A critical internal review of NHS Digital has found the organisation relies on out of date technology, has skill shortages in multiple areas and its data services are operating below expectations.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Review are summarised in the Fit for 2020 report which highlights 11 main areas of concern, including NHS Digital’s “out-of-date technology”.

“The business is using out-of-date technology in key areas and the adoption of innovative digital solutions and automation is often too slow”, the report stated.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.

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