The government needs to address previous failures in its digital transformation plans for the health service, including a failure to address variation in digital maturity, involve frontline staff in changes and tackle digital exclusion, a parliamentary committee has said in a report released today.
The House of Commons’ Health and Social Care Committee’s report Digital transformation in the NHS highlights five major areas where it says the government needs to act: levelling the digital playing field for different regions and trusts; involving and engaging staff; improving digital skills and salaries for recruiting technology talent; focusing on digital exclusion within the population; and overhauling the NHS App.
Friday’s report follows an evaluation by an independent expert panel in February that was deeply critical of the government’s progress in digitalising the NHS, accusing it of “inadequate funding” and a catalogue of “opportunities missed”.
Although the Health and Social Care Committee report emphasised that past efforts to move the NHS onto a more technologically sustainable foundation had been disappointing, the committee suggested the current government was aware of the necessity of overcoming existing obstacles and that there were reasons for optimism this time around.
“Successive governments have attempted digital transformation of the NHS. Progress has been slow and uneven, and there is now substantial variation between organisations,” the report said. “This attempt has the potential to be different, with clear intentions and funding to address factors that have frustrated progress in the past.”
A key obstacle to digital progress in the NHS has been “the preponderance of out-of-date ‘legacy’ IT systems and hardware that cannot handle the demands of a modern digital health service,” the report said, noting that some parts of the health service lack even basic functioning IT equipment. The government needs to ensure that NHS systems are raised to a minimum standard of digital capability, the report said.
As part of this aim, the committee said the Department of Health and Social Care (DHSC), NHS England and integrated care boards (ICBs) should follow the Hewitt review’s recommendation that they work together to develop a standards framework to be adopted by all ICSs, to improve interoperability and data sharing. It said: “this should include working closely with sectors that could feed into shared records in the future, including pharmacy, mental health and community health to ensure that what is put in place meets their needs.”
NHS executives responsible for the digital transition generally welcomed the report.
Dr. Paul Jones, chief digital information officer at the Leeds Teaching Hospitals, called the report “considered” and welcomed its delineation of the challenges of digital transformation. He added: “Too often national bodies have abdicated the plight of NHS organisations with poor, aged infrastructure as a local problem. It is, but one that cannot be fixed locally as the demands on funding are too broad and the cost of IT solutions too high for the funding levels in the NHS. These funding levels have not grown with the demand and use of digital services, so many Trusts are struggling to keep the digital lights on let alone innovate and drive transformation.”
A digitally able workforce
The health service also needs to engage and involve leaders, clinicians and frontline staff in the process of digital transformation, the report found. It added: “Coproducing digital initiatives with staff –including, but not limited to clinicians – is essential to ensure that these offer improvements to existing working practices and problems. The government must ensure that those working in the NHS have the time and headspace to engage with digital transformation.”
The Committee also acknowledged the challenges of recruiting tech talent to the health service, given the much higher level of remuneration in the private sector. It advised the government to allow NHS England to move away from Agenda for Change pay scales when recruiting Data, Digital and Technology (DDaT) specialists. It recommended that the DHSC implement the DDaT Pay Framework for NHS England to ensure it has access to the people it needs.
Jones said he was “delighted” at the recognition of the limits of the Agenda for Change pay scales, but questioned where the additional money would come from for the recruitment of tech specialists.
James Reed, chief clinical information officer at Birmingham & Solihull Mental Health NHS Foundation said :”Probably most interesting is the commentary on workforce and the difficulty in attracting staff because of the pay disparity with the private sector. This is a major issue for most Trusts and it’s only likely to get worse without action.”
Combatting digital exclusion
The report reiterated the challenge the health service faces serving those unable or unwilling to engage with digital healthcare, including those with “problems around access to technology, digital skills and confidence, and motivation to use a digital service.” As people in this category are likely to experience digital exclusion more widely, a cross-government approach will be key to addressing the problem, the report said.
Part of addressing digital exclusion, the report found, is setting out the benefits of using technology for patients and addressing risks and patient concerns, including concerns about data use. The report noted that the government is developing the NHS App as a “front door” to NHS services that can alleviate pressures on the health service; “Its success in achieving this will depend on whether it can present a compelling case for using the App, such as when it was used to host the Covid pass in 2021,” the report said.
Reed observed that the report appeared to miss the fact that the NHS app was secondary in importance. “What really matters is all the providers (such as GPs) committing to use it for making appointments available etc,” he said.
Jones said he found the amount of the report dedicated to the NHS app “strange”. He added: “As a CIO in a large teaching hospital the NHS App is almost an irrelevance. It may be of more interest in primary care, but this focus may show a lack of understanding of the complexity of heath IT. A typical teaching hospital will have hundreds of applications in use across its estate, providing niche, specialist information and data to staff and patients.”
In a broader observation about health apps, the committee reflected that although apps provide an accessible entry point to health technology for users, “it can be almost impossible for patients to identify quality apps from ones that present risks in terms of efficacy or security,” raising the risk that a negative experience will make users less likely to use digital services in the future. The report recommended that the DHSC ad NHS England introduce a comprehensive NHS accreditation for third-party apps.
At the same time, the report said the government should not forget that there will always be those who need or prefer to use non-digital channels.
“The NHS is a universal service. The government must ensure that it maintains twin-track digital and non-digital services to prevent people from missing out on healthcare they are entitled to,” it added.
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