The government recently announced a newly formed organisation NHSX to oversee digital, data and technology. The new unit will effectively take a position above NHS Digital, who is believed will continue with its current remit.
We asked industry leaders for their comment and reaction to the newly formed organisation.
Contributors include:London North West University Healthcare NHS Trust, Allscripts, OLM, Lancashire Care NHS Foundation Trust, Elsevier, CCube Solutions, InfoFlex, Highland Marketing, Channel 3 Consulting, InterSystems, Mersey Care NHS Foundation Trust, Deontics, Changing Health, Draper & Dash, Isosec, Ingenica Solutions and X-on.
Jeremy Nettle, who started his career in the NHS before working for health tech companies including Oracle, and who now chairs Highland Marketing’s advisory board
“We know from the Cabinet Office that the government has been frustrated with the NHS’ slow progress on IT and with its apparent reluctance to embrace the business change opportunities that IT offers.”
“Also, that it wants the NHS to move a lot faster on citizen/patient access to mundane systems such as hospital appointments. With the creation of NHSX, it looks as if it has lost patience and decided to launch a bold initiative to get it up to speed with the rest of government.”
“After all, we’ve had apps that tell bus and rail passengers about timetables, platforms, stops and even diversions and delays for years. And simple technology like this can deliver significant cost and data benefits.”
“When British Airways realised some years back that they had a passenger data quality issue, it solved it by letting passengers book their own flights, passing off the cost to them while making sure the data was accurate and up to date. They even tied it to passport information, so it was acceptable to the UK Border Agency.”
“The move to create NHSX is also in line with what has been happening in the life sciences sector. For the past five years, many life sciences companies have moved to set up a digital team independent of their IT set-up. The team is tasked with doing ‘exactly what it says on the tin’ and, typically, it is given around two years to ‘do’ digital transformation and deliver efficiency savings; while IT continues with business as usual.”
“The creation of NHSX casts some doubt on the future NHS Digital. But the government probably thinks that it failed to take the initiative and maybe got bogged down in developing software solutions, instead of looking for commercial off the shelf solutions.”
“NHS England has stepped into the gap to some extent. But the Department of Health and Social Care is where policy is meant to be set, and the present secretary of state has made it clear that he wants to lead key areas personally. It’s a brave move; time will tell whether it is a game changing one.”
Sonia Patel, Joint Chief Information Officer, London North West University Healthcare NHS Trust
“This is a unique opportunity, if we get it right to improve coordination and delivery of digital developments and ambition across the NHS. This has to be our top priority to improve coordination that currently straddles across NHSE, NHSI and NHSD.”
“Our second priority is to catch-up with other industries and that we need a national dev-ops unit. For anyone that wants to know more about dev-ops read ‘The Phoenix Project’ we’ve implemented it at Hillingdon. With right environment and conditions that are agile and adaptive also eases the on-and-off boarding of tech industry’s support as required to help the NHS in the best way.”
“With the combination of the above should result in thirdly, ensuring digital policies, standards and development are get faster to frontline organisations, workforce, patients and citizens and truly embrace the digital opportunity for the NHS top engage in new and meaningful ways.”
“Top of our agenda is digital apps and correspondence to patients, to rapidly deliver a modern EPR for the workforce and maximising and mainstreaming population health management into health and care delivery.”
“Within the Acute sector interoperability has never been a challenge, we hit walls when trying to interoperate across care setting boundaries particularly primary care. This has never been a technical issue it is a legacy commercial challenge and this does need national support and attention without resolving some of this big issues we will never really delivery a workable and sustainable long term plan to support integrated care services.”
Richard Strong, Vice President and Managing Director EMEA, Allscripts
“There are still some uncertainties about how NHSX will operate, but if it means that organisations like the Department for Health and Social Care and NHS England come together to set policy and standards then it could be a positive development.”
“Allscripts is very committed to open standards, but standards need to be set in collaboration with industry. They also need to be set globally. When the NHS adopted HL7v3 [a standard developed by Health Level 7 that is being superseded by the FHIR protocol] it implemented its own version, rather than the global one, and that was a challenge for international companies.”
“We also need to drive adoption. The use of the NHS Number has been mandated for more than a decade, but it is still not used as the primary identifier in all systems. So, if NHSX was able to engage with suppliers, and work globally, and drive adoption it could have a real impact.”
“Matt Hancock and his advisors have also shown interest in open source and open connectivity. OpenEHR is a very interesting development, and one that our global digital exemplar partner, Salford Royal NHS Foundation Trust, is using alongside its Sunrise electronic patient record to run agile projects with its healthcare community. We are an open company, that supports open standards and open systems, and if NHSX is being set up to support these developments, then we will not only welcome it but look forward to working alongside it.”
Guy Wood-Gush, CEO, Deontics
“I’m supportive. Its creation and senior reporting lines within the NHS structure, put digital at the heart of NHS policy (in line with the Long Term Plan) and provide an opportunity for senior management to shape a coherent digital policy, including standards and interoperability. As a new, separate entity, it will have the opportunity to introduce a new culture which is more embracing of change and capable of dealing with a different set of suppliers. While many digital suppliers are large, established companies, many digital suppliers, like Deontics, will be smaller and more nimble. Such smaller suppliers have a different set of requirements of the NHS, needing rapid decision making and a clarity of process which is almost completely missing from traditional NHS procurement departments. If NHSX can avoid the trap of being overly bureaucratic and operating in a matrix where nobody has any real power, then it can be very helpful in improving productivity.”
Ian Chuang, Chief Medical Officer, Elsevier
“The ambition of NHSX is to align and expedite the digital transformation of healthcare provision across the NHS is a welcome development, especially in relation to digitisation of secondary care which for too long has lagged behind EPR deployment in primary care.”
“A robust digital infrastructure, a commitment to interoperability and effective data sharing are all key dependencies for effective use of clinical decision support (CDS) systems and artificial intelligence in health. As Professor Dr Bob Wachter said last year, the use of these type of solutions can no longer be seen as elective but instead as essential to guiding clinicians in their decision-making. And this guidance through CDS provides advantages to ensure consistency in best practice standards-of-care across healthcare organisations, clinicians, especially as temporary staffing come and go to due to the issue with staffing shortages.”
“The importance of individual NHS organisations not reinventing the wheel each time applies not just to common technologies and services, but also to how the NHS uses the evidence base that informs clinical practice in the battle against variability in practice and improving clinical outcomes. The combination of effective EPR systems, structured CDS content derived from evidence-based medicine from research literature, and real world evidence derived from patient data can open up a new world of systematic feedback loops which drive a continuous process of improvement in clinical decision-making and guideline improvement.”
Vijay Magon, CEO, CCube Solutions
“Finally, the long awaited attention on digital technology is becoming a reality. This was explicitly listed within the NHS Long Term plan and now a new body has been setup to oversee it – NHSX is a new organisation setup to bring together the Department of health and Social Care, NHS England and NHS Improvement, to focus on digital transformation. NHSX will be led by a new CEO.”
The Department of Health and Social Care has confirmed the responsibilities of NHSX will include:
- Coordination and consistency: Setting national policy and developing best practice for NHS technology, digital and data – including data-sharing and transparency.
- Setting standards: Developing, agreeing and mandating clear standards for the use of technology in the NHS. Ensuring that NHS systems can talk to each other across the entire health and care system and the NHS can incorporate the latest innovations without breaking the technical plumbing underneath.
- Driving implementation: Helping to improve clinical care by delivering agile, user-focused projects. Developing digital care pathways and solving administrative challenges across the NHS and empowering developers and data analysts internally and externally to drive forward technological change.
- Radical innovation: Supporting the use of new, emergent and effective technologies by the NHS, both by working with industry and via its own prototyping and development capability.
- Common technologies and services: ‘Ensuring that common technologies and services, including the NHS App, are designed so that so that trusts and surgeries don’t have to reinvent the wheel each time. Ensuring that all source code is open by default so that anyone who wants to write code for the NHS can see what we need.
- Reforming procurement: Helping the NHS buy the right technology through the application of technology standards, streamlined spend controls and new procurement frameworks that support our standards.
- Cyber policy: Setting national strategy and mandating cyber security standards, so that NHS and social care systems have security designed in from the start.
- Digital capability: Championing and developing digital training, skills and culture so our staff are digital-ready.
- Governance: delivering an efficient process for technology spend, domain name management and website security. The effectiveness of governance arrangements will be regularly reviewed.
“This is exactly what is needed to manage the digital transformation in the NHS and ensure that the exciting innovations both within the NHS and its suppliers (big and small) can be orchestrated to deliver the clear objectives set out in the Long Term Plan.”
Marc Warburton, Chief Executive, InfoFlex
“InfoFlex fully supports the aims of NHSX. It is essential that patient data easily and securely flows between the various IT systems used in the health and care sectors if patient care and patient involvement is to improve. Data sharing standards at the clinical level are urgently required and meeting these standards needs to be at the centre of all systems used to support patient care. Patients believe that their data is easily shared between IT systems used to support their care. NHSX can enable this by ensuring that this happens at the level of clinical detail required.”
Jessica Bradshaw, Managing Partner, Channel 3 Consulting
“Arguably it may be helpful to have a more centralised approach to developing and delivering a digital strategy for the NHS through the creation of NHSX. But what is more important is the approach the new organisation takes. We would like to see this new organisation tasked with identifying the variable digital maturity across NHS organisations, before mapping out the steps and funding needed to reach an achievable digitisation destination. Part of this is about recognising that digital adoption cannot happen in isolation – it must be supported with organisational change if the NHS is to truly embrace the opportunities presented by technology.”
David Hancock, Client Engagement Director, InterSystems
“In measuring its impact NHSX must look to whether it makes a fundamental difference to the transformation of IT across health and care. Will it increase the speed, quality, coverage and consistency of transformation across health and care? One of the most pressing questions has to be, to what extent can NHSX support implementation? I am indebted to a senior CIO in the NHS who said that to make digital transformation work we need just three things: people (and critically good relationships between them), money and IT.”
“NHSX should also consider that nearly every local health economy is starting from a different place. This means top-down implementation will not work, and each health economy may need to take a different route to get to the technology vision that the Secretary of State produced in October 2018.”
“Will we get more clarity and consistency on strategy? There are differences between the strategy of GDEs and LHCREs, and the vision from government. NHSX might seek to reconcile these and create a roadmap that helps suppliers and the service move to the open model espoused in the vision.”
“We know NHSX will be promoting and enabling the good practice in user-centred design, open APIs, public cloud and other ‘IT’ challenges. But it must also provide money, and it must make people and relationships work, to have the transformational impact in the service that the Secretary of State wants.”
Dr Arun Chidambaram, Deputy Medical Director, Mersey Care NHS Foundation Trust
“We’re fully behind NHSX and hope it can deliver value by bringing the industry together to really make a difference. The biggest challenge is being patient focused and ensuring clinical engagement. Clinicians need to see what is in it for them and the patient.”
“As a GDE we have been doing a lot to tackle the workflow challenges that exist and technology is a big part of this. We’re also doing a lot of engagement work; the important thing to always keep in mind is technology is about people and should always add value.”
“We look for the clinical problem first rather than looking at a solution and thinking what can it do for us. We have set up a clinical leadership group to talk about the clinical issues and then we start to look for solutions to the challenges.”
“We need to think of electronic pathways and look for how we can take mundane work away from clinicians or automate the processes away from people.”
“We have some exciting work coming up, opportunities with 5G, interoperability and joining up systems and we’re thinking about how mental health data can support population health management. All this can then support predictive analytics. Going forward it’s going to be vital to have systems that talk to each other.”
Orlando Agrippa, CEO and Richard Parker, COO, Draper & Dash
“The announcement of the formation of NHSX is a clear signal that Matt Hancock intends to make sure that the digital elements of the NHS long term (LTP) plan will be overseen, perhaps more than any other aspects of plan, by him and his office.”
“The headline content of the plan is consistent with what has been trailed before. However it’s worth emphasising that the measures to deliver interoperability through the setting and mandating of clear standards plus using common technologies e.g. the NHS App to avoid duplication of development-effort are great to see and long overdue. Similarly, reforms to procurement to match new standards and support for agile, user focussed projects to improve clinical care through the use of technology are welcome statements and things we would recognise as being positive from a wider Tech industry perspective.”
“Perhaps the most significant feature of the announcement of NHSX however is the governance structure it ‘connects with’ rather than ‘sits within’.”
“When the LTP was first announced we commented that the lack of a ‘guiding hand’ in terms of implementation would potentially rub-up against the ambitious timelines laid out in the plan. The LTP talks about ‘system change’ through incentivising systems to ‘work together’, rather than taking a clear stance on the sort of structural reforms that might be required to fully deliver the ambitions set out. We thought this was likely to place some risk on the overall plan being delivered on time or even at all.”
“In creating NHSX outside of the existing NHS England / Improvement or NHS Digital infrastructure, Matt Hancock has signalled an intention that, through direct DHSC oversight, he won’t allow the digital health agenda to be side-tracked by more typical NHS stresses, strains and perhaps overly bureaucratic systems and process; we think this is a really positive move.”
“Matt Hancock also seems to be aligning NHSX to the wider Government Digital Service and other central government functions in order to learn from their experiences and ensure there is continued alignment with the Digital, Data and Technology profession across government. Again this is both positive and welcome.”
Michael Latimer, CEO, Isosec
“I welcome the announcement on NHSX. It is a great opportunity for a fresh and meaningful look at how the latest digital technology can help transform the NHS.”
“It can still be difficult to nurture innovation and get great software and technology into the NHS, there are so many unnecessary barriers that are outdated and no longer fit for purpose. I hope that the new NHSX will operate as ‘equal for all’ so that major vendors are encouraged to prioritise interoperability with more open technology for the benefit of the NHS. One example we are repeatedly coming across is the difficulty getting EPR’s to work seamlessly on iOS and Android, the NHS must be close to 10 years behind the private sector in this case and is missing out on improving efficiency for operating both inside and outside of hospital environments.”
Dr Damien Marmion, CEO, Ingenica Solutions
“Let’s hope the formation of NHSX and its aims to direct digital policy is the step forwarded needed; bringing together the responsibilities to one special unit rather than being split across multiple agencies will hopefully take technology adoption forward at a greater pace.”
“As an innovative health tech company, Ingenica Solutions is helping to drive digital evolution in the NHS, and we hope that this development will facilitate faster decision-making to implement digital change.”
Paul Bensley, Director, X-on
“With announcements around NHSX, axing the fax and using email instead of snail mail, Health Secretary Matt Hancock is clearly on a mission to place technology at the heart of healthcare. We wholeheartedly agree that, with the right tools in place, doctors and their support staff can be given more time to care, and improve the patient experience. The starting point for this transformation was neatly summed up in the recently-published code of conduct on data-driven health and care technology. Understand users, their needs, and the context. So whilst email works for most, it does not work for all. People want the outcome to be a discussion with a suitably qualified professional, who can help meet their needs in the most effective way possible. Staff want systems that are simple to use, and help them do their jobs without hindrance. As Steve Krug says about human-computer interaction – don’t make me think. If NHSX can champion technology that makes it as easy as possible for people to complete the tasks that are important to them without making them think too hard, then we are well on the way to making a success of much-needed NHS digital transformation.”
Mark Denton, Chief Product Officer, OLM
“We are pleased that NHS has created this specialised digital innovation unit; NHSX. With the UK‘s Health and Social Care landscape, real change is needed. Unfortunately, neither new departments nor policy guarantee success on their own. For the NHSX to have real impact (and not just be a branding exercise) the new standards it creates must have teeth. Too often Government policy is only advisory for example the ‘Cloud First’ policy was introduced in 2013. The Cloud First’ policy was mandated for central government, but only advisory for other public organisations. Today, 6 years later the move to true public cloud is only just being to gain momentum in public bodies outside of central government.”
John Grumitt, Chief Executive, Changing Health
“Digital tools are playing an ever more valuable role in helping people better manage their health. For our part, technology allows us to support people in ways we’ve never been able to before, showing them how to fit positive, manageable, sustainable lifestyle changes into their normal routine – all via their smartphone. It allows individuals to access that support more easily, and allows health economies to scale it rapidly.”
“So the creation of NHSX is a win-win for everyone: an accelerated digital transformation across the health service means improved health outcomes and improved patient experience, at scale. Research suggests this transformation will improve job satisfaction among clinicians too.”
“We’re looking forward to working with NHSX in championing digital tools, combined with psychological expertise, to make a real difference in thousands of peoples’ lives.”
Tom Poulter, Deputy Director of Health Informatics at Lancashire Care NHS Foundation Trust
“With the new unit yet to be fully established it is difficult to say at this stage exactly what this will mean for provider organisations as its full remit has yet to be understood. I know that it will provide consolidated oversight of national digital strategy and policy directives for the NHS and this will be welcome in providing increased focus and co-ordination.”
– Thank you to our contributors –
