What Good Looks Like: NHSX’s seven measures of success

Earlier this week, NHSX published its much-anticipated ‘What Good Looks Like’ framework for NHS leaders, to support organisations with ‘best practice’ guidance on digital transformation.

HTN covered the release of the guidance, as well as the simultaneous publication of the ‘Who Pays for What’ strategy and the new Unified Tech Fund and its complementary ‘prospectus’. But now it’s time to delve a little bit deeper, continue the conversation and ask for your comment.

Here we take a closer look at the seven “success measures” that NHS leaders can judge and assess their organisation’s digital offering by. These are:

  1. Well led
  2. Ensure smart foundations
  3. Safe practice
  4. Support people
  5. Empower citizens
  6. Improve care
  7. Healthy populations.

Each success measure provides guidelines for both Integrated Care Systems (ICSs) and wider NHS trust organisations. Here, we’ll compare the seven sections on each, looking for the commonalities and the differences.

1. Being well led

So, what does good look like from a leadership perspective? NHSX’s guidance says that leaders across both types of services should “own and drive” the digital transformation journey and place “citizens and frontline perspectives at the centre.”

Recommending that ICS decision-makers have “a clear strategy” for transformation and collaboration, it adds that Integrated Care Boards (ICBs) should “build digital and data expertise and accountability into their leadership and governance arrangements.”

The framework sets out that an ICS would have a system-wide digital and data strategy that drives ‘levelling up’ and which is also underpinned by a sustainable financial plan. The guidance also suggests that governance should be established to “regularly review and align” all organisations’ strategies in this area, including an ICS-cyber security plan, programmes, procurements, services, delivery capability, and more.

Strategy input from clinical representatives from across the ICS is also recommended, as is identifying ICS-wide solutions for improving outcomes by “regularly engaging with partners, citizen and front line groups”, and investment in board development sessions to boost digital competence and ICS-wide multidisciplinary CCIO and CNIO functions.

In wider organisations, many of the same aims apply, such as the need to build board expertise and accountability for transformation – but with the recommendation that there is a CIO, CCIO or similar role as a member or attendee of the board. In addition, another indicator of ‘digital health’ for trusts and similar organisations would be to “ensure board ownership of a digital and data strategy that is linked to the Integrated Care System (ICS) strategy and underpinned by a sustainable financial plan”, as well as board development sessions around managing cyber security risks and achieving the NHS the sustainability agenda.

2. Ensure smart foundations

The second measure focuses on ‘smart foundations’, with all healthcare systems and providers instructed that “digital, data and infrastructure operating environments” should strive to be “reliable, modern, secure, sustainable and resilient”. This should include all organisations having “well-resourced teams who are competent”, to deliver those aforementioned modern digital and data services.

The ideal measure of success within this scope will include having a system-wide strategy for, or an investment in, “building multidisciplinary teams with clinical, operational, informatics, design and technical expertise” to deliver the required digital and data ambitions.

Similarly, any ICS or organisation should progress towards net zero carbon, sustainability and resilience ambitions by meeting the Sustainable ICT and Digital Services Strategy (2020 to 2025) objectives, and also make sure that “all projects, programmes and services meet the Technology Code of Practice and are cyber secure by design.”

ICSs are also expected to invest in a modern and simplified infrastructure, consider consolidation of spending, strategies and contracts, level up the use and scope of electronic care record systems, and lead the delivery and development of an ICS-wide shared care record (ShCR). This is matched by other organisations being expected to maintain a “central, organisation-wide, real-time electronic care record system”, extend systems to all services, and provide a data contribution to the ICS-wide shared care record.

Other organisation types should also focus on areas such as planning a move to the cloud, while ensuring hardware, software and end user devices are all “within the suggested supplier life cycle and fully supported”, remove older technologies such as fax machines and non-emergency pagers, and maximise the use of modern telephony to support staff.

3. Safe practice

When it comes to measuring safe practice, the gold-standard will be based around all organisations maintaining “standards for safe care”, as set out by the Digital Technology Assessment Criteria for health and social care (DTAC). Routine, system-wide reviews of security, sustainability and resilience are expected, with “digitally-enabled outcome-driven transformation” at the heart.

Centralised cyber security capabilities, for which ICSs are expected to have a system-wide plan, are expected, with other organisations instructed to “fully use national cyber services provided by NHS Digital”. Both ICSs and other organisations are advised to support a senior information responsible officer (SIRO) and data protection officer (DPO) within their ranks as part of an “adequately resourced ICS-level cyber security function.”

Compliance with the Data Security and Protection Toolkit and NHS national contract provisions related to technology-enabled delivery, along with clear processes and plans in a number of other safety-related areas, such as for reviewing safety recommendations and alerts, and ensuring “clinical systems and tools meet clinical safety standards as set out by the Digital Technology and Assessment Criteria (DTAC) and DCB0129 and DCB0160″, are further commonalities.

4. Support people

What should good look like in terms of supporting people across the digital landscape? NHSX says that a workforce should be “digitally literate” and able to “work optimally with data and technology”, while digital and data tools and systems should be “fit for purpose and support staff to do their jobs well”.

Both ICSs and other organisations would need to create and nurture a digital first approach, including the sharing of improvement ideas from frontline workers, and also support flexible and remote working, where appropriate.

ICSs are directed to promote the use of tools that will enable “frictionless movement of staff” and create system-wide professional development and training opportunities. Supporting staff to “attain a basic level of data, digital and cyber security literacy, followed by continuing professional development” is a similar target for other organisations, along with the provision of access to digital support services 24-hours-a-day.

5. Empower citizens

Guidance around empowering citizens to take an “active role” and help manage their health digitally includes, for both ICSs and wider organisations, placing citizens at the centre of service design and providing them with access to a “standard set of digital services that suit all literacy and digital inclusion needs”.

Many common goals are shared in this section, such as organisations collaborating to develop a “single, coherent ICS-wide strategy for citizen engagement and citizen-facing digital services”, and one which is led and co-designed by citizens. Further guidance focuses on making use of national tools and services, supplemented by local ones, as well as aligned use of digital communication tools for self-service pathways, allowing people the ability to contribute to and access their health data, and having a “clear inclusion” strategy to ensure “digitally disempowered communities” can make the most of digital opportunities.

Care plans, test results, medications, history, correspondence, appointment management, screening alerts and tools, are all highlighted as areas that citizens should be able to access.

6. Improve care

To improve care, the embedding of digital and data “within their improvement capability” is highlighted to ultimately help “transform care pathways, reduce unwarranted variation and improve health and wellbeing.”

NHSX says that digital solutions should “enhance services for patients and ensure that they get the right care when they need it and in the right place.”

This would be achieved by using data and digital to redesign pathways across organisational boundaries, with ICSs having a system-wide approach. It’s recommended that all organisations make use of the tools and technologies that support safer care, such as EPMA and bar coding, and also provide decision support to help clinicians with best practice, provide remote consultations, monitoring and care, and enhance collaborative and multidisciplinary care planning through digital tools.

7. Healthy populations

In its seventh and final success measure, the framework recommends ICSs make improvements to population health and wellbeing by using data and utilising “collective resources”, with insights from data to be used to “improve outcomes and address health inequalities”.

Other organisations would also use data for their own care planning, as well as support the development and adoption of “innovative ICS-led, population-based, digitally-driven models of care.”

There would also be the delivery and development of an “ICS-wide intelligence platform with a fully linked, longitudinal data-set” – which would include primary, secondary, mental health, social care and community data –  for “population segmentation, risk stratification and population health management”, with other organisations contributing both data and resources to support this. Implementation of ICS-created pathways and personalised care models for at risk groups, which will use digital platforms to coordinate care across settings, is also be a part of this target area.

Among ICS responsibilities would be making sure PCN multi-disciplinary teams and others have “access to timely population health insight and analytical support”, while all organisations would be expected to make data available to support clinical trials and AI tool development, and also to collaborate across academia and industry.

Matthew Gould, the Chief Executive of NHSX, explained that the guidelines were designed specifically to be “helpful, empowering and clear” and set out what frontline leaders need to “set out what they should be driving towards.”

With this in mind, HTN is planning a future industry view piece on What Good Looks Like. Does it look good to you? To have your say, share your comments and opinions on the new framework with us at