Smart says STPs must be ‘clear and credible’ on tech

The NHS’ chief information officer has declared that sustainability and transformation plans are the “only game in town”.

Will Smart, speaking at EHI Live 2016 today, said the STPs at their best will provide a roadmap for technologists to follow.

“We must really engage with the STP agenda and make sure that is as radical and farsighted as possible,” he told the event at the NEC in Birmingham.

Forty four areas of England are working on STPs, which are the vehicle for taking forward the proposals in the Five Year Forward View to close a £30 billion funding gap across the NHS by 2020-21.

In the technology space, the STP process has largely overtaken the development of local digital roadmaps, which were once billed as the vehicle for identifying IT priorities and securing funding for them.

NHS England, NHS Improvement and the Care Quality Commission are vetting the plans, but four councils have broken ranks and put their STPs on their websites.

The first STPs to be published, for Birmingham and Solihull and North Central London, identified technology as a significant enabler of new ways of working and shifting patients from physical to digital services.

However, they indicated they were looking for investment from central government. The latter claimed it needs £159 million over the next four years, and an additional £21 million in 2020-21 for its digital projects alone.

Smart said that from a technological point of view he is looking for “clear, coherent and credible” plans that address the challenges that are being faced. 

However, in a second session at the Health CIO Network conference, which is co-located by the show, Smart dampened down expectations of central funding.

"I can't afford many £153 million [sic] chunks of cash, so I would dial back your aspirations about what will come from the centre," he said.

He added that there needed to be a balance between national and local approaches to IT, echoing a theme of the Forward View and the subsequent Personalised Health and Care 2020 strategy.

Both argued that neither the centralised approach of the National Programme for IT nor an earlier 'let a thousand flowers bloom' strategy had worked.

Smart identified patient portals as a service that were being developed in isolation by different healthcare orgniastions, that it might make sense to deliver from the centre.

Smart, who replaced NHS chief clinical information officer Keith McNeil as the first keynote speaker in Birmingham at short notice, also gave more details about the controversial exemplar programme unveiled at last month’s Expo in Manchester.

Following the launch of Dr Robert Wachter’s review of NHS IT, which recommended focusing national funding on the most digitally enabled trusts first, 12 acute trusts were chosen as ‘global digital centres of excellence.’

The move prompted questions about why other types of organisation were not included; and how the move would benefit other providers.

But Smart said this morning that a further round of ‘national’ exemplars will include mental health, community, specialist and ambulance trusts.

The first 12 exemplars were selected based on a “clearly articulated strategic and clinical vision,” he added. They were trusts that had “thought deeply about what their agenda was and how they were going to deliver it.”

He further told the Health CIO Network Annual Conference that one aim of the exemplar programme was to build up a set of "blueprints" that would work across the NHS, to accelerate digital uptake. "We are just trying to make progress as quickly as possible," he stressed.

Until his appointment as NHS CIO in July, Smart was CIO at the Royal Free London NHS Foundation Trust, which has since become London’s only global digital centre of excellence.

Smart made his first big speeches in his new job a rallying cry for the importance of technology in delivering on the NHS’ wider objectives.

But he also included the somewhat paradoxical statement that “there is no such thing as digital healthcare, no such thing as e-health.”

“There’s only healthcare,” he clarified. “Our job is to work with those who deliver healthcare.”