The NHS response to COVID-19 has accelerated digital transformation across health and care. From the increase in virtual outpatient appointments, to remote monitoring of ICU patients, trusts have delivered new services that would have normally taken months or even years.

Many NHS leaders have said "there is no going back". Trusts want to build on the progress they have made during the first phase of rapid digitisation and ensure digital remains central to the continued restoration and recovery of services. Harnessing the momentum of crisis response for long term strategic progress will be the central challenge faced by every board over the next decade.

This guide has been written for board members of all types of NHS trust to support them in the new era of digital leadership required by the pandemic. It outlines how digital issues impact on strategic and operational concerns for executives and non-executives. It explains the issues and trade-offs that leaders should be considering, provides examples of good practice - from the NHS and beyond - of how other organisations have addressed them, and sets out some of the difficult questions that boards will need to address.

Every trust is at a different stage of its digital journey. Every board in the country will already have some experience of introducing new digital solutions, working online or integrating legacy systems. This guide is written for organisations that have begun their transition to working in the internet-era, but who still have a substantial legacy to manage - in terms of technology, processes, working practices and capability. It is also written for those seeking to make the most of the unique circumstances that trusts face in responding to the pandemic.

As part of the Digital Readiness Programme, Health Education England has compiled eight elements of good digital leadership:

  • The board understands the changes being brought about by the use of data, information, knowledge and technology in health and care. The board understands the opportunities and risks of these changes and the changing expectations of staff, stakeholders, patients, service users and the public.
  • The board and wider organisation has a culture of open discussion, experimentation and sharing, led by visible leaders.
  • Everyone within the organisation understands users’ needs, as well as organisational performance, and are empowered to act to improve them.
  • The organisation has a suitably skilled and empowered workforce.
  • The organisation is supportive of cross-functional, non-hierarchical structures as well as traditional hierarchies. Trust leaders consider where power to affect change should be, inside and outside of the organisation.
  • The processes that the organisation uses to underpin its functions are fast, integrated, light and meet patient, service user and staff needs.
  • The risks associated with use or adoption of digital are understood, weighted appropriately against benefits and appropriate assurance is available.
  • The organisation is supported by technology that is scalable, interoperable, flexible, fixable, resilient and fit-for-purpose and the board understands how to assure itself of this.


Digital does not exist in a vacuum. Nor is it a panacea. Good digital leadership is not significantly different from good leadership. But certain capabilities are becoming increasingly important if boards are to maximise the benefits and minimise the risks associated with the new digital world. These should be on the mind of any leader looking to make their trust fit for an uncertain future.