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November 29, 2021updated 02 Dec 2021 4:27pm

NHS digital transformation reboot could trigger ‘change fatigue’, experts warn

The NHS has accepted the recommendations of a review into its digital transformation strategy, but with the health service still battling Covid-19, the changes could be disruptive.

By Pete Swabey

The UK’s National Health Service has accepted the recommendations of a high-profile review into its £8.1bn digital transformation programme. Experts have welcomed moves to clarify how digital transformation is governed at the NHS but, with the health service still battling the effects of Covid-19, the new measures could trigger ‘change fatigue’, they warned.

nhs digital transformation

The NHS has adopted the Wade-Gery review’s recommendation to merge NHSX and NHS Digital with NHSE/I. (Photo by sturti/iStock)

Last week, health secretary Sajid Javid announced that the Department of Health and Social Care had accepted the recommendations of the Wade-Gery review, an assessment of digital transformation in the UK health service that was led by NHS Digital chair and former chief executive Laura Wade-Gery and conducted by management consultants McKinsey.

The stand-out recommendation is to fold NHSX, the digital strategy unit founded in 2019, and NHS Digital, which provides IT services to NHS Trusts, into NHS England and NHS Improvement (NHSE/I). Other recommendations include committing to a ‘patient-centric organising principle’ for digital transformation; boosting the NHS’s digital skills base; and creating a new operating model for digital transformation, including the creation of a new ‘transformation factory’.

NHS digital transformation and the future for NHSX

The review proposes that the NHSX ‘evolves’ into the strategy function of a new transformation directive at NHSE/I. “Having successfully advocated for the integration of digital into the whole, NHSX no longer needs a separate identity,” it says. NHS Digital should be embedded into NHSEI as its “tech function”, it advises, with NHS Digital interim CEO Simon Bolton becoming NHSE/I’s CIO. These recommendations were adopted at the start of last week.

The merger follows criticism of the complex and decentralised way in which digital transformation was governed at the NHS. Last year, the House of Commons’ Public Accounts Committee said it was “concerned that governance arrangements for NHSX have still not been finalised over a year after it was set up”.

It’s clear to most that the governance of digital transformation in the NHS would benefit from a more coherent approach.
Dale Peter, TechMarketView

“It’s clear to most that the governance of digital transformation in the NHS would benefit from a more coherent approach,” says Dale Peters, public sector research director at IT analyst company TechMarketView. “The introduction of NHSX raised questions about the role of NHS Digital, and although this has become clearer over time, there are still significant challenges created by managing multiple remits, stakeholders, and budgets across NHSE/I, NHSD and NHSX.”

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A person familiar with digital transformation at the NHS, who spoke on the condition of anonymity, said that splitting digital strategy out from delivery, as had been the case with NHSX, had always been questionable. “Corporations don’t separate conception from execution,” they said. “They have top-level people on the board who understand digital change.”

However, another anonymous source questioned whether NHSX had existed for long enough for the benefits of the model to be realised. “It’s quite surprising that an organisation [was] created and then changed within two years,” they said. “That’s not very long for an organisational structure to establish itself.”

As part of the new ‘Transformation Directorate’, the review recommends the creation of a ‘transformation factory’, “a scalable capability that integrates clinical, operational and technological resources to transform patient pathways and service delivery”. This capability “mirrors the practice across leading public and private organisations”, the review says, and will require new investment in skills and capabilities.

One anonymous source said that private sector experts have often tried to establish a highly process-driven approach to digital transformation in the NHS, but that the nature of the NHS’ work means that this approach may not be suitable. “You can sell peas and sausages with the same information systems, but you can’t quite deliver care with those kinds of strategies,” they said. “Care is changing constantly and hospitals are very different in their traditions and structure and ways of doing things. We see this recurrent resort to models from external industry coming into conflict with the internal culture… of the NHS.”

Skills ‘intervention’ for NHS digital transformation

In order to develop the skills needed to realise this new approach to transformation, the Wade-Gery proposes a “fundamental organisational capability intervention”. “Understanding the importance of data and digital and being able to use them effectively must become a requirement for staff at all levels in NHSE/I and in the wider NHS, increasing alongside their seniority,” it says.

The review notes that the opportunity to do life-saving work is an attraction for digital talent, but it must be accompanied by “an empowered working environment and suitable remuneration”. This cultural transformation will be a challenge for the NHS leadership, says TechMarketView’s Peters. “Creating the right working environment to attract the requisite skills will require a significant cultural shift and this is never easy,” he says.

Experts told Tech Monitor that, whatever the benefits of the review’s recommendations, the timing of the changes could prove disruptive. “There are concerns about how disruptive the reorganisation will be and whether now, when we are still battling against the impact of the pandemic, is the right time to restructure,” says Peters. “The organisation will need to avoid entering a period of inertia whilst the details are ironed out.”

One anonymous source added that initiating another reorganisation so soon after the creation of NHSX could trigger ‘change fatigue’. “When there are a lot of organisational changes, people spend a lot of energy adapting… and that distracts from what they actually should be doing.”

The Wade-Gery review was initiated when the former Tesco executive was appointed chair of NHS Digital in July 2020, with the aim of determining “the critical capabilities and digital operating model” required to deliver digital transformation across the NHS.

The drivers for the review were not made explicit but in November the Public Accounts Committee laid out the NHS’s digital transformation shortcomings. The Committee slammed the NHS’s “poor track record” for digital transformation and said it was ‘alarmed’ at the lack of progress since 2011, when the disastrous National Programme for IT was scrapped. The NHS’ goal to become paperless by 2018 had been missed, the report noted, and there was “a very long way to go” before its less ambitious goal of achieving a ‘core level’ of digitisation by 2024 would be realised.

According to the Committee’s report, NHSE/I estimates that its ongoing digital transformation will cost £8.1bn.

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