Tackling the winter crisis and future-proofing the NHS


By Rob Shaw CBE, Mastek Adviser and former Deputy CEO of NHS Digital.

Digital infrastructure has the potential to transform the NHS’s response to additional winter pressures by delivering seamless routes of discharge, which accelerate patient flow and maximise available capacity.

For too long, digital infrastructure has been viewed by the NHS as discretionary spending rather than a core budget. If we are serious about protecting the NHS ahead of future winter pressures, digital infrastructure must be at the heart of winter planning and a key priority for NHS England and local NHS systems.

Last winter, 60 per cent of patients in NHS hospital beds were medically fit for discharge. Ahead of this winter, the NHS has invested £200 million and expanded its program of “traffic control centers” to provide an initial point of discharge to ease patient flow through the NHS. This additional capacity aims to free up NHS beds, but it fails to solve the problem of where patients go next.

NHS hospitals shouldn’t be used as traffic control centres; they should be equipped to act as digital command centres, empowered to unlock community care in their local area.

We need to look beyond the provision of extra beds as a solution, and move to a data-driven approach of managing patient flow through NHS hospitals and into community settings. Digital infrastructure in the NHS is key to reducing delayed discharge and maximising community capacity. Digital infrastructure has the potential to seamlessly match community care with a patient who needs it and to coordinate staff to deliver any step-down care that is required.

The Digital Command Centre model currently exists in pockets of the NHS, providing a comprehensive data taxonomy of capacity and staffing levels within a local health ecosystem. It allows NHS staff to quickly identify an appropriate point of discharge within their local area, coordinate urgent and elective care against available staffing numbers, and arrange discharge transport and medicine delivery for at-home care.

Digital Command Centre models can be found in the London Care Record, where patient records from across the capital can be accessed across acute and community settings and have been proven to accelerate discharge from the hospital to care homes.

A Digital Command Centre approach can also be found within the Leeds Care Record, which has created interoperable data sharing across acute hospitals, community services, GPs, social care, and hospices in the region. Nurses reported that the Leeds Care Record allowed them to “discharge and refer more quickly as information is more readily available, and we’re aware of what community care is in place.”

Currently, these examples of local best practice exist as islands of interoperability amid a wider NHS landscape where data on local NHS capacity is trapped within inadequate digital systems and is inaccessible to staff who are desperately trying to match a patient with a point of discharge.

The route to NHS Digital Command Centres: a three-step plan

Step 1: First, do no harm. The depth of winter is not the time to introduce a system-wide overhaul of digital interoperability. Digital solutions must empower staff at times of peak capacity and not act as a hindrance to the delivery of patient care. Before anything else, digital solutions must be resilient. At points of peak winter capacity, digital outages can be fatal, and autumn should be used to test digital systems and to rehearse for adverse events. The introduction of updated digital systems should also build upon existing infrastructure and should avoid forcing NHS staff to work with alien digital tools. Digital infrastructure should identify efficiency within existing patterns of work and empower staff to work effectively during peak winter pressures.

Step 2: Start with what you have. No single operating system will magically combine all the existing data sharing systems in the NHS. The NHS data landscape is messy and complex and requires tailored solutions that target fragility in local systems and maximise their strengths. March to September is a crucial window for the adoption of new digital solutions. It allows us to build on the experience of the winter past and provides an opportunity for staff to gain familiarity with new systems. Focus on data security and system resilience. These are the foundation stones of effective delivery during peak winter months. Digital systems should be dependable, accessible, and should promote confidence in data sharing between NHS services.

Step 3: A Call to Action for NHS England. Digital suppliers and local NHS services can’t promote system interoperability alone. There is a key role for NHS England to play in outlining national standards for interoperability which local NHS services can strive towards. National standard setting also puts suppliers on notice and holds them to account for the systems they provide and how they can support the delivery of joined-up care. Without these standards, we risk perpetuating a landscape of islands of interoperability, where mature systems neighbour immature ones, without any direction of travel towards wider dissemination and adoption of best practice.

To truly transform the NHS and prevent winter pressures becoming crises, the NHS must move to a more digital and data-driven approach, where data serves as an enabler for a system under constant pressure. The above three-point plan can serve as a framework for delivering real change, while recognising the challenges in the NHS.

About the author: Rob Shaw CBE is an Adviser to Mastek, having previously worked as Deputy CEO of NHS Digital.

About Mastek: Mastek is an enterprise digital & cloud transformation specialist that engineers excellence for customers across 40 countries, including the UK, Europe, US, Middle East, Asia Pacific and India. We help enterprises navigate the digital landscape and stay competitive by unlocking the power of data, modernising applications, and accelerating digital advantage for our customers.