendors can develop third-party applications that then use the aggregated FDP data as well. This is an interesting concept that means that some of those existing solutions that have been developed can plug into the new FDP to use that national level data. Further ICSs, Primary Care Networks and Acute Trusts have also been working with other third parties to develop analytics solutions for Population Health Management, as well as developing their own tools in-house. This marketplace concepts suggest that these solutions have a potential place for any healthcare provider looking to leverage the FDP.  

Inspiring Confidence 

The NHS has had an uneasy relationship with data projects for more than a decade. Whoever wins the FDP contract will face resistance and intense scrutiny, and the spectre of patient data privacy concerns will never be far. To succeed, they will not only need the products to support the creation of a robust FDP, but also the skills to inspire confidence and garner support from stakeholders across the board. Given Palantir’s chequered history in this respect, the next five years could be a rocky ride.