NHS tech bosses outline cost of coronavirus app development

Progress so far

On the advances around digital transformation in the NHS more generally, Wilkinson was asked about how far along the health service was in terms of delivering the government’s ambitions.

The NHS Digital chief then outlined the various recent achievements of her team, including the delivery of the NHS App, the NHS email system that serves 1.4 million users, and the Microsoft Teams platform, which was rolled out under a tight schedule in early 2020.

Wilkinson also pointed out that NHS Digital is the national data custodian system. “A huge amount of our work is collecting data, curating it, linking it, analysing it, and then disseminating it to a great number of places,” she said, adding that her team deals with a number of legislative responsibilities around information governance.

“A huge amount of progress has been made in the past three years. We are really ambitious about what we can do, and we can be more ambitious now than we were in the Long-Term Plan, even though that’s a relatively recent document,” Wilkinson said.

“What we’ve been able to do during this Covid period is go even harder and faster, get a much more effective data sharing system, and various other victories. So we can be more confident than we ever have been before about the potential for the digitalisation of the system,” she added.

Despite all the achievements outlined by the NHS Digital chief, a number of challenges were raised in the PAC committee hearing, such as the proliferation of legacy systems and security issues associated to them.

Wilkinson accepted that this is a key area of complexity, and that it is complicated to move away from these old platforms, but that her team is working on enabling the migration to digital alternatives as much as possible.

Commenting on security, she said NHS Digital is enabling trusts to constantly assess their risk profile through a variety of processes and generally make organisations more robust through access to various technical defenses provided centrally that they can tap into.

“We’re acutely aware that there remains significant cyber risk in the system associated with legacy systems. The Microsoft deal that we worked on earlier this year is enormously helpful, because it does allow a lot of a lot of migration away from some of those environments,” Wilkinson said.

“It’s a long and complicated journey away from legacy and there is undoubtedly a cyber risk associated with legacy systems. The strategy just has to be to pursue with eradicating them as hard and fast as we can,” she added.

Discussing the strategic guidance of trusts in terms of new system selection under the digitisation strategy and provided by NHSX, Gould noted that the aim was to go against the “monoculture” seen in the extinct National Programme for IT, and that one of the lessons learned was that it is necessary to tailor technology to the context of the NHS body in question.

“We need to provide more guidance to trusts, not just on what which electronic patient records they choose, but more generally around what should be expected of different sorts of providers in health care, in terms of technology and digital transformation,” he said, adding that his team is working on a project called What Good Looks Like, which is to set out criteria for these initiatives, as well as driving interoperability and defining standards.

“We’re doing two things there that will help: one is setting standards so that when trusts buy technology, they conform to the same technical and semantic standards so that even if they buy two different systems, they can speak to each other,” Gould said, adding that NHSX has also introduced procurement frameworks to ensure that purchases of any system is vetted and compliant with the new vision.

According to the executive, NHSX is working on ensuring that “every part of the country has a shared care record in place”, which will allow patient data to flow properly between different care health and social care providers.

“We know it can be done because it’s done very effectively in some parts of the country, but it’s even more important now that every part of the country should have that shared care record in place. We are moving as quickly as we can to create a procurement framework so that bits of the country that need to put one in place can buy technology with confidence,” he said.

When asked to provide a timeframe for interoperability in the healthcare system, Gould said he estimates this should be achieved in the next five years. That timeframe is due to the pool of about 400 systems that don’t talk to each other across the NHS, as well as legacy.

“Even if we enforce standards and ensure that all the bits of the estate are compliant, it will take years for that legacy of states to catch up with the standards it will be replaced and sorted out with,” he noted.

Ongoing review

In May, the National Audit Office (NAO) released a report where it said the digital transformation of the NHS is plagued by issues such as lack of clarity, changing strategies and insufficient funding.

The NAO report also noted the plan is progressing at a much slower pace than anticipated. The current estimated cost of the digital transformation is £8.1bn, to be spent between 2019-20 and 2023-24. Trusts are expected to contribute £3bn towards the cost.

According to Williams, discussions are taking place with NHS England around the financial framework for next year and beyond, and that new deal with reflect the unplanned circumstances presented by the pandemic. However, he noted that the transformation plan isn’t just about the money, “it’s about trusts understanding what good looks like, having leadership buy-in, and bandwidth to to deliver”.

When challenged over aspects of the transformation programme such as the eradication of paper, something that was promised for 2018 and hasn’t been fully achieved yet, Williams said the target hasn’t been watered down and that many trusts are already digitally mature in that respect, but in general, the route to delivery was different to the previous government ambitions for a paperless NHS.

“There is an element of ensuring that the funding is available to match that ambition as well as the gold standard. But this is not simply a question of money, that’s a broader change programme,” he said.

The witnesses in the PAC hearing were also challenged in terms of whether they considered the delivery timeframe for transformation for 2024 realistic given the challenges around implementation that still exist. On that point, Williams noted that, considering the Covid crisis, “capability is being built” so that the government can re-identify milestones and metrics and be able to flag where the transformation might be off track.

The PAC committee also wanted to know who was accountable for the success of the transformation plan and who they should be holding to account. In answer to that question, Gould said he was the main accountable person, but it was a collaborative effort, with NHS Digital playing a crucial role. “It is definitely a team sport,” he said.

When asked by Labour MP Olivia Blake over how NHS Digital and NHSX were working together, the PAC committee heard there are some difficulties that still need to be ironed out, such as concerning clarity from Gould’s organisation around what is required from Wilkinson’s team – one of the issues noted in the NAO report. “It’s a work in progress, but it's getting better all the time,” he said.

Wilkinson agreed with the NHSX chief, and argued that inserting a new organisation into an already complex context is complicated, considering that NHSX interfaces with NHS England, NHS Improvement and NHS Digital. “Getting all of that right isn’t that straightforward,” she said.

According to the NHS Digital chief, there wasn’t a lot of work put into setting the boundaries between the roles and organisations at the genesis of NHSX, and the focus on Covid over the past six months has meant some overlaps have emerged, but Gould and her are aware of the issues. “We’re both in agreement and we’re both very committed to making that work this year,” she said.