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Digital and data-driven technology has great potential to help the NHS meet the challenges it faces. Yet realising the benefits of technology-enabled care can be difficult, and progress has been slower than hoped. Lord Ara Darzi's report on the state of the NHS in England and the Prime Minister’s response highlight the urgent need to make progress in digitising NHS services. It is therefore vital to understand the factors that influence the adoption of technology in health and care. This analysis shares learnings from the success of four teams from the Q community's innovation lab (Q Lab) in building trust and confidence in technology-enabled remote monitoring. The teams highlighted that a solid foundation of good design, data accuracy and safeguarding is important but not in itself enough to build trust to the degree needed for technology adoption. Key factors influencing trust and confidence include technology’s potential to enhance existing services, the level of clinical risk involved, intersections with health disparities and the interconnection between staff and service users’ trust. To increase trust and confidence in digital technology, we recommend investing in co-design processes with end users and working collaboratively in partnerships, including with the tech industry, voluntary and community sector organisations and improvement experts. There also needs to be consideration of and clear dialogue about how technology-enabled care can enhance care models as well as its limitations.

This document presents the digital strategy for the Royal Liverpool and Broadgreen University Hospitals Trust (RLBUHT). This strategy is one of the NHS Global Digital Exemplars. The Royal Liverpool and Broadgreen University Hospitals Trust set out to digitally transform health and social care with in Liverpool.

This International Patient Summary roadmap (G7-IPS) supports the G7 commitment to deliver on the rights of patients to have access to their health information, and through using open and interoperable standards it enables this information to be used at the point of treatment or care. The roadmap outlines the component parts required for implementation and the standards which will be used to ensure alignment and interoperability across the G7 community. Although developed by the G7 countries, other countries, should they wish to, will be able to adopt the same principles and use the open and interoperable resources.

The What Good Looks Like (WGLL) Hub has been developed to support NHS staff and their organisations in achieving What Good Looks Like.  It brings together a wealth of digital health information and features good practice examples of technology-enabled healthcare, standards, guides and policies, useful tools and templates and networking information.  It will help you with your digital transformation work. The What Good Looks Like framework has 7 success measures: Well led. Ensure smart foundations. Safe practice. Support people. Empower citizens. Improve care. Healthy populations.

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. Recommendations 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.

By placing patients at the heart of care, the future of healthcare looks promising. However, we must remember that technology is not used in isolation and has to be developed and implemented with and for the user. The involvement and understanding of the end user is pivotal to the success of any digital health solution, intervention and initiative. Healthcare companies and start ups can improve adoption by engaging members of the healthcare community and the public in creating better digital healthcare systems that will improve access to care, are more inclusive, augment existing systems and address the real immediate issues. Integrate technology into the overall patient journey, focus on improving the existing system and address the immediate challenges. Ensure relevance and suitability by co-designing the systems with the users, patients, care teams, and the other stakeholders if they will be involved in the care delivery process. Focus on the clinical specification of the disease while designing the tools. Develop an inclusive design with the help of the consumers to ensure all the pain points are addressed. Minimise selection bias by including marginalised community segments to ensure inclusivity. Implement comprehensive training and provide continuous technical support and improvement. Extend patient education beyond digital literacy to include health literacy to promote and encourage healthy behaviour in society. Incorporate training of caregivers and family members to promote better disease management. Include care teams and clinicians in the training and support programmes to ensure that key player understands how best to use the tools and data-driven systems. Ensure health data is stored and shared securely and ethically Include transparent data policies in the overall project guidelines that are available to the patients. Educate the patients so they understand when and how to give consent to information sharing. Develop comprehensive, transparent, and inclusive policies and guidelines promoting equal access. Encourage reimbursement schemes of digital tools and virtual care. Built-in flexible financial and payment models to reduce the cost of care.