New review highly critical of NHS Digital’s capabilities
- 19 July 2017
A critical internal review of NHS Digital has found the organisation relies on out of date technology, has skill shortages in multiple areas and its data services are operating below expectations.
The report also says it is unclear what NHS Digital’s core purpose is, stating that expectations are ill-defined expectations and uncertain operational boundaries adversely affect NHS Digital’s delivery performance.
NHS Digital responded to the Capability Review findings in its Fit for 2020 report, published 18 July, but has yet to publish the actual full review report. The review was carried out by consultants Deloitte and Accenture, both organisations have previously worked closely with NHS Digital and have former staff now working as directors at the organisation.
The findings of their Capabilities Review are summarised in the Fit for 2020 report which highlights 11 main areas of concern, including NHS Digital’s “out-of-date technology”.
“The business is using out-of-date technology in key areas and the adoption of innovative digital solutions and automation is often too slow”, the report stated.
It found that few people are aware of NHS Digital’s role and functions in their entirety – especially its statutory role.
The report went on to point out skill shortages in areas that include cyber security, business analysis, clinical resources and software development and systems engineering.
Within the executive summary of the report – the review found frustration regarding data services , “We are recognised for our expertise in delivering large scale infrastructure and technology live services, but there is frustration about our handling of data services.”
Modernising data services was one of the areas of concern, stating: “Feedback from customers was that these services were below expectations. Delivering better here will have the largest impact on brand and reputation.”
It referred to its digital culture and behaviour skills as “historic”, which in turn “impacts NHS Digital’s ability to drive change at scale.” The review also assessed the organisation’s commercial capability as “basic to average”.
In its cover letter, NHS Digital chairman, Noel Gordon, says the culture of the organisation will be “reinvented”, to become “more flexible and responsive to the very dynamic environment in which we operate”.
Fit for 2020 says NHS Digital will address the findings through a variety of actions including establishing a National Security Operations Centre for cybersecurity, implementing a business intelligence tool to access data and transforming its website.
To foster innovation a “thought leadership” programme will be created, alongside a network of entrepreneurs and software developers.
To address the workforce concerns, graduates and apprentices are being targeted and recruitment processes will be digitalised.
Communication with front-line organisations is also identified as another issue at the national agency:
“Our local stakeholders say we are distant from the front-line, and this is exacerbated by the way we communicate with other organisations, which is experienced as ‘transmitting’ information rather than ‘engaging’ with organisations.”
In a staff letter, sent out by Rob Shaw, interim chief executive of NHS Digital, he described his pride in the work completed such as the NHSmail2 programme and the electronic prescription service. “We are rightly proud of what we’ve done but there’s still much more to do.”
“Work has already started and a Fit for 2020 team has been established to deliver these commitments – the majority of these will be completed by April 2018.”
The independent review was done between October 2016 and March 2017, and commissioned by NHS Digital to review its readiness for delivering the National Information Board’s Personalised Health and Care 2020 strategy.
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11 concerns from the Capability Review:
- National role and clarity of service offer – Ill-defined expectations and operational boundaries adversely affect NHS Digital’s delivery performance.
- Customer needs and front line engagement – NHS Digital does not maximise value of every customer interaction
- Fostering innovation – No organisational processes for using insight in solutions and introducing new ideas that address fundamental challenges of the business
- Modernising data service – Feedback from customers said data services were below expectations
- Assurance and ownership alignment – Inconsistent governance and assurance arrangements
- Strengthening cyber capability – Can grow internal and external cyber services
- Strengthening commercial capability – Commercial capability is assessed as basic to average
- Workforce skills and agility – Limited use of alternative resourcing channels damages NHS Digital’s ability to adjust to differing workforce demands
- Digital culture and behaviours – NHS Digital’s ability to drive change at scale is affected by established ways of working
- Modernising the internal technology landscape – The business is using out-of-date technology in key areas and the adoption of innovative digital solutions and automation is often too slow.
- Industrialising the delivery model – NHS Digital has not defined its business architecture clearly enough
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15 Comments
If NHS Digital (and it’s predecessors CfH or counterparts like NHS Improvement) can’t deliver at scale it’s because NHS is not a single entity like M&S or Walmart. As long as we have a thousand medium sized independent NHS entities, anything at scale is impossible.
Good old blame the centre. Blame the central bodies.
Just like the recent cyber attack, its incredible that no one is looking at themselves in mirror rather than throwing stones from their fragile greenhouses. What are we the NHS doing as a whole to review our capability?
Least they had the bravery to look at how they can improve. So should we!
“Although there has been a rapid foundational capability roll-out for cyber security, there is still opportunity to enhance and mature both internal and external cyber services.”
This must be in the running for the most opaque statement by a government body in 2017 – hardly in the running for a Crystal Mark award. http://www.plainenglish.co.uk
NHS Digital’s role is a no-win one in many respects. Had the Information Centre culture prevailed at the time of the CfH/IC merger NHS IT would now be in a far better place. Instead, the CfH culture swamped the far more pragmatic and open culture of the Information Centre – a mistake that fresh minds at the top of NHS Digital are only now correcting.
Sitting downstream of NHS/England, which sometimes behaves like a herd of indecisive wildebeest, massively over-embracing clinical IT fads and then dropping them again is a part of NHS Digital’s problem. NHS/E too often comes up with programmes that benefit the NHS nationally at the expense of the NHS locally – but does so in the knowledge NHS Digital, CCGs (and suppliers) will mainly face the fallout from that.
No surprises in the article. Have asked NHS Digital ( and previously HSCIC)for advice and/or support and got nowhere fast.
My Experience is different – We asked NHS Digital for help and we have had nothing but excellent engagement – development – Support – Advice and Help.
Why do we try to build all this capability internally, there are companies that are better at this and can be more responsive and innovative – should we. It explore that as an avenue for change? The NHS should not try to do everything, focus on what it is good at and then see how you use industry convergence to support that.
I never understood why of all the things the NHS could focus on it chose the IT. It’s a massive, complex and expensive landscape where millions are invested in R&D alone. The NHS and public sector as a whole have an appalling track record on this too and things are not really improving.
Their priority should be ensuring the system is sufficiently open and accessible so that individuals can engage and industry and innovate around them. The NHS should focus on identifying what is out there that is good and adopting it.
It beggars belief that I still cannot choose to receive emails from the NHS instead of letters in the post. Anyone who says “what about security blah blah” should be relieved of their post or preferably taken out and shot.
Isn’t that substantially what the “National Programme for IT” was about. A selection of the major international IT and change management (the crème de la crème), who knew better than us, who knew exactly how to modernise NHS IT, had better systems, products and people. £millions spent only to find out that the commercial companies vastly underestimated the demands and complexities of the NHS, and seems to have substantially pulled out of their contracts.
Not saying it isn’t a reasonable expectation (after all why reinvent hundreds of wheels all over the NHS) and wouldn’t the NHS so much better (safer, more efficient, etc.) if we all used the same systems, running across the whole NHS. But if the major international IT giants failed, lets not rush to leap over the same cliff too soon.
Perhaps a lot more research into not just companies and their offerings, but also the massive cultural, process reengineering and change management investment needed to have any hope of some success.
Shooting people will simply create more burden on the NHS, but I agree. Just like alcohol and guns the NHS & IT do not make happy bedfellows. Is it not the case that NHS tried to outsource IT services to regional IT service provides a decade ago only for the whole project to fail in spiraling costs as the private sector sought to delivery “value-added” services to the NHS. I suspect that today’s preference for in-sourcing services and capabilities stems from a basic distrust of private sector suppliers to deliver the “value” that they charge for. There are some areas of IT where it is simply unrealistic for a deeply cost conscious organisation like the NHS to set out plans to deliver cutting edge capabilities such as those in cyber security. Most health organisations have a budget of several thousand pounds at best to allocate to cyber security and the chances of NHSD finding and retaining the skills required to run an effective SoC in today’s ultra competitive skills market are low so they should push these functions out to trusted suppliers.
We conducted a review of the then HSCIC’s patient & public engagement efforts several years ago; this seems to have got worse over that time. Did the reviewing organisations look at this element at all?
>just look at the new Digital Hub
How is this directly contributing to evolving the organisation on concerns such as workforce capability or modernising internal technology and data services?
>the focus on in house software development
Choosing technology platforms and using platform suppliers over building software that works, working within limitations of legacy technology and outsourcing NHS content creation overseas doesn’t seem like an in-house software development focus.
Well reading the report it actually suggests there’s a lot of good in the organisations.
Further the organisation is evolving significantly, just look at the new Digital Hub and the focus on in house software development.
The title doesn’t match the story or the actual report. Do you ever consider how demotivating the story is to staff?
#poorjournalism
Journalism doesn’t look to motivate people, it’s job is to hold people to account for their acts.
If you you’re looking for motivation, ask your manager for it.
I find the staff at NHS Digital to be very good but problems exist.
This is a very real problem ‘Our local stakeholders say we are distant from the front-line’ I’d say a critical fault, it is not a problem with NHS Digital at fault itself but a problem with the structure of IT/informatics within the NHS. My view is their is a lack of IT/informatics between NHS orgs and the centre. As an example look at the wannacry virus, the attacks were mostly regional – so why did NHS digital get the blame and not East of England NHS? How does NHS Digital get experience in the field if the jump from organisations to digital is so huge???
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