Trust leaders are committed to advancing digital and data maturity within their organisations, are demonstrating resilience and understand the importance of this agenda in increasing productivity, improving patient safety and ensuring a high-quality experience for NHS staff and service users. However, the barriers to going further, faster are clear and the government will need to work with the NHS to address these and achieve its ambition for digital transformation of healthcare.
This report's findings echo the results of the 2023 NHS Providers State of the Provider Sector survey which revealed that nearly 80% of trust leaders believe technology plays a key role in ensuring the sustainability of health services. Despite this, six in ten trust leaders (61%) feel that the NHS is not fully leveraging the potential of digital. NHS Providers is engaging with NHS England (NHSE) and the Department of Health and Social care on this agenda.
Trusts are working towards delivering the next generation NHS within an exceptionally challenging external and internal context, externally – including continued financial pressures and increasing demand on services, and internally – grappling with aging digital infrastructure and challenges recruiting and retaining digital, data and technology professionals. Reaching a shared vision for digital transformation will rely on a variety of underpinning enablers highlighted by our survey responses and wider engagement with the provider sector:
Increased investment and appropriate funding mechanisms for digital transformation
Access to capital is essential, however it is important to note that digital infrastructure is increasingly moving towards a revenue model, and therefore, there is also a need to ensure sufficient revenue funding for digital transformation. Additionally, there is a need for multi-year settlements that allow trust leaders to better invest strategically in long-term digital transformation. This includes a rethinking of national funding allocation processes and timings. Late in the year allocations with high administrative burden for providers receiving the funding reduces trust leaders' options, and limits the ability to deploy funding efficiently in a way that delivers most value for money.
Balancing investment in digital infrastructure and innovation
Long-term, sustained investment is crucial for translating the commitment to digital ways of working into improved outcomes. Within this, trust digital leaders are calling for a balanced investment focus on improving aging foundational core digital infrastructure in addition to the small pots of money for spearheading new technologies, such as artificial intelligence.
Comprehensive Digital Data and Technology (DDaT) workforce plan
Given the widespread challenges trusts face recruiting and retaining DDaT skillsets and the number of vacancies, providers will welcome publication of the awaited NHSE Digital Data and Technology Workforce Plan. There is a clear need for a comprehensive plan for developing in-house digital skillsets within the workforce to meet the digital challenges facing the NHS.
Increased focus on cyber security and prevention
Given the widespread impact and disruption of NHS services that cyber attacks can bring, there must be a continued focus on cyber assurance and preparedness. While there is high awareness of the threat of cyber, there is not always comprehensive understanding across boards of the cyber risks being carried by the trust. This is because vulnerabilities can stem from any part of the supply chain, including with external suppliers. National support is needed to ensure there are appropriate standards for supplier cyber resilience and response capacity if an incident does occur.
Need for continued support on frontline digitisation
NHSE's Frontline Digitisation programme, which provides central funding, strategic support and knowledge-sharing to paper-based trusts to implement electronic patient record systems, is a positive step in supporting trusts. Continued national support is needed to achieve a minimum digital standard across all trusts. While increased funding through NHSE's Frontline Digitisation Support Offer has been helpful, trusts have fed back that accessing capital through the programme has been difficult, imposing a large administrative burden on trusts. Trust leaders would encourage more streamlined access to capital facilitated by improved funding processes and pathways.
Empowering local autonomy while maintaining commitment to national directives
Providers welcome consistency in approach and messaging around the national digital priorities as this gives clear direction for trust digital leaders and allows for measurement of progress year to year, such as through NHSE's annual Digital Maturity Assessments aligned to the What good looks like guidance. Importantly, as trusts work to meet national expectations around digital development, trust leaders must feel empowered and supported to choose the most appropriate approach for achieving outcomes given their local populations and context. This starts with prioritising a focus on the outcomes the NHS is committed to themselves, rather than focusing on directives around the specific digital tools and technologies used for achieving these outcomes.
Clarity on where digital responsibility sits at a local, system and national level
The Hewitt Review examined the roles and powers of integrated care systems (ICSs) and set out a number of recommendations for improving use of data and digital ways of working as a key enabler for achieving the four core purposes of ICSs. Trusts are working within their ICSs and collaborating with system partners to deliver on the digital agenda. However, further clarity is needed on the operating model for digital, data and technology, how this is structured and where responsibility lies at a local, regional and national level. This includes clarity on expectations for partnership working within systems when it comes to shared digital assets, teams and tools, where appropriate, and the route for funding large digital projects.