Achieving a digital NHS is a national policy priority. Over the past few months, we’ve had a new ‘tech vision’ in The Future of Healthcare, key digital commitments in the NHS Long Term Plan, and a Secretary of State who has continuously raised the potential of digital to transform the NHS.
Of course, much of this isn’t new. For the last decade, we’ve had a host of digital policy initiatives that have promised comprehensive electronic records, improved patient access and a more strategic use of data across the system. Now, enter NHSX – a new organisation to lead on digital, data and technology, to deliver these ambitions and harmonise what have historically been fairly disparate initiatives.
With digital ostensibly taking centre stage, our new report examines the role of national policy in digitising acute trusts – where it’s helping and how it could be improved, while outlining some key lessons for NHSX as it shapes its priorities. Uncertainty over how the new organisation will operate in practice and the status of existing digital programmes makes it difficult to predict what will happen over the next few months, but the following three areas nonetheless stand out as firm areas of challenge.
1. Having the support to implement standards is just as important as the standards themselves
We found that people are broadly happy with the current policy approach. They recognise that on many levels, trusts need to be allowed to progress at their own pace – to focus on their local priorities while having a supportive framework from the centre. In practice, this has meant an increased focus on providing national standards (for things such as interoperability), to which organisations and suppliers then need to adhere.
But, while nobody we spoke to disagreed in principle with the centre mandating interoperability standards, they were frustrated at the process of implementation. Unrealistic timeframes, unfinished standards and limited digital maturity of surrounding organisations led some to feel that the mandates were driven more by technical solutions than a concerted effort to understand the problem they were developed to address.
Having a clear understanding of the priorities and capabilities of the system, alongside a robust and coordinated plan for engagement, communication and implementation, will be vital for digital policies to succeed.
2. Get the priorities right
Aiming to achieve world-class standards of digitisation (spearheaded by the Global Digital Exemplar programme) is commendable, but it is not something that can or should be rushed. More basic steps are needed first. This is not just about sorting out Wi-Fi before AI, it’s about making sure that organisations have the time and support to implement and then embed the huge changes that digital transformation requires.
Being pushed so hard to achieve grand levels of digital maturity could undermine this. The primary aim of using digital solutions should be to improve care in the way that works best for the NHS, which first means focusing on what is most needed by patients and staff.
3. Focus on the workforce
Establishing the right infrastructure is not only about the tech. As we’ve mentioned before, workforce and digital issues are interdependent. The NHS is desperately short of staff, and the digital workforce is not spared from those same recruitment and retention challenges.
Supporting clinical staff to develop the skills and confidence to work with technology is crucial, but the non-clinical workforce must not be forgotten. In a competitive skills market, getting individuals with essential digital skills is tough. More needs to be done to provide appropriate career pathways and pay frameworks that make sure the NHS can attract the necessary staff. Without this, there is a risk that the ambitious digital projects set out in the Future of Healthcare and the Long Term Plan will be unachievable.
Where will the balance be struck?
Many of the issues in our report are interrelated. NHSX will supposedly be taking responsibility for ensuring "coordination and consistency", meaning there’s a clear opportunity for the centre to take a more unified approach to digital strategy, and to address the feelings of disconnect we identified between individual organisations and the national policy approach.
But to do this, it’s clear there needs to be much better and more effective two-way communication between national policy-makers and local NHS organisations. Failing to understand the needs and priorities of the system risks digital yet again becoming viewed as a barrier or a distraction, rather than an opportunity. As history has shown, getting this wrong can be costly.
What’s certain is that getting the balance between national standardisation and local flexibility right is fundamental to successful digital change, and determining exactly where that balance should be struck will be an ongoing question for policy-makers. Will NHSX have all the answers?
Hutchings R (2019) “Going digital: three crucial areas for NHS policy”, Nuffield Trust comment.