Uncertainty created by NHSX overhaul may risk digital gains of pandemic
- 16 February 2021
Following the news that there’s a plan to create an NHS ‘transformation directorate’, Digital Health’s editor-in-chief, Jon Hoeksma reflects on why be believes a new organisation could risk the digital gains made during the pandemic.
One of the mottos of the technology start-up industry is to ‘fail fast’. Reports predicting that NHSX is to join together with a number of other organisations to create a new transformation directorate, less than 19-months after it was launched, suggests that it may be abiding by this maxim.
In November, Digital Health exclusively reported that the unpublished Laura Wade-Gery Review would recommend a new Digital Transformation unit be established, creating uncertainty over the future of NHSX.
On Monday, a HSJ report suggested a proposal had been made that would see NHSX joining a new ‘transformation directorate’ with the ‘brand’ being retained.
Matthew Gould, CEO of NHSX, gave a briefing to staff at 11.30am on Monday and has since said in a staff bulletin that the organisations work will continue, adding “NHSX will continue to champion digital transformation as a joint unit of DHSC and NHS England, and no functions are transferring out of NHSX or back to the Department.”
Avoiding silos
The role of the new transformation directorate is ostensibly to avoid silos and to embed transformation. The changes come as part of a much wider shake up of the NHS outlined in a new white paper, with minsters taking back direct control in a bid to reverse the devolution of the Lansley reforms.
But if a new transformation directorate is to lead the charge on health and care transformation, it leaves the obvious question of ‘what will even a scaled-back NHSX be left to do?’. Its future looks uncertain at best, particularly for staff who have worked extremely hard throughout the crisis.
Set up 19-months ago, NHSX had only just begun to get going when Covid-19 hit. Arguably, it is being re-organised before it ever got started. Many of the key staff have only just been recruited to its various ‘missions’ and the agency has yet to even publish a full strategy. An alternative strategy would have been to improve NHSX and give it a chance to find its feet.
Leading the transformation
Although it has done a lot of supporting work during the crisis, including key guidance on information governance and fast-tracked procurements to enable remote care and working, it has not been plain-sailing for NHSX.
The false start and repeated delays to the NHS Covid-19 App have been a source of widespread criticism of the organisation, which began work on the app in March 2020 before it was later taken on by NHS Test and Trace.
Monday’s HSJ report suggests that NHSX CEO Matthew Gould, appointed into the role by Matt Hancock, will not head the transformation directorate.
By contrast, NHS Digital is seen to have performed relatively well during the Covid-19 crisis and its continuation was signaled in last week’s white paper on health and care, albeit with a new duty to share data. Similarly, NHSEI will be expected to be in the driving seat on national-level data and analytics on PPE and vaccines during the crisis.
For many NHS IT leaders, the latest changes have been greeted with gallows humour of ‘moving the deckchairs’ variety, as there have been many past re-organisations.
The recurring theme is organisational upheavals, no matter how well-intentioned, inevitably sap time, energy and attention as people work out whether they still have a job. On this occasion it is happening when there is a unique opportunity to build on, and secure, the digital achievements of the crisis.
Getting out of the ground
One of the main criticisms of NHSX from NHS IT leaders was that it took a frustratingly long time to establish itself during a period in which NHS IT policy was in limbo. Past policies on Global Digital Exemplars and Local Health and Care Records were wound down, but nothing was put in their place.
Unfortunately, if NHSX is to be transferred to a new digital transformation agency as part of NHSEI, then the change will almost inevitably carry a high opportunity cost, bringing delays and uncertainty as digital is once again put back into the melting pot.
NHSEI, itself created through the partial merger of two agencies, has a long and mixed track record on IT and digital, often characterised by rivalry with NHS Digital.
Indeed, one of the reasons that NHSX was created by Matt Hancock in 2019 was to break the pattern of sporadic internecine fighting and often paralysing bureaucracy between the various agencies with a hand in digitisation and transformation.
Remarkable achievements
The NHS has unquestionably achieved a remarkable amount on digital in response to the unprecedented public health emergency, particularly in remote care and working.
Yet, arguably, these have primarily been emergency short-term responses crafted by local NHS organisations and communities, not at the centre or its agencies which have served the NHS best when removing blocks. And the uncertainty created by the looming NHS reorganisation will be a major block.
The digital progress of the crisis may yet prove ephemeral and at risk without significant new investment to now go further. The crisis proved that we need plenty of hospitals, but it also proved we need an accompanying investment in digital health infrastructure. The government has pledged to build 40-50 new hospitals, but where is its promise of the investment to build a world-class digital health service?
The challenge of the NHS reset and immediate post-Covid period is surely how to embed the digital changes and systemically sustain the transformation needed. For instance, now moving from remote to virtual and self-care at scale.
National and local leaders have said that the NHS was able to move so quickly in a crisis because the deadening bureaucracy between agencies was lifted for a while. How to sustain this ability to move very fast at scale is perhaps the greatest challenge of NHS digital transformation when the crisis abates.
This is perhaps the greatest challenge for the coming period and where the new white paper offers cause for hope, with its focus on establishing ICSs (integrated care systems) and stronger regional structures.
9 Comments
A joined up single National Strategy for Health AND Social Care promised by our current PM when he was first elected is long overdue and it shows.
Politicians and the mass media (which seems to inform much of their decision making) fall into the trap of seeing everything in silos, Primary Care, Secondary Care, Tertiary Care, Mental Health Care, Social Care (Children), Social Care Working Age) and Social Care (Older People). When hospitals are over-capacity the press blames “bed-blockers” or disparage people who present in ED because they feel unable to access Primary Care services. The cry of “something must be done” goes up and another short term and expensive “fix” is prescribed by politicians which simply moves the problem downstream from one silo into another.
We have a rapidly ageing population with worsening levels of health and well-being at both ends of the age spectrum as today’s teenagers are frankly fatter and less active in general than any preceding generation. The Covid-19 pandemic has temorarily hidden from view the worsening Cancer, Diabetes, Mental Health, Cardio-vascular and other epidemics many of which have their roots in poor levels of public health.
We obviously need a National Digital Strategy and suitable organisations to support and sustain the digitisation and improvements in outcomes of but without a National Strategy for Health and Social Care which addresses the challenge of funding the care of my generation of baby boomers as our bodies start to age rapidly and require increasing health and social care support any improvements will be marginal.
A car entering the Dakar Rally with a fantastic support crew will end up languishing in the desert if it doesn’t have a decent set of roadmaps and a navigator who knows where he or she is going and why!
Those that can, do. Those that can’t reorganise or write a white paper, to make its way into my NHS progress ‘fiction’ list’.
Help, I am drowning in alphabet soup. Could someone please explain in words of one syllable what are NHSX, NHSEI, NHSD, eRS, SCR and the ” transformation executive”. I suspect they are bodies created at different times in a massive confusion of mind, and the sole outcome is that they all trip each other up.
Let’s be frank, NHSX has always been surplus to requirements from the get go. Arguably, it was a ministerial indulgence by a then new Secretary of State and a tool to rid the NHS of the old guard of the digital agenda that used the GDE as a facade to promote one EPR above all others in the new millennium (hope you catch my drift). A credible next step is to scrap NHSX, wind up NHSI and absorb NHSD into NHSE.
There should be NHSE, ICS and local organisations only. Simple structures are far better for decision making, transformation and accountability.
yep, the person that is served by H&SC needs ONE EPR !!! he/she does not need one in the SE and then one in the NW if he/she moves from the SE to NW either on a permanent or temporary basis. further more, if the “quality” of a person’s EPR living in the SE is different to a person’s EPR living in the NW is significantly different then i for one would think that would be a national disgrace ! good tech/data levels quality in a way that words will never do, does that make sense ?
to merge NHS E and NHS D would be a disaster ! there are reasons why the quality of clinical care are different across the nation, there are no reasons why the quality of digital heath provision are different across the nation, only feeble excuses … think outside the NHS box, think retail, think financial, think IT platforms .. the same digital service across the nation ! to merge NHS E and NHS D would be a disaster, what is needed is real accountability in (y)our NHS
The world will not stop turning if NHSE and NHSD are merged. If we are being honest, NHSD operates as the information services and a PMO function of the NHS. Both functions can be delivered as a department within NHSE. And in relation to a single or common EPR system, we all know that the forces shaping the systems in use in the NHS will not agree to one single or common system unless legislated in law (good luck with that!). An opportunity was missed when the NHS did not set about building its own EPR system. The ‘best’ system is hiding in plain view: the NHS needs to acquire one of the current dominant GP and Community EPR systems and extend it to acute, tertiary and social care. It is a risk worth taking. But that would require a very brave and forward thinking Secretary of State. Programmes like LHCRE, ICR, HIE etc. are an admission of defeat and that the boat has sailed on a single or common EPR system. The financial services industry is littered with different systems but importantly has a common standard. It therefore does not matter that we bank with Bank X or Bank Y. Information sharing is highly developed in the industry and competition is encouraged as it stimulates innovation and creativity. The NHS Spine has not innovated for decades now and same goes for the single Secondary Uses Service (SUS). We need to bring NHSD under NHSE while getting rid of NHSX.
I disagree G, what is your background G ? NHS D is not just info. What about eRS, SCR, ePRESCRIBING + These thing are DOing @ the national level and save the UK tax payers billions. My understanding is that NHS E ‘manages’ NHS Hospitals and GPs, and tries ensure quality of outcomes and equality. I agree with an awful lot of what you have said but NHS/H&SC clinical and NHS/H&SC digital are very different things, there is a very strong argument that the digital side of the NHS/H&SC should become independent of the NHS, When the NHS was launched digital did not really exist, maybe this is the basic problem that the NHS faces – it has failed to recognize the role digitization plays in delivering efficiency at scale …
The NHS moved Fast because it was forced to by external forces, it had no choice.
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