With news that Dr Tim Ferris is to depart as NHS England’s transformation director in September, Digital Health News editor-in-chief Jon Hoeksma considers what has been his track record on digitising the NHS and what can we expect next.
The past two years have seen huge uncertainty and upheaval in NHS IT nationally with the abolition of NHSX in 2022 and the demise of both NHS Digital and Health Education England in early 2023. The current waves of job cuts at the vastly expanded NHSE are due to remove 30% of staff.
Over the same period, we have seen massive political instability, with Secretaries of State for Health come and go in rapid succession.
More parochially, we have seen a succession of NHS IT leaders depart: Sarah Wilkinson, CEO of NHS Digital in 2021, Matthew Gould, CEO of NHSX in 2022; Simon Bolton, interim CEO at NHS Digital in 2023.
One constant on the NHS IT scene throughout this period has been Tim Ferris as national director of transformation at NHS England.
Digital as part of transformation
Despite not having digital or IT as part of his job title Ferris has carried the national brief for digital throughout the past two years, exerting significant influence on the direction of travel.
As a practicing clinician with an impressive career in clinical leadership at Massachusetts General, one of the world’s top healthcare institutions, Ferris has been impressive, providing thoughtful leadership and insight into many of the knotty issues of how to effectively use digital and data for healthcare modernisation.
His experience contrasts with most recent NHS national digital leaders, who had variously joined from the Home Office, the Foreign Office and manufacturing.
In public speeches and blogs, he has argued that it is cultural factors, such as local NHS leadership and organisations’ appetite for risk, that are as important to ensuring digital enables transformation as national investment, which has been severely limited over the period. He has also been a passionate advocate of population health management and power of data.
Ferris has of course been director of transformation during a period the NHS has been under massive demand and financial pressures, with a desperate need to find ways to use technology to curb spiralling waiting lists.
This has driven more headline friendly initiatives on virtual care, as well as seemingly announcements every few months about the NHS App.
During massive upheavals a period of relative calm on digital targets
But in a period in which Secretaries for State for Health have come and gone so quickly they’ve barely got to know the brief, there have been relatively few new NHS targets on digital.
And this relative calm – in what has previously been a restless series of breathless targets and bewildering array of initiatives – arguably has helped provide an opportunity to focus.
The target that has loomed largest came courtesy of Sajid Javid back in February 2022, when he said he wanted 90% of NHS trusts to have EPRs in place by December 2023.
Though few believed in the target when it was set (and it will certainly be missed) it has served to galvanise attention back onto acute provider digitisation of the least digitally mature trusts.
Focus under Ferris has been completing provider digitisation
Over the period this has been the main digital focus for Ferris: completing provider digitisation, particularly in acute trusts, getting all hospital trusts to a baseline of EPR capability, through a series of over-lapping initiatives on digital maturity, convergence and levelling-up.
We’ve also begun to see greater focus on supporting front-line digitisation from NHS England through supporting knowledge transfer and best practice in areas like EPR optimisation.
In many ways the levelling-up agenda inverted the earlier Global Digital Exemplar programme from 2016 to 2020, which also aimed at provider digitisation, but which targeted national investment at the most digitally advanced hospital trusts.
The aim under Ferris has been to support the third or so of trusts (estimates have varied) without modern EPRs to first develop business cases and then procure and implement EPRs, often jointly or collaboratively.
There have been twists and turns along the way and promised funds have come and gone, but on the whole the focus on bootstrapping less digitally mature providers has been sustained.
One veteran NHS CIO told Digital Health News that he thought the Ferris approach on levelling up has been “sensible and sustainable”, and one which he believes is likely to continue after his secondment ends.
Focus on small number of EPR suppliers
As part of this approach NHS England has steered trusts towards procuring EPRs from a small number of proven suppliers. At times this has often looked like promoting a US duopoly of Epic and Cerner.
The trend towards buying from fewer suppliers that gained momentum under GDE has significantly accelerated over the past 2-3 years, particularly as ICSs, taking their cues from NHSE, have driven convergence on EPRs.
One London NHS CIO told Digital Health News: “It does feel like we’ve made a real breakthrough on provider digitisation over the past few years. I do worry that there is less choice of suppliers, but we are accelerating on digital maturity”.
Relationship with Epic
Indeed, one of the biggest criticisms of Ferris is that he has at times been perceived to be too close to one supplier in particular: Epic, advocating and championing the system used by the organisation he will returning to at the end of his secondment, Boston’s Partners Healthcare.
Given that Ferris has regularly returned to work at Partners Healthcare throughout his secondment Epic is the system he personally uses. And he has spoken of how having this single system knitted together Partners into a coherent organisation.
From the beginning of his time at NHSE there were strong rumours that Ferris intended to do a national deal for Epic across the whole of the NHS; and that to this end he had a series of meetings with Judy Falconer, CEO of Epic.
Ultimately, plans for an NHS-wide deal failed to materialise, supposedly scotched by Treasury, but the Wisconsin-based EPR supplier has nevertheless appeared to be championed by NHS England when it works with trusts on business cases and procurements.
This perceived market bias has caused huge frustration among other suppliers critical of the extremely high cost of the US supplier and led to dire warnings of the consequences to cost and supplier lock-in of a monopoly market.
Champion of Federated Data Platform
The perception of having one preferred supplier who can do no wrong has also been a major criticism of the other flagship digital programme during Ferris’s tenure: the controversial £480m Federated Data Platform (FDP), where incumbent Palantir is widely seen to be the favoured supplier.
Though responsibility for FDP sits with Ming Tang, NHS England’s director of data and analytics, Tim Ferris has been the senior board executive sponsor and champion for FDP, giving it top level support and seeking to rebut concerns about whether the US AI and analytics spyware company is a suitable partner for the NHS.
The departure of Ferris in the autumn will coincide with a key period in the procurement of FDP and may yet potentially weaken NHSE support for the controversial project as the next General Election draws closer.
Too much focus on acute provider digitisation
But perhaps the biggest disconnect of the past two years is the lack of alignment between NHS Long Term Plan transformation goals, the development of Integrated Care Systems, and supporting national NHS IT strategy.
One CCIO told Digital Health News. “I work in an DGH and recognise that the provider digitisation needs to be completed, but even so there has been far too much focus and investment on acutes, not nearly enough on the rest of the health system, and almost none on social care.”
With Integrated Care Boards (ICBs) now in charge of digital strategy and funding, the future direction on NHS digital strategy should be far more locally determined, moving past the long march of provider digitisation to focus instead on delivering truly integrated care and on how to use data, AI and analytics far more effectively for research, population health and patient engagement.
Insufficient focus on developing digital capabilities of ICBs
But while the current mood music is all about devolution and local ICS decision making, this remains fragile and very early. A recent HSJ report found only half of ICBs yet had digital strategies and the swingeing cuts on 30% of staff and prospect of mergers to follow is not an auspicious start.
Without significant additional support many ICBs may yet prove too weak and poorly resourced to effectively formulate and deliver genuinely transformational digital strategy
The focus under Ferris on baseline provider digitisation for the digital have-nots was in short welcome, necessary and long overdue. But it was in many ways the necessary completion of foundations required before more far-reaching and ambitious transformation of health and care, underpinned by digital and data, can occur.
Transformation may have to follow Ferris
The lasting legacy of Ferris may prove to be to have focused on completing the work of frontline digitisation that will finally enable his successors to properly focus next on achieving genuine transformation.
Its human nature when confronted with complex systems problems to reach for a simple solution like “ruthless standardisation” or "managed convergence. It telegraphs that the leadership have failed to grasp the complexity when a deliciously simple solution to a 30 year old conundrum turns up with the new guy… Ferris didnt understand it any better than Grainger ,Im afraid, but hopefully he wont turn up working for a major supplier who did well under his reign… it would be nice to see an open appointments process for his succesor and for someone to be apponted who isnt surprised by the complexity of the task.
This might be worth reading before the next leader is appointed
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