Digital Health 2023 Year in Review

Digital Health’s editor-in-chief Jon Hoeksma looks back at the key trends and big stories over the past 12 months

The year has been one of sharp contrasts for digital health. Across the NHS the pressures have been intense, with record waiting lists, industrial action, and increasingly fractious labour relations.

The biggest story of the year was the NHS in continuing crisis as waiting lists soared towards seven million and opinion leaders wrote obituaries for the health service. Against this backdrop digitisation and data efforts struggled to get national airtime, even though much local progress was made.

FDP proves immune to NHS cuts

The exception to this, nationally, was the year-long saga of the Federated Data Platform, offering a company and founder out of central casting. And a seemingly bulletproof big data and AI project that fanned Big Brother concerns, and that appeared immune to the deep budget cuts affecting much of the NHS and frontline digitisation in particular.

At Rewired in March Louis Mosely, UK MD Palantir, pulled out of a debate with legal campaigner Cori Crider of Foxglove and was replaced by a cardboard cut-out.

Over 3,500 people did, however, make it to Rewired2023 to make it the biggest and best UK digital health show of the year. For 2024 Rewired moves to Birmingham NEC while legal wranglings over FDP look certain to continue.

GSST and Kings become biggest EPR programme in London

March saw Guy’s and St Thomas’ NHS FT and Kings FT postpone their go-live with the biggest EPR programme yet in London. They eventually went live in October.

NHSE cuts cast long shadow over NHS IT

One constant across the year was the continuing convulsions at NHS England following its take-over and closure of NHS Digital in January 2023, triggering massive job cuts. In May it was revealed that over 9,000 jobs were to go at NHSE, almost 40% of the total.

The cuts have unsurprisingly badly hit morale and capability, particularly among ex-NHS Digital staff, as many staff and teams focus on whether they will have future roles. As the year ends, the process grinds on and a round of compulsory redundancies looms.

With such deep job cuts NHSE has been hemorrhaging much needed experience and knowledge in digital that it will surely sorely miss.

Unexpected collateral damage from NHSE cuts

And like a large rock dropped into a small pond, the impact of the cuts have spread far and wide with unforeseen consequences. Bodies that had depended on NHSD and NHSE to fund important long-term workforce and professionalism initiatives have been left high and dry.

Most notable among the casualties in informatics is the Faculty of Clinical Informatics, where the drying up of funding from NHSE, coupled with catastrophically myopic leadership and debilitating internal splits mean the organisation will likely not survive into 2024.

All change at the top

There have been some big changes in national leadership too, with Simon Bolton former CEO at NHS Digital departing in January as his organisation was taken over by NHSE. Bolton told the Commons Health and Social Care Committee that the greatest challenge was getting the right digital skills into the NHS.

After a lengthy recruitment process John Quinn was named as NHSE’s new national CIO in June. Meanwhile, Dr Tim Ferris’s time as director of transformation at NHS England came to an end in September; he was replaced by Dr Vin Dawakar.

The legacy of Dr Ferris’s time leading on digital, with the policy focus on convergence and targeting limited national investment to less digitally mature trusts was seen in the surge of EPR procurements that reached contract award over the year.

Flurry of EPR contract awards

Notable EPR contract awards and go-lives over the year included:

Sheffield Teaching Hospitals NHS FT, which selected Oracle Health to provide a new EPR in an £85m deal in February.

The Norfolk and Waveney Acute Hospital Collaborative, where three trusts jointly selected Meditech to provide their EPR.

Barking, Havering, and Redbridge University Hospitals NHS Trust, which said it is to move away from paper-based records after selecting a new EPR from Oracle Health (as we have all still to get used to calling Cerner) in a 10-year deal worth £44 million.

The start of November saw The Royal Wolverhampton NHS Trust (RWT) sign a 10-year contract with System C for an integrated EPR system, which will replace the trust’s in-house built EPR and accelerate its digital maturity and roadmap.

In November, South Eastern Health and Social Care Trust in Northern Ireland went live with encompass EPR from Epic – the first trust in the country to go live. The key to the Northern Ireland project is the integration of health and care from the outset.

Nervecentre the new kid on the block on EPR

The year ended particularly strongly for EPR challenger Nervecentre, which in November won a joint tender to supply University Hospitals of Derby and Burton (UHDB) and Chesterfield Royal Hospital (CRH) with a new EPR.

And in December Nervecentre followed up their double with winning Northampton General.

No surprise on FDP contract winner

December also saw the culmination of the longest running story of the year, the award of the Federated Data Platform contract to Palantir, in what must surely count as the least surprising contract award of the year. The award in December, the height of pantomime season, seemed fitting for a company founded by Peter Thiel, an ultra-libertarian US tech billionaire straight out of central casting.

The fall of Babylon

Another long-running saga that reached its fateful denouement, was the spectacular fall of Babylon Health, worthy of Dante. Once the epitome of disruptive digital health and standard-bearer of UK start-up scene, its fall from grace was spectacular if not entirely surprising.

In the case of Babylon, it turned out that being slick at lobbying, gaining high level political influence (before his own defenestration Matt Hancock was once Babylon’s cheerleader in chief) and investing in huge marketing campaigns, couldn’t overcome overblown claims about its AI technology that insiders revealed (as confidentiality clauses became moot) had more closely resembled a bunch of spreadsheets.

2023 the year of generative AI

Irrespective of Babylon the inexorable rise of AI continued to gather breakneck momentum in a year where tech and mainstream media was dominated by all things generative AI, ChatGPT, LLM and Sam Altman. To help explore the bewildering range of products, models and start-ups, Digital Health launched a new show AI and Data at the end of October.

Six+one reasons why short termism rules

The dismal mixture of politics, crisis, money (or the absence thereof) and tail-end government all served to make national policy initiatives on digital (with the notable exception of FDP) largely reactive and strictly short-term. This was seen in NHSE’s seven (or six+one) short-term digital priories, which had time-scales measured in months.

In September Digital Health News reported that the flagship initiative electronic bed management and capacity planning had been allocated £68m and inspired by the then Secretary of State for Health visiting Maidstone and Tunbridge Wells.

Victory on 90% EPR target declared

One very longer-running objective that was declared met this year was for 90% of trusts to have an EPR. NHSE CEO Amanda Prichard declared an early victory. This was rather at odds with estimations by Tim Ferris earlier in the year that less than half of EPRs were up to scratch.

Over the course of the year money for front-line digitisation continued to be syphoned off to help pay for deficits and the costs of strike actions. In July the government’s Infrastructure and Projects Authority revealed the £2.6 billion programme had been cut by £700m at the beginning of 2022-23.

Then in November Digital Health News revealed that a further £300m of front-line digitisation funds was at risk of being raided to help cover £800 million of the costs of industrial action.

Hope for 2024

There can have been few years tougher for the NHS and health professionals than 2023. As well as the toll of a service in permanent crisis, the national solidarity on the NHS during the pandemic has receded into distant memory, with increasingly vitriolic attacks from sections of the government and national media on the integrity and professionalism of staff.

The status quo no longer looks tenable. One way or another 2024 looks like a year that will trigger change. Whether this comes from a General Election remains to be seen.

Mending and renewing the NHS will take time, leadership and sustained effort and resources – and be an endeavor in which digital and data will surely have a key role to play. The hope for 2024 is that we will come to look back at 2023 as the darkest hour before the first glimmering of dawn.