- The NHS has historically faced significant challenges when attempting digital transformation. There are a range of reasons for this, but fundamentally the digital transformation of health and care is incredibly complicated. The roll out and implementation of digital solutions during the COVID-19 pandemic - a crisis the like of which the NHS has never faced before - is therefore particularly impressive, progress was made in a matter of days and weeks rather than months or years. A successful national coordination and procurement process saw many trusts implement software such as Attend Anywhere and Microsoft Teams, which transformed care delivery, while individual trusts developed and launched their own digital solutions to aide them in their response to the virus.
- The COVID-19 pandemic has provided trusts with a single sense of purpose and a sense of urgency. Clinical and operational staff working on the front line, but also those supporting them (including digital and IT departments) have worked intensively to develop, implement, test, adapt and roll out new digital solutions. Not all digital innovations have been successful, but trust leaders speak of their teams "failing fast and failing forwards". There is a new innovative spirit and confidence across the sector which trusts are keen to maintain into the future.
- Trusts have been able to deliver this digital progress because of the support and changes made by the government and its arms length bodies, in particular NHSX and NHS Digital. This has involved supporting the roll out of nationally procured software, making additional funding available, and advising trusts on complicated regulatory and policy areas such as information governance.
- Much of this success has only been achieved because financial restrictions were loosened. Benefits realisation of digital transformation are notoriously difficult to quantify, the disbenefits of failing to invest are often easier to demonstrate, which can make internal business cases difficult to stack up. The government made clear at the start of the pandemic that the NHS would receive whatever it needed financially. This approach, along with greater acceptance of financial risks, meant trusts could mobilise fast by investing in new tools and innovations.
- It is now time to maintain momentum, build on these early successes and continue to transform services for patients and service users. Much of the initial success was built on the hard work and goodwill of NHS staff who went above and beyond. This is not sustainable in the long term, as it has left teams burnt out and exhausted. Instead, new conditions for success must be created:
- Funding must be made available for the sector to match its ambitious plans for digital transformation. Currently trusts spend between 2–3% of their total income on digital transformation. Lord Darzi has suggested this needs to be closer to 4–5%. Rather than divert funding from existing services, there is an opportunity with the comprehensive spending review to properly fund this important aspect of healthcare delivery.
- Nationally, the central leadership of NHS digital strategy, policy, operations and data collection should be clarified. Currently there remains ambiguity around decision making at national, regional, system and organisational level, as well as the different roles and responsibilities of NHSX, NHS Digital, NHS England and NHS Improvement, and the Department of Health and Social Care.
- A balance must be struck between driving bottom up efforts to digitise services where we know much of the true innovation takes place, and top down efforts to coordinate services, procurement and implementation, which is how economies of scale, interoperability and integration can be achieved (for example with the recent Microsoft 365 deal negotiated on behalf of the sector). To do this, trusts must be guided by a clear vision of "what good looks like" in terms of digital transformation. Alongside this, there should be a clear road map for delivery that leads trusts through the different stages of their digital maturity. - The size of the prize is enormous. The sophisticated digital transformation of health and care services has the potential to drive improvements in care quality and outcomes, while at the same time enhancing efficiency in terms of resource and activity management. Truly integrated health and care records will lead to the better coordination and management of care delivery. Exemplary patient and public facing services will improve user satisfaction and meet people’s raised expectations of twenty first century public services. In addition, population health analytics and artificial intelligence will begin to change the way we think about healthcare delivery.
- The users of these new digital solutions – that is NHS patients, service users, carers but also NHS staff – must be listened to during this next wave of digital transformation. This engagement is essential given the continued challenge of digital exclusion. There needs to be a flexible approach so new digital ways of working can reflect local need and preferences. For example, we know given the choice, many clinicians would prefer to have sensitive conversations face to face rather than via a screen. For all the advances in digital technologies, health and care will always remain people-centred.