Technology continues to progress and improve. As it does a health and care system needs to be able to remove old or unwanted technology to be able to embrace newer technology along with the benefits that can bring.

There is little published research on legacy systems in the NHS. The limited published work appears to indicate legacy technologies are a problem resulting in frustration, inefficiencies and inconvenience for staff, patients and carers. In essence there’s an unknown jigsaw of overlapping technologies that has developed over time. The relentless drive towards the next emerging technology means modernisation remains a low priority. Newer tech can be often left sitting on this unstable jigsaw of legacy technologies.

But what are legacy technologies? They are not just old computers or old software but technology that no longer meets the needs of today (e.g. doesn’t have modern capabilities like webcams), is no longer part of the tech strategy so needs to be decommissioned (e.g. beepers), and technology that might be modern but responds like it’s unsuitable (e.g. slow, unreliable, poor design). The following insights are taken from the responses from my previous posts, thank you to all contributors.

Small but with an outsized impact

Staff experience of legacy technology appears to be divided. Some staff really struggle with legacy tech and are not seeing improvements. While others rarely encounter legacy technology and do not experience legacy tech issues.

But most people do believe that the NHS has a problem with old computers that slow down even the most basic of tasks. This is potentially due to most staff  encountering old versions of software (e.g. Windows) still being used. Some even see legacy technology continuing to be purchased into the NHS drawing out the problem.

“I would suggest that not only is it an unknown problem, it is not taken seriously. Many new procurements are still buying legacy software.”

Without comprehensive mapping and tracking of tech it’s impossible to quantify the extent of the legacy technology in the NHS. However, it is highly likely that the amount of legacy technology is just a small part of the total technology in use. But it has an outsized impact, far greater than would be suggested when looking at proportions alone.

Root causes

Staff in organisations with legacy tech struggle with multiple types of legacy technology in combination. For example, they are faced with using faxes and laptops missing webcams. In their perspective the budgets or strategies don’t account for modernising technologies.  This would align with previous reports that have found that Trusts do generally underspend on tech investment. Unfortunately there could be significant potential gains in efficiency by tech modernisation but this remains low priority for many.

There are some legacy technologies that continue to be highly visible such as faxes. But it’s possible that there’s lots of hidden legacy tech, as mentioned above without the mapping it's not possible to quantify.

“often there is unknown forgotten legacy systems and tech that is not accounted for. E.g. monitors or disease specific systems.”

Unknown types and amounts of  legacy tech in use leads to insufficient budgeting and so it gets missed when trying to deliver strategic plans. As part of the strategic delivery plans and budgeting there needs to be a preparation stage that maps the relevant existing technology and matches this to what’s required for any future new features, functions or technologies.

“An important topic, surprisingly neglected at a strategic level. Although ironically every frontline healthcare professional I know will have a story about this.”

One challenge to mapping legacy tech is some IT departments may not have a deep  understanding of user needs and how that looks across multiple departments. An IT department with limited knowledge of user needs and technology usage could result in limited awareness of what software efficiency is required.  When there’s insufficient control on software efficiency staff struggle with fundamentally good machines which act sluggish and unreliable.

Catch-22 collaboration and new tech initiatives

What is the outsized impact of legacy technology? It creates problems when implementing new initiatives in the NHS. For example virtual wards are one of the newer tech enabled solutions being rolled out by the NHS. However they are being bogged down by the jigsaw of legacy tech. This can be exacerbated by siloed working where departments avoid changing to newer, potentially better systems to avoid upheaval. This means multiple different systems with incompatible technology capabilities hold back implementation of newer approaches like virtual wards.

“I am trying to get virtual wards going. 6 IT systems no integration as such.”

The increased focus on collaboration could overcome this issue if enabled through leadership behaviours. But collaboration itself can also lead to it's own issues.

ICS’s should be bringing about a more collaborative approach to how the NHS works. In doing this they will need to consider how they approach digital transformation. Already staff are experiencing challenges where the most digitally mature health care provider is held as an exemplar. This means the plan is to scale the tech and ways of working across the ICS. But it essentially risks creating a cascade of modernisation needs. Many other providers will need to modernise first for then the tech and approaches from the exemplar organisaiton to be spread.

Instead of benefiting from collaboration it creates a tension across organisations that are expected to be collaborating. Why? Because with a finite pot of money the most digitally advanced organisation stand to receive less funding so the other organisations can modernise sufficiently for the technology to spread.

This leads to a catch-22 situation. The most digitally capable organisation has the solution that is most in demand to scale. But these solutions can’t be scaled unless they sacrifice their share of funding to benefit other providers. Hence it’s important to have the right leadership, incentives, drivers and rewards for digitally advanced providers.

Is there a way forward?

Legacy tech is likely to be a small proportion of tech in the NHS however it also is likely to have outsized impact. This stubborn tech has far reaching consequences for newer tech enabled initiatives so needs a greater consideration in strategic planning and budgeting.

To move forward the modernisation of legacy tech it needs to be prioritise and integrated within digital transformation thinking. This means the as part of any strategic planning the presence of legacy tech should be mapped. The dependencies of future tech on any legacy tech needs to then be costed as a modernisation cost within the strategy budget. However, this doesn’t escape the fact core shared systems will need upkeep.

There’s much still to be done to create a health and care system that can strategically decommission technologies. If a healthcare system like the NHS is unable to continually modernise legacy technologies in use, it will be unable to fully benefit from the use of cutting edge technologies.

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