NHSX urged to rethink national policy to enable healthcare digitisation

As the NHSX launch approaches in July, a report has outlined areas the new central unit leading national digital strategy in the health service should focus on to further its digitisation progress.

Better governance and a talent plan, as well as setting realistic expectations around the digital maturity of organisations across the system, are among the areas where NHSX attention will be more urgently needed, according to the report by think tank Nuffield Trust.

The study sought to find out how the national policy affected trusts’ approach to digitisation, how it was helping and hindering progress, and what could be done differently to support digital transformation across the health service.

Based on interviews with 72 senior digital leaders in national organisations, NHS trusts and frontline healthcare professionals, the report investigated the issues by using an assessment designed to evaluate the digital maturity of the healthcare bodies surveyed.

On initiatives such as the Global Digital Exemplar and the Fast Follower programme, the reaction from leaders polled was generally positive, but the report argued that the trusts felt that reaching the intended digital maturity expectations set were unrealistic in all cases, despite pressure from the centre on organisations to do so. 

Such measures of digital maturity should be reconsidered, the report noted, along with ongoing work on national infrastructure to support the digital ambitions set out by the programmes.

Making the NHS an attractive place to start, build and progress a career in digital technology should be another crucial area of focus for the NHSX going forward, according to the report.

Despite work in this area carried out by bodies such as the British Computer Society, the Federation of IT Professionals and the Digital Academy, the report argues there is more to be done, as the trusts surveyed are facing “significant challenges” around recruiting and retaining the skills needed to support digital efforts in the NHS.

Many of the IT leaders surveyed felt the Agenda for Change grading and pay structure is inappropriate and is “severely hindering” the ability of the NHS to compete with the private sector in terms of employer attractiveness. Establishing clear career pathways and professionalising digital roles should be a priority to address the issues, the report recommended, alongside appropriate salary frameworks.

The need to legitimise the chief clinical information officer (CCIO) role was also felt by many of those polled. This extended beyond engagement with boards, the report noted, and included the need for a clearer career pathway, an accreditation and significant time to dedicate to the role.

Managing relationships with digital suppliers is another area healthcare IT leaders surveyed found challenging, particularly when it comes to making system changes in a timely manner, according to the study. A more proactive engagement with suppliers around standards around software changes and clearer central reporting mechanisms is needed, the report said, as well as national procurement of standardised IT systems.

The report also noted low engagement with local data sharing efforts due to concerns around information governance. It pointed out that there is more scope for central bodies to address the issue, by introducing legislation and guidance around the pros and cons of sharing data in certain circumstances.

Regarding policy, the report pointed out that while setting digital standards – particularly when it comes to data access across the health system – is a key task for national bodies and there has been positive work done in that regard, the national strategy for implementation is “often lacking”.

To overcome these challenges, the report recommended that standards should be implemented through setting deadlines as well as coordination of efforts to support digitisation across national bodies and ensuring comprehensive piloting prior to national roll outs.

NHSX is hoped to address many of the issues cited in in the report through streamlined decision making in addition to policy and delivery mechanisms, according to the chief information officer of health and care in England at Nuffield Trust, Will Smart.

“Our secretary of state sees technology and data as the biggest opportunity for the NHS over the next decade,” Smart said. “This, combined with the availability of proven and affordable technologies, means achieving the fully digital health care service the country needs is finally a realistic prospect over the next five years.”

Compliance to open standards will be one of the key components of the intended overhaul of technology in the NHS, with “nationally agreed open standards with locally led delivery” being at the core of the NHSX agenda.

Ensuring continuous systems upgrades is another priority in the government’s new approach to healthcare IT, with  modular contract structures and “decoupling IT stacks” to allow trusts to swap and upgrade services as they evolve and get cheaper, without rebuilding the plumbing.

On skills, health secretary Matt Hancock has talked about intentions to make the health service a destination workplace for IT professionals. A wider IT recruitment exercise will kick off in the summer to support the ambitions of digital strategy unit NHSX, but there are still concerns around the health service’s ability to attract and retain staff.