Poor communication between central and local NHS ‘hindering digitisation’

Better communication and engagement between policy makers and NHS providers is needed to support the digitisation of healthcare, the Nuffield Trust has said.

In a report released last week, ‘Achieving a digital NHS: Lessons for national policy from the acute sector’, the independent health think tank said while current policy approach was useful in achieving wide spread digitization, national bodies often set “unrealistic timeframes” without understanding the supplier market or local NHS organisations.

Poor communication on how national policy impacts local plans; why a particular solution has been suggested; and the benefits it will bring, are hampering the adoption of technology in the health system.

Establishing a “clear dialogue” between local and central bodies is “essential” for ensuring national policy supports local digital advancement, the report said.

This should include the development of clearer digital standards, including appropriate deadlines for implementation and better guidance for how they should be used and interpreted.

This fragmented approach to digital policy in the NHS is expected to be addressed by the newly formed NHSX, but the report notes there is still “uncertainty” as to how body will work in the future.

Conversely, some national policy makers involved in the report felt “frustrated” with local providers attitudes and felt organisations should be able to take more responsibility for their digital programmes.

In a blog post on the report, author Rachel Hutchings said: “For the last decade, we’ve had a host of digital policy initiatives that have promised comprehensive electronic records, improved patient access and a more strategic use of data across the system.

“Now, enter NHSX – a new organisation to lead on digital, data and technology, to deliver these ambitions and harmonise what have historically been fairly disparate initiatives.

“Uncertainty over how the new organisation will operate in practice and the status of existing digital programmes makes it difficult to predict what will happen over the next few months.”

She highlighted three key points as firm areas of challenge:

1. Having the support to implement standards is just as important as standards themselves: Understanding of priorities and a plan for engagement and implementation is “vital” for digital policies to succeed
2. Get the priorities right: Pushing for “grand levels” of digital maturity without getting basic steps right could “undermine” digital transformation
3. Focus on the workforce: The digital workforce is not spared from staff shortages and more needs to be done to provide appropriate career pathways to attract the necessary staff

Addressing the need for a digitally ready workforce, the report found many trusts experience “significant challenges” with recruiting and retaining a workforce necessary for digital change.

“A lack of professionalisation and a clear career pathway with accompanying qualifications for digital roles limited opportunities for learning and development,” the report found.

Additionally, many felt the role of chief clinical information officer (CCIO) needed to be legitimised beyond engagement with boards, including a clearer career pathway and accreditation.

NHSX provides an opportunity for central policy makers to take a “unified approach” to digital strategy, Hutchings added.

But, in order for this to happen, there needs to be “much better and more effective two-way communication between national policy-makers and local NHS organisations”

“Failing to understand the needs and priorities of the system risks digital yet again becoming viewed as a barrier or a distraction, rather than an opportunity,” she added.

“What’s certain is that getting the balance between national standardisation and local flexibility right is fundamental to successful digital change, and determining exactly where that balance should be struck will be an ongoing question for policy-makers.”
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Other key findings in the report:

• More needs to be done to communicate the purpose of digital standards beyond technical teams – particularly in highlighting the potential benefit they offer the organisation
• Managing supplier relationships can be challenging, with some trusts to engage suppliers in making systems upgrades and changes in a timely manner. Central NHS teams could play a wider role in improving this.
• Clear guidance about the benefits and drawbacks on data sharing need to be established in order for better data sharing across the NHS – currently some providers refuse to engage due to concerns around information governance.
• The need for ongoing national and local investment to achieve digital maturity “cannot be underestimated”, whether that is for organisations to maintain existing programmes or make the most of new opportunities
• Central NHS needs to be “realistic” about likely levels of funding to maintain and support Global Digital Exemplars (GDEs) and accommodate a switch from capital to revenue funding
• GDE trusts did not feel reaching a HIMMS level 7 was realistic in all cases, yet trusts felt a pressure to achieve it quickly
• National NHS should look beyond GDE blueprints to share best practice

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