Digital transformation in community health services
Community providers, in common with all organisations operating in the health and care system, face significant challenges as they look to embrace the opportunities generated by digital transformation. Yet there are specific opportunities for community health services to deliver better care for patients and service users by maximising the use of digital technology. With a mobile workforce already comfortable with operating remotely, community health services perhaps have most to gain from a fast-evolving digital world that offers significant potential to change the nature of provision. Their flexible, community-based model of service provision is well-suited to testing small-scale innovations in digital.
Informed by case studies and a survey of leaders from within community providers, Digital Transformation in Community Health Services explores the challenges and opportunities presented by digital transformation within the community sector, and makes recommendations for how national NHS bodies and providers can work together to overcome barriers and achieve the full potential of digital innovation.
- Digital transformation has been a key priority of the NHS for many years and is critical to achieving multiple goals within the NHS Long Term Plan, including the ambition to deliver more care in the community. But, the potential for digital transformation within community health services has received relatively little national support, prioritisation or targeted funding to date.
- There are many opportunities for community health services to deliver better care for patients and service users by maximising the use of digital technology, including remote monitoring, virtual consultations and self-management tools. The COVID-19 pandemic has accelerated progress, with community providers adapting rapidly to new ways of working and embracing a digital-first approach where appropriate. Providers and national NHS bodies want to build on this momentum.
- Community providers face a range of challenges in delivering digital transformation:
- Insufficient access to capital and revenue funding.
- Insufficient access to nationally allocated funding impacting on organisations’ ability to deliver interoperability.
- While most community provider leaders believe their own organisation has sufficient internal expertise to drive its digital strategy forward, fewer than half believe all staff understand and support organisational aims in this area.
- As integrated care systems (ICSs) take on an increasing role in system-wide digital leadership and transformation, community providers need to be resourced and supported to maximise the potential from digital improvement and build on existing momentum in many providers.
With a mobile workforce and a community-based delivery model, community providers are well-placed to make rapid progress on digital development. It is clear that this would have benefits for patients and service users, as well as the delivery of more integrated and better value care. Most see the digital aspirations for the sector set out in the NHS Long Term Plan as achievable, but only a minority report seeing clear leadership on digital transformation, whether at system, region or national level. Similarly, there are cultural barriers to digital transformation, and community providers highlight concerns around broader staff engagement with organisations digital agendas.
Importantly, systemic issues are also preventing community providers from moving forward with their digital transformations, with the majority reporting that they had insufficient capital or revenue funding for digital transformation. This is particularly the case for community interest companies, and this inequity must be addressed. Lack of funding is viewed as having a particular impact on organisations’ ability to deliver interoperability and workforce development. There are also challenges associated with short-term funding opportunities, and the balance towards capital rather than revenue funding.
Community providers are enthusiastic about digital transformation and committed to maintaining and progressing digital improvements that have taken place during the COVID-19 pandemic. However there are clear barriers around leadership, organisational culture and funding that must be addressed to enable all community providers to achieve true digital transformation for the benefit of patients, staff and systems.
Recommendations for policy makers
Develop the national business case to invest in digital transformation in the community sector.
- NHS England and NHS Improvement should undertake an assessment at national level to ascertain the level of capital and revenue spending necessary to implement and embed digital improvement in community health services as specified in the NHS Long Term Plan, with a move to multi-year funding if possible.
- NHS England and NHS Improvement should also undertake work to understand the extent of the barriers that community interest companies face in accessing funding, and to level the playing field wherever possible.
Clarify leadership and prioritisation of the digital agenda at regional and national levels within the NHS.
- The way that accountability and functions for the digital community health agenda are currently separated between organisations (for instance between NHSX, NHS Digital, NHS England and NHS Improvement and the Department of Health and Social Care) can be complex and opaque. Now that NHSX and NHS Digital are set to be merged with NHS England and NHS Improvement, there is a need for clear communication about the new national leadership structure for the digital agenda.
Deliver support for providers to develop digital capacity, capability and infrastructure.
- NHS England and NHS Improvement should seek to share best practice between providers and ICSs.
- NHS England and NHS Improvement and Health Education England (which will merge with NHS England and Improvement in April 2023) should work closely together with other relevant bodies, to help address immediate and future skills and capability gaps within the workforce
- National NHS bodies should provide support to community providers and system partners to agree an approach with suppliers of software systems and other digital resources that enables true interoperability. This is required both in agreements struck by individual community providers and national procurement exercises.
Recommendations for community providers and ICSs
Promote the digital agenda across all levels of organisations and systems.
- Leaders at all levels within organisations and systems should be supported to embrace digital approaches, develop digital capacity and capability, and facilitate the cultural shift necessary within the wider community workforce.
- Community providers should build training for staff at all levels on how to use digital technology, with a particular focus on supporting staff who will be using digital approaches with patients more frequently in future.
Integrate and embed the digital agenda within all parts of organisations and systems.
- Community providers should communicate the purpose of digital improvement beyond technical teams, and seek to integrate IT teams with the rest of the organisation.
Work with regional and national bodies to share best practice across community providers.
- Particularly around interoperability, digital training and skills, and creating cultural shifts in organisations; all of which are viewed by community providers as key enablers to digital transformation.