Abolishing NHSE diverts attention from local staffing shortages

Upheaval at the centre is a distraction which could worsen shortages of digital expertise on the frontline, argues Dawn Greaves, associate director of digital transformation at Leeds Community Healthcare NHS Trust

Wes Streeting has insisted that the skills required to drive digital transformation remain “extremely important”, despite the dismantling of NHS England.

“Those skills, that functionality, we absolutely don’t want to lose,” the secretary of state for health and social care told the Commons Health and Social Care Committee.

This was welcome – but is it enough? You could argue that digital has always been vulnerable to cuts at times of pressure, and that there is little reason to expect anything different this time around.

The tremors from the announcement that NHSE is to be abolished are still being felt, not just at the centre but in local health systems and organisations.

The decision to integrate NHSE’s functions into the Department of Health and Social Care (DHSC) aims to reduce bureaucracy and save costs, along with the aim of reducing the growth of corporate services.

At the same time, there is an expectation that we continue to deliver the three shifts of moving care from hospital to community, moving from analogue to digital, and shifting from treatment to prevention.

Essential work threatened

The balance of national coordination and oversight versus frontline delivery of change and transformation has always been a tricky one to handle.

Schemes are agreed nationally with the expectation that NHS trusts implement them, on top of any integrated care board (ICB) or local strategies for transformation.

Resources within NHS organisations are always stretched, whether that is digital staff to implement and transform or clinical staff who need supporting through transformation.

Unfortunately, the focus on restructuring and the uncertainty it creates has the potential to move focus away from the essential work being undertaken by frontline teams.

This distraction could lead to delays to delivery or closing projects down altogether if there is no national support.

Part of the reason why the prime minister’s announcement of the abolition of NHSE came as a shock is that Streeting himself had earlier appeared to rule out such a move, on the grounds that it would be too disruptive. And yet here we are.

NHSE has already significantly reduced in size in recent years, cascading governance and oversight to regional teams and integrated care boards (ICBs).

ICBs are now also facing significant reductions. Where does this stop?  And when will the focus move to frontline delivery of transformation?

Working across the Leeds footprint, we often find it difficult to recruit to some of the more specialist digital roles.

It can take many months to find a suitable candidate, if there are any applicants at all.

This is causing organisations to look more at buying in expensive external support or partnering with other organisations to share resources.

While this can bring some efficiencies, it can also lead to organisations not getting an effective service, where there are multiple competing priorities for a single resource.

Staff unsupported or frustrated

In community trusts, much smaller organisations than acute trusts, there is little room for career development of some digital roles.  This often leaves staff feeling unsupported or frustrated, which is another reason why they may choose to leave the organisation or even move out of the NHS.

With the impending changes, there is a high likelihood of more digital staff choosing to leave the NHS to work in the private sector for more security, stability and potentially a higher salary with less burden.

There have been national shortages of experienced digital expertise in the NHS for many years.  I feel the news at national level – the abolition of NHSE – has diverted attention from digital staffing shortages.

Our people are our most valuable assets, we should protect them and enable them to work efficiently and effectively.

Digital transformation is a vital enabler to make our services more productive.  We must protect the vision for a digital NHS and the resources to deliver the transformation, particularly in frontline organisations.

The expectations on digital are getting higher and higher but internal budgets are being sliced. That’s not a recipe for success.

Dawn Greaves is associate director of digital transformation at Leeds Community Healthcare NHS Trust.