Health Service Focus

Digitising the acute sector: the barriers to ambition

Rachel Hutchings, a researcher in policy at the Nuffield Trust and co-author of the recent report, ‘Achieving a digital NHS: Lessons for national policy from the acute sector’, writes for NHE about the biggest barriers to digitising healthcare.

In recent years, policy to achieve a digital NHS has moved away from the over-centralised approach taken by the National Programme for IT to one that provides a supportive framework from the centre, alongside the flexibility for local NHS organisations to progress at their own pace.

The NHS Long Term Plan and Future of Healthcare strategy clearly signals this, with both outlining a series of ambitions to make digital healthcare a reality, including the key commitment for ‘fully digitised secondary care services by 2024’. We now also have NHSX – a new organisation established to lead on digital, data and technology and deliver on these ambitions. 

However, as our recent Nuffield Trust report on lessons for the acute sector shows, for these ambitions to become a reality a number of key challenges need to be addressed.

Rachel Hutchings, a researcher in policy at the Nuffield Trust

Vital hurdles to clear 

Firstly, providing trusts with the necessary support to implement standards is just as important as the content of the standards themselves. An increased focus on providing national standards for key ambitions such as interoperability and data security is a reflection of the current approach by the centre to provide an environment for digital to flourish without being overly prescriptive. 

But for these standards to be effective, more attention needs to be paid to implementation. Timeframes are often unrealistic. Suppliers (whether large or small) have their own projects and limited resources, and making the necessary technical and organisational changes can be challenging, particularly for trusts with limited digital maturity.  

It is widely accepted that digital transformation is as much about changing culture and working practices as getting the technology right. It is essential that this is continuously recognised by having a clear understanding of local organisations’ needs and capabilities. 

Secondly, successful digitisation will not be possible without the workforce to deliver it. Digital transformation requires technical skills such as integration, data analytics and cybersecurity, as well as experience in project management and leadership. But, as with the wider clinical workforce, recruiting and retaining individuals with these skills is a challenge. Restrictions on pay caused by Agenda for Change makes it hard for the NHS to compete with more lucrative offers from the private sector. 

At the same time, digital roles have historically suffered from a lack of professionalisation, meaning fewer opportunities for learning, development and advancement than there are for other roles. While there are many positive existing initiatives, there needs to be a concerted effort to make sure these are coordinated across the whole country.  

Finally – and underlying all of these challenges – is the need for the NHS to focus on the right priorities. In such a rapidly evolving environment, aiming for ‘world-class standards of digitisation’ (led by the Global Digital Exemplar programme) is admirable, but it is not something that can be rushed, and focusing on getting the essential things right is needed first. 

This is not only about establishing the technological infrastructure. It means looking beyond blueprints for specific digital solutions and ensuring that less digitally mature trusts are supported with more fundamental things such as developing their digital strategy, getting an engaged board and recruiting the necessary workforce. It also means a sustainable funding model to support digital transformation – not just a reliance on short-term injections of money. 

This is important not only to optimise and embed existing solutions, but also to make sure the NHS is prepared for future developments. 

An ongoing challenge 

Striking the right balance between national and local approaches to digitisation will be a continuous challenge. Better communication and engagement with local organisations, as well as a clear understanding of the capabilities of the whole system, will go some way to addressing these issues. 

At a time when NHSX is developing its approach, getting these things right will be an important step to achieving its goals.