Digital first – but digital eats last


Digital health policy expert, Roger Greer, says that government action on its ‘digital-first’ plans must match its ambition.

The NHS has just turned 75, and across the country, parkruns, bake-offs and blue light-ups on buildings have taken place to celebrate this anniversary. The government celebrated the NHS’s 75th birthday with a present of its own: the NHS Long Term Workforce Plan, aimed at ensuring “an ambitious, sustainable and resilient NHS, there for patients now and for future generations”.

The NHS has felt more turbulence and change in the past five-to-10 years than at any point in the preceding 70. The Covid pandemic’s impact on the NHS has been severe, and the health service will suffer with the effects of long-Covid like many patients across the country. Its impact is still being felt by patients and services in every part of the UK. But as well as the negative impacts, Covid was also a catalysing event for the NHS in its use of data and digital technologies.

Prior to Covid, the NHS App had around 500,000 users. It now has over 30 million users, and is a key foundation of the government’s plan to digitise the NHS and make it more fit for the future. Could this have been the case prior to the pandemic and the mandated use of Covid passes? That’s up for debate; but the public health emergency provided the opportunity to seek solutions in innovation.

The Workforce Plan is not so much a big bang event; but it could have a significant impact on health and care policy over the next 10-15 years. The challenge is ensuring that it meets the data and digital needs of the NHS, and delivers the ambitions of a digital-first health service.

The challenge

Despite this digital-first ambition, it is digital and data strategies that are often last to the funding table. As soon as there are frontline challenges, NHS England’s budget for data and digital is the first to be cut. This means that the advancements in key digital and data infrastructure, digital skills and implementing innovation fall even further behind where they should be.

That is not to say the NHS has not thought significantly about data and digital – there have been 21 documents that touch on data policy released by the government in the past 18 months (HT to Jess Morley for collating).

Priority 3 in the NHS’s 2023 mandate is: “Deliver recovery through the use of data and technology”. The Health and Social Care Committee’s report on digitisation of the NHS touched on the need to ensure a digitally-literate workforce. The Workforce Plan also has explicit aims around training in data and digital.

So, what does the Workforce Plan say about the future of digital and data skills in the NHS?

  • Nationally, the NHS Digital Academy has been established as the home for digital learning and development.
  • With NHS Providers, the Digital Boards Programme has delivered over 80 trust board development sessions to date.
  • The NHS Health Education England (HEE) framework for spread and adoption of workforce innovation sets out an approach for systems to follow.
  • NHS England, HEE and NHS Digital are now a single organisation and can develop tools, training and resources to support workforce redesign in practice, such as:
    • Skills mix blueprints for local adaptation and adoption.
    • Training programmes to build ICB capability in workforce transformation approaches such as the HEE Star and the six-step workforce planning approach.

The Government clearly recognises the potential positive impact that data and digital can play in making the NHS fit for the next 75 years; but also to solve some of its short term challenges. However, it is only a starting point, and is not nearly ambitious enough to deliver on the needs for the NHS right now.

More importantly, the challenge with policy is in the delivery. For every new plan or report which is published, there are 5 previous incarnations sitting on shelves of Departments in Victoria Street, and on the desks of consultants brought in to deliver them.

The conditions for delivery are in place. The Government has merged NHSX and NHS Digital into NHS England, alongside Health Education England, aligning digital, data and the training within one department, which “allows us to better align and co-ordinate planning and action, at every level of the service, so we can have the greatest possible impact for staff and, by extension, patients and citizens.”

The success or failure of the NHS to train for digital and data will be the scale of financial and technical support provided to deliver on the Government’s promises, and how far frontline challenges are allowed to overtake data and digital policy as priorities in the near term.

The delivery of this plan will also be impacted by the current political backdrop, the health backlog and the looming General Election, which will bring its own challenges, particularly in the event that Labour form the next Government.

Hope vs reality

Can digital and data be at the forefront of health policy in the next 10-15 years? It has to be. The NHS cannot move into 2024 and beyond with only a nod towards digital and data. It has the power to have such a huge and positive impact on the sector; on the way the NHS manages population health and individual care; how it plans services; how it conducts research into the latest treatments; how it interacts with patients on a day-to-day basis; and on how patients receive care and treatment.

The NHS needs not only a workforce plan fit for purpose, adaptable, and able to be delivered across the next 10-15 years; but wider support for those innovators who are delivering the tech and digital and data services. This means proper reimbursement and pathway to market for innovation.

The Workforce Plan is only one part of how the NHS becomes a modern, adaptable service. It requires all parts of the system to align around the power of data and digital. If it gets there, is the challenge, and one which it has failed to fully deliver on to date.

Roger Greer is Associate Director at PLMR Healthcomms and was previously Senior Stakeholder Engagement Officer at NHS Digital.