Digital technology is transforming every industry including healthcare. Digital and data have been used to redesign services, raising citizen expectations about self-service, personalisation, and convenience, and increasing workforce productivity. The pandemic has accelerated the shift to online and changed patient expectations and clinical willingness to adopt new ways of working. In addition, it facilitated new collaborations both in the centre of the NHS and wider local health and care systems. Together, these changes have enabled previously unimaginable progress in digitally enabled care pathways.
The goal of this review is to build on this progress and ensure the national NHS (defined as NHS England and NHS Improvement (NHSEI), NHSX (X) and NHS Digital (D)) can lead the transformation of the wider healthcare system, supporting integrated care systems (ICSs) to deliver better citizen health.
The current position
The review conducted extensive interviews during its data gathering phase and identified 6 areas where the current situation could be improved.
- Transformation model: the NHS is organised to focus on disease areas or settings of care, rather than the health and care journeys of citizens. Greater focus at the centre on the needs and experience of diverse users, including addressing inequalities, would facilitate transformation. Transformation is split across multiple different teams and is often overshadowed by requirements of the day-to-day. Many senior leaders see digital as a separate not embedded enabler and there needs to be greater clarity on the roles of national, regional and local in driving transformation.
- Funding and benefits: transformation funding is currently split between revenue and capital and dispersed across the organisations. Tech funding is variable, often diverted and not necessarily linked to strategy and outcomes, incentivising either monolithic programmes or small-scale initiatives.
- Leadership: variable commitment, experience and interest amongst senior leaders in digitally enabled system transformation, with too few integrative leaders able to effectively bridge managerial, clinical and digital.
- Capabilities: there is insufficient focus on ‘soft’ levers including hiring and recognition, limiting the development of a digital culture which rewards iterative and step wise approaches.
- Data and technology: the separation of responsibilities for digital strategy and infrastructure results in a lack of clarity on target state data and technology architecture. This separation also creates friction for the sharing of data for administrative and planning purposes.
- Organisational responsibilities: the responsibilities across different central organisations are unclear, resulting in duplication of activity and issues with the commissioner-delivery partner model.
It is therefore the review’s conclusion that the centre of the NHS (defined as NHSEI, X and D), as currently constituted, and despite considerable progress and the best intentions of many people, remains too far away from being able to achieve the goal of a digitally enabled health system that makes use of modern technology and data sharing to create joined up services to support all citizens and improve outcomes.
The review has 9 recommendations, under headings of mindset, operating model, organisational consequences and enablers for change:
- Recommendation 1: commit to a patient and citizen centred organising principle for future service transformation.
- Recommendation 2: consider and mitigate digital inequality in all service transformation. Expand the role of the SRO for Health Inequalities to include digital inequality.
- Recommendation 3: commit to building patient and citizen trust and acceptance in the use of health data to improve outcomes. Provide more efficient access to data for analytics that ensures privacy and can be used to improve care delivery.
- Recommendation 4: reorientate the focus of the centre to make digital integral to transforming care, with NHSEI overall accountable for executing digitally enabled service transformation. Provide clarity around the role of the centre, underpinned by a clear enterprise architecture and align with the ICS operating model.
- Recommendation 5: implement a new operating model across NHSEI, X and D to drive digital and data transformation.
- Recommendation 6: re-align organisational responsibilities to ensure delivery of the new operating model.
- Recommendation 7: undertake a fundamental organisational capability intervention across NHSEI and D to build and nurture the skill base to support data and digitally enabled transformation and adapt ways of working to support the new operating model.
- Recommendation 8: revise financial management arrangements both within NHSEI and between NHSEI and DHSC.
- Recommendation 9: re-prioritise NHSEI spend to lift the quantum devoted to digitally enabled system transformation. Assess the level of ‘technical debt’ across the wider NHSEI system and update estimates of technology spend required to enable the delivery of safe technology operations. In conjunction with DHSC, make the case for increased funding to deliver safe technology operations.