Since March 2020, the Digital Boards programme has engaged over 2,000 trust leaders across over 40 events and almost 100 bespoke board development sessions.

We’ve published numerous resources for trust leaders, including six leadership guides on the fundamentals of digital transformation for NHS boards. These publications include examples of good practice and advice from across the sector.

This final guide distils the key messages that have underpinned our programme along with the learning from three years of delivering the Digital Boards programme.

How to use this guide

This publication is not designed to be exhaustive. Instead, it provides a snapshot of what matters most when it comes to board leadership in key aspects of digital transformation, from digital strategy to making the most of electronic patient record systems (EPR).

As a busy board leader, you may want to refer to different chapters as you prepare for board meetings, signpost colleagues to specific content and case studies, or reflect on the questions posed throughout. For more information, please refer to our previous publications.

Hear from NHS leaders what the top questions boards should ask about digital transformation should be:

Questions for boards

Watch the video below to hear directly from NHS leaders the key questions that all board members can ask to assure themselves on digital transformation.

Defining digital – making sure you’re aligned

Digital transformation requires fundamental changes which can only be driven by collective leadership of the whole board. But to do this, boards need to be aligned on what digital means. In our board development sessions, we use the following definition:

Applying the culture, processes, operating models and technologies of the internet era to respond to people’s raised expectations.

Tom Loosemore    Partner, Public Digital

Technology is important. But to achieve the service transformation any organisation needs to thrive in the internet-era, there’s a lot more. The culture, the processes and form the organisation takes are equally important.

What this broad definition of digital makes clear is that responding to the consequences of such change is a job for the whole board and whole system.

Many of the most well known bi IT project failures that you may have read about or seen in the media tend to have a particular root cause to their failure – they were given to the chief information officer (CIO), IT department, group of consultants or a single big outsourced supplier to worry about. Projects fail not because people are inadequate but because the rest of the organisation wash their hands of them. Delegating digital to one place – one executive, or one team, or one set of skills (or worst of all, one consultancy), will get you into trouble.

Digital is a collective responsibility for board leadership. Everyone on your board plays a vital role in making it happen – in delivering it, in creating the organisational culture, processes and operating models that allow it to be delivered.

Where are trusts now on the digital transformation journey?

Since our programme launched in 2020, trusts have made progress in a number of areas, but significant challenges remain:

  • Large strides were made during the pandemic, but leaders are anxious about letting progress slide backwards. This includes the growth in remote and hybrid working, the expansion of other digital tools and increasingly more sophisticated and focused trust digital strategies.
  • More trusts are procuring and deploying EPR systems. Over the last few years there have been a number of high-profile deployments across the provider sector. In December 2022, NHS England estimated that 181/211 trusts in England had some form of EPR in place, with the ambition for 90% of the sector to have implemented a system by December 2023.
  • Those already with EPRs are working hard to improve these systems. By focusing primarily on usability and continuous investment, trusts are optimising their EPRs which is helping enable more efficient and safer care.
  • Expanding virtual wards. Trusts are combining face-to-face delivery with new technologies to provide more care at home. Not only is this improving patient care, but both staff and patient feedback continues to be extremely positive.
  • Funding remains a significant constraint for many trusts. Digital leaders are adept at working with what they have. However, insufficient funds have meant trusts have been unable to replace core infrastructure or legacy systems, while others have experienced delays in their EPR journey. Last year, it was thought the NHS England technology budget was worth less than half the £2.1bn originally allocated by the government in the 2021 Autumn Spending Review.
  • Staff burnout is slowing the pace of change. Despite enthusiasm for digital, there remains limited bandwidth across the workforce. Clinicians struggle to carve out time in their day job and digital leaders continue to struggle to recruit and retain talent. To help address this, trusts are appointing clinical digital leaders and the momentum continues to build for further professionalisation of chief clinical information officers (CCIOs) and chief nursing information officers (CNIOs) as well as digital allied health professionals (AHPs).
  • Cyber remains a risk. Another ransomware attack in 2022 showed the threat of cyber attacks has not gone away and underlines the importance of robust cyber security.
  • Capitalising on the establishment of integrated care systems (ICSs). With systems placed on a statutory footing in July 2022, integrated care boards are finding their feet and trusts are now looking sideways to their partners to collaborate and align even further on digital.

Our learning

Foreword from Sir Julian Hartley, Chief Executive, NHS Providers

Throughout my time on trust boards, I've learnt that one of the key ways to drive value is through empowering people and teams. And this is certainly true for digital transformation. Through our board sessions, interviews and events, the Digital Boards team have heard a number of common reflections from trust leaders on leading the digital agenda and empowering digital teams. These themes indicate progress is being made and that trust boards are increasing their digital confidence and capability:

  • There is greater collective ownership of the digital agenda.
  • Digital is becoming more integrated within wider strategies.
  • Boards are building confidence in their assurance role. They are managing risk more strategically and getting to grips with the right questions to ask.
  • Boards are getting closer to the digital user experience.
  • Boards are recognising the importance of joining up their ambitions across the system.
  • Boards are more confidently prioritising work.
  • Trusts are investing in cross-functional multidisciplinary teams.
  • Boards are exploring the connection between digital and improvement agendas.

Following the success of this work, and the launch of our new Digital ICS programme, we set out eight broad themes for good digital leadership. You can read more about them in this blog written by Saffron Cordery, deputy chief executive