Lack of funding fuels doubt outpatient appointments will become digital

A lack of capital funding for digital technology has left finance directors with “little or no” confidence that physical outpatient appointments will be reduced, a Kings Fund report has found.

The NHS Long Term Plan commits to redesign services over the next five years to avoid up to a third of face-to-face outpatient visits, including through the use of digital.

But the report, How is the NHS performing? July 2019 quarterly monitoring, found half of NHS finance directors surveyed were “somewhat” confident that outpatient numbers could be reduced, while the rest had little or no confidence.

“First, there is a lack of capital funding (and associated revenue) to invest in the digital technology that could enable remote consultations to replace physical outpatient appointments,” the report said.

Siva Anandaciva, chief analyst at The Kings Fund and author of the report, told Digital Health the “appetite and ambition” for reform is there, but it wasn’t being realistically “calibrated”.

“Technology is clearly one of the lynchpins in the ambition to reduce physical outpatient appointments. But taking the NHS as a whole, the story of digital technology funding in recent years is both relatively opaque and disappointing,” he said.

“It is a story full of initial promise – such as CSR 2015 committing to a multiannual billion pound investment – with little evidence that this funding flows to the frontline in a timely way.

“Capital budgets in the NHS overall have been deprioritised in recent years with several consecutive years of taking over £4bn of funding earmarked for capital investment and transferring it to revenue budgets to cover the day to day running costs of the NHS.

“The costs of this are becoming clear with under-investment in facilities, equipment and digital technology hamstringing ambitions for the NHS to transform how it delivers care.”

He said transforming how outpatient services were run was necessary, with technology “absolutely key” to this ambition.

“But until there is more certainty that adequate capital and revenue funding will be provide to invest in the development and implementation of these technologies it is hard to see how the ambitions of the long-term plan for outpatient care can be achieved,” he added.

Last week the Government pledged a £1.8 billion cash injection for the NHS, with part of the money going towards harnessing the potential of new technologies.

Some 20 hospitals will benefit from a £850 million funding package to upgrade outdated facilities, while a further £1 billion will boost NHS capital spending to tackle urgent infrastructure projects.

However, it was not clear how much of the funding would be spent on digital.

Experts welcomed the funding, but said more was needed to address the “woefully inadequate” spend on digital technology in the NHS.

Richard Murray, chief executive of the King’s Fund, said in response to the funding that a “longer term” investment programme was needed to modernise the NHS to take advantage of new technology.

Chair of the Digital Health CCIO Network, James Reed, said a “further commitment” of funding was needed to “fundamentally” change the way the NHS worked.

While Digital Health CIO Network chair Adrian Byrne said IT in the NHS needed “committed, ongoing funding”.