Last year, we played back the key reflections that we heard from trust leaders during our board sessions, interviews and events. Twelve months on, we can now point to the practical ways in which trust boards are putting these into action:

Digital is more than just the technology

Board leaders are adopting a new digital mindset that expands their understanding of digital to include more than just IT. Digital applies the culture, processes, operating models and technologies of the internet era in response to people's raised expectations.

Leaders in practice: The first goal of Torbay and South Devon NHS Foundation Trust's digital strategy is to embed digital into the board and recognise that "digital transformation is more about changing the way the organisation runs itself than technology fixes". Liz Davenport, chief executive, has said the board has a leading role in giving teams "greater clarity of purpose, freedom to act and permission to focus on delivering minimum viable services in weeks, not months". 

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2  ​Boards are managing risk more strategically

Leaders are getting to grips with the right questions to ask when gaining assurance for large digital projects. In doing so, boards are equipping themselves to take a proportionate approach to risk, which includes assessing the risks of doing nothing. One chair reflected that a mature risk appetite at board level is marked by explicit conversations exploring and defining the board’s risk appetite, gaining assurance from digital experts, and reviewing risk registers as live resources. As they put it, “this is about translating the question ‘what keeps you up at night?’ into meaningful insight and most importantly, action.”

Leaders in practice: Lancashire and South Cumbria NHS Foundation Trust implemented a new electronic patient record (EPR) during the middle of the COVID-19 pandemic. In the run up to go live, the trust’s leaders focused on readiness across three areas: operational, technical and clinical safety. Through regular ‘deep dives’, chaired by either the trust chair or the chief executive and with several executive directors present, the board were sighted on risks early and were close to the issues. During this period, Dr Ayesha Rahim, the trust’s deputy medical officer and chief clinical information officer encouraged the board to “ask the questions they didn’t feel comfortable asking”.  

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There is greater collective ownership of the digital agenda

Digital is no longer the preserve of the IT department. As an enabler of transformation, safety, productivity and much more, board members recognise they each have a role to play in enabling and supporting new digital ways of working. Boards are also identifying the similarities between the digital and quality and improvement agendas to deliver service transformation.

Leaders in practice: In order to mainstream digital thinking at board level, Milton Keynes University Hospital NHS Foundation Trust has divided the digital agenda into four key themes, each led by a different executive member of the board:

  • infrastructure, including wifi, devices and upkeep of their electronic patient record system

  • patient technology, which focuses on patient facing tools

  • staff technology, including training, bank staff scheduling and other projects that enable staff to do their job well

  • clinical technology, which encompasses any clinician-led innovation. 

The chief executive, Joe Harrison said: "it is the responsibility of the whole board to have the confidence to invest in technology and create this space for innovation."

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4  Boards are getting closer to the digital users’ experience

Boards continuously recognise that genuine user-centredness is needed to unlock the potential digital brings to transform the patient and staff experience. Trust leaders are seeing the value that having open and responsive feedback channels can bring when designing and improving services. 

Leaders in practice: As chief executive at Kingston Hospital NHS Foundation Trust, Jo Farrar takes time to listen on the IT help desk to get a sense of the current pain points faced by staff and to better understand what processes are used internally to address these.

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5  Digital is becoming more integrated within wider strategies

Increasingly, trust leaders are embedding digital as an integral part of their wider corporate strategy. It is becoming rarer for digital to only be discussed at board level when approving business cases. Boards are instead setting a clear vision for how digital can enable the trust’s wider goals.

Leaders in practice: Portsmouth Hospitals NHS Trust has applied design principles to build their digital strategy so that it is focused, clear, realistic and user centred. The strategy centres around five pillars that all digital solutions should meet: make things simpler, better connected, faster, enabling, and secure.

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Trust leaders are rising to the challenge of system working

As the future of the systems landscape continues to evolve, leaders are grappling with challenges around interoperability, divergent starting points and building transformation capability across the patch. While many are at the beginning of their journey, there are early successes, quick wins and a huge appetite to raise the profile of system-level digital priorities within trust boardrooms.  

Leaders in practice: During the height of the pandemic, as reliance on technology to deliver care became more crucial, Surrey Heartlands Health and Care Partnership ICS looked to improve digital capability across the system by sharing laptops, desktops, monitors and headphones with community partners. This, in turn, built trust between different organisations and meant that the whole system was better positioned to meet the needs of patients.

Katherine Church, chief digital officer across the ICS argues “digital success within an ICS will depend on leaders’ abilities to break down organisational boundaries, collaborate effectively and maintain focus on health outcomes and the patient journey.”

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Board leaders are more confidently prioritising work

Now more than ever, boards must make difficult decisions when prioritising projects – weighing the long-term benefits of forward-thinking digital investment against shorter-term solutions that meet an immediate need. To achieve sustainability, the NHS must set realistic expectations that translate into specific priorities for organisations and systems.

Leaders in practice: Mandy Griffin, a former NHS chief information officer and now non executive director at South West Yorkshire Partnership NHS Foundation Trust shared this reflection: “The reality is that you have limited resources which means you can’t deliver all the big-ticket digital items different services may be asking for. In our digital strategy we included a metric that scored each digital proposal in terms of patient, staff and financial benefits. This will inform our business case pipeline and we’re working with our divisional directors to ensure they own each priority.” 

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Trusts are investing in cross-functional multidisciplinary teams

Trusts are starting to build truly multidisciplinary teams that include design, technology, clinical and operations. By breaking down silos between IT, clinical and operations staff, teams can better navigate what’s safe, operationally feasible, and technically possible. Some trusts have revisited their operating models to join up their digital, quality improvement and transformation capability and embed this within frontline delivery.

Leaders in practice: Toby Avery, chief digital information officer at Surrey and Borders Partnership NHS Foundation Trust, describes his vision for multidisciplinary teams within the trust: “For us, a fusion team is the bringing together of diverse competencies to design for the outcome. Historically we have often designed solutions to meet a need, but we have done it based on the preferences, interests or bias of those designing it. The result has been either a solution that is not fit for purpose or one that people do not use. A fusion team aims to mitigate these natural biases that we all have by bringing the right people into the entire design, build and implementation cycle.”

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  • You can hear more about the ‘fusion teams’ at Surrey and Borders Partnership NHS Foundation Trust in a blog from Toby Avery.
  • Read more about how boards can support digital teams in our leadership guide on Building and enabling digital teams.


Boards are exploring the connection between the digital and quality improvement agendas

Trust leaders recognise the similarities between digital and quality improvement approaches including: iteration, standardisation and ensuring services are user centred. Improvement and digital approaches call for wider culture change that is underpinned by board leadership. Trusts are now looking to blend these ways of working to deliver transformation across services.  

Leaders in practice: North West Ambulance Service NHS Foundation Trust used a Plan Do Study Act (PDSA) approach to test and iterate the implementation of a new digital safety check system. Detailed user feedback was captured throughout the testing period as the new system was scaled across the trust. Maxine Power, director of quality, innovation and improvement suggested the success of this work was “driven by a clear sense of purpose, the leadership of an authentic clinician, the incubation of ideas, rigorous testing, rapid modification and a clear understanding of ‘why?’.”

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