Commoditisation of NHS tech is a problem, says NHS Digital interim CEO

Too many technology systems are being used across the NHS, according to NHS Digital interim CEO Simon Bolton.

Speaking at a Westminster Health Forum today (15 November), Bolton said the NHS needs to get to grip with the number of systems in use and the variability this brings to patient care.

Bolton said that since joining the NHS, he has been “struck” by the “absolute spectrum of technology solutions that we’ve got to fix the same problems”.

He said the number of different electronic patient record systems (EPRs) and the number of different hospital systems cause big variabilities across the system, which is hindering the delivery of the kind of care the NHS needs to provide across the system.

“When you’ve got 40, 50, 60 different EPRs across different hospital trusts, that dilutes the level of experience that you can build, the capacity to drive interoperability, and not least, driving a tendency to increase variability for care pathways,” said Bolton.

“I think we should get to a position where we are probably using, in secondary care as an example, somewhere between four and six EPRs across the nation.

“We can build the expertise in, but importantly, we can build the commercial relationships with those suppliers to get the kind of products and services that we want, and also make sure that we get those suppliers delivering the service that we expect from them.”

Bolton said this is not a “short-term play”, but rather looking at where the NHS should be in the next 10-15 years.

“I know that doesn’t sound very ambitious, but this is about generational change,” he said, adding that many trusts have invested millions of pounds on these systems, and it will take some time to figure out “what we want this to look like”.

Bolton added: “So what would I do? I would start to identify the right supplies that need to be in place for the future, start to construct commercial relationships with those.

“I think there should be a greater level of mandation around the solutions we can use across the system.”

He added that he was by no means arguing for another National Programme for IT (NPfIT).

The NPfIT was launched in 2002 to reform the way the NHS in England uses information. As part of the programme, trusts were mandated to use certain EPRs, but although some parts of the programme were delivered successfully, others encountered significant difficulties, such as deploying detailed care records systems. Inevitably, the programme was canned by the government.

Bolton said he believed there should be a choice, but that choice should be restricted to a more manageable group of suppliers.

This is not just restricted to EPRs, he said. In June 2020, NHS Digital signed a landmark deal with Microsoft, giving all NHS organisations in England access to Microsoft 365, aiming to give staff a better way to work more efficiently and deliver better care for patients.

“I think we’re pretty good at running that,” said Bolton.

“But yet we still have parts of the NHS that want to move to Google or do different things, and I’d argue that that’s a crazy place to be, where we’ve got commodity-type solutions. We should be leveraging our national buying power, our ability to build expertise and knowledge to do things once, or at least a limited number of times.”

Bolton took over as interim CEO of NHS Digital in June 2021 following the departure of former CEO Sarah Wilkinson, having previously spent time as CIO at NHS Test and Trace during the pandemic.

However, NHS Digital is due to be merged with NHS England in January 2023, at which point Bolton will depart as interim CEO.

The move will see NHS Digital’s role as a separate arm’s-length body of the Department for Health and Social Care cease to exist as staff and assets are transferred to NHS England. This will create a single statutory body for data, digital and technology – news that has not been well received by all.

In March 2022, former NHS Digital chair Kinglsey Manning penned a letter to the British Medical Journal saying the plans would endanger the rights of citizens in regard to how their data is collected and used by the NHS, and called the move a “grave error”.

But Bolton disagreed, saying he did not believe it to be a grave error, but “vitally important”, adding: “The alphabet soup we’ve had at the centre of the NHS has been really problematic.”

He said it has felt like a competition between NHSX, NHS Digital and NHS England. “We need to bring that together and consolidate it and provide real clarity of leadership to the whole system, particularly around technology,” he said.

“We need to demonstrate that we are protecting patient data at all costs, because this is a question of trust. And we need to make sure that, as we move into a single NHS England, we’ve got the mechanisms in place.

“We are building those at the moment to ensure that we do have appropriate governance to make sure that data is used properly and with due cause across the system, and we will be open about how we do that.”