Industry Opinion: health tech experts have their say on NHSX’s ‘What Good Looks Like’

At the end of August, NHSX published its long-awaited ‘What Good Looks Like‘ framework, to provide guidance and support for NHS trusts on their digital transformation journeys.

After covering the release of the new guidelines, focusing on the ‘seven measures of success‘ and the new Unified Tech Fund and prospectus – which aim to make the process of bidding for funds simpler for organisations – HTN decided to reach out to our audience to find out their views.

We asked and you answered, telling us what you think about the new framework and funding layout, as well as providing your opinions on whether anything was overlooked or should be included in the future.

HTN would like to say a huge thank you to all of the readers – including NHS clinicians, suppliers and innovators –  who responded to the call for our latest Industry Opinion piece. Below are just some of the replies –  we hope everyone enjoys reading each others’ thoughts…

Framework in focus

Based on the responses we received, the reaction to the What Good Looks Like framework has been warm but with plenty of constructive feedback on how the guidelines could be further improved and reminders about the need to insure inclusivity.

Tom Whicher, CEO of DrDoctor, wrote into us with a somewhat poetic view of the guidance, stating: “The framework has been referred to as a ‘clear north star’ for digital success, but with seven different areas of focus, I see it more as a constellation, with each star burning brightly with its importance.”

However, he was also keen to bring the publication back down to earth, adding: “I think it’s important to view this framework as just that – a framework. It’s a starting point, or rather a number of starting points, from where the real work needs to begin. Within each of the success criteria, whilst they all focus on crucial deliverables within digital health, there is a decided lack of specificity on how to approach, quantify and execute these deliverables. The task to make our health service ‘good’ is one of great magnitude and realistically each of the seven elements are independent projects in their own right.

“Whilst we’re being realistic, given the magnitude of the task at hand, building the capability to execute on each and every point will require a lot of time and resource, and it is important that we recognise just how big a task this will be.”

Dr Hina Lad, RIBA, ARB, PhD, Architect-Healthcare Planner at Imperial College Healthcare NHS Trust also got in touch to praise the “great aspirations” of both What Good Looks Like and Who Pays for What, but also highlighted: “The need to build a better-improved, secure and reliant digital and data framework for all, supported and governed by accountable leaders is long overdue.

“To make this work the outcomes need to be clearly defined and monitored.  The lack of integration and a comprehensive network establishment for all of NHS has proven difficult, time and again to sustain. The failure of the universal use of a single EPR system is known to all. The simple fact that primary care, mental health and social care consist of independent GP practices, clinics, specialist community services and healthcare centres which are not linked to secondary care is the fundamental problem. Creating a network across groups of ICS with NHS Trusts would be truly transformative through joint funding.”

Liz Ashall-Payne, founding CEO of ORCHA, commented: “ORCHA welcomes the What Good Looks Like framework – not only for its detail but also for its direct approach, as it cuts through the challenges of digital transformation to give clear strategic direction. Our review team particularly welcomes the focus on safe practice and the role of the DTAC. There are a significant number of high quality and effective digital health products but not all reach this high standard and we need to provide clear guidance and help to those that fall short on clinical standards, data privacy protection or usability.

“With the government-backed DTAC as an additional assessment tool, we are optimistic that standards will rise. We are currently guiding many clients through the DTAC and are finding it a worthwhile process. The focus on empowering citizens is equally welcome and has been my passion and focus for many years.”

Dr Dan Bunstone, NHS GP and Chief Medical Officer at Push Doctor also welcomed the framework, picking out that it “refers to specific upgrades to digital communication which will undoubtedly deliver benefits for clinicians and patients alike.”

“For example,” he said, “self-service pathways and better triage services mentioned in point five will ensure patients are directed to the most appropriate clinician in the first instance and will go a long way in reducing GP workload and patient recovery times.”

However, he also added that “interoperability will be a challenge to overcome as the NHS begins applying this framework” and that, “in striving for this single system, we also need to create a more bespoke piece which has the flexibility to meet individual needs of regional populations”, as “health inequalities have already been exacerbated by the COVID-19 pandemic, and it is therefore hugely important that providers of digital healthcare support the closure of the inequality gap – both health inequalities and digital inequalities – and do not inadvertently create new issues around digital literacy and access.”

Kenny Bloxham, Managing Director at Healthcare Communications, also shared his view on the framework, considering how it can help industry partners support the NHS: “The What Good Looks Like framework will enable us to assess and adapt how we support our partner organisations so they can deliver the best care possible. We are pleased to see literacy and digital inclusion needs are at the core of the WGLL framework for empowering citizens.”

Peter Corscadden of Hyland Healthcare, meanwhile, praised the timeliness of the release: “The relevance and timing of the new NHSX framework cannot be overstated, given the exceptional circumstances the organisation has faced in the last 18 months.

“Healthcare is changing and digital enablement is the route to a better patient experience and outcomes. While the needs of individual trusts must be recognised, legacy systems and lack of standards-based interoperability continue to hamper progress. The future success of NHS England’s wider digital strategy will require a commitment to near-universal interoperability, alongside a clear focus on the significance of digital care.

“While initiatives, such as the Global Digital Exemplars and Digital Aspirants programmes, continue to shape trusts’ digital transformation journeys, the ‘What Good Looks Like’ guidance offers an opportunity to create greater clarity and harness existing and emerging best practice. It’s critically important that the wider digital transformation lessons are shared throughout the NHS.”

Thoughts from Jonathan Bingham, CEO at Janeiro Digital were that “the strategy and fund together provide part of a much needed framework” and that it “feels like the first step towards realising the policy in practice and the beginnings of really beginning to move the needle towards the vision set out in the NHS Long Term plan of a tech-enabled and empowered NHS, where patients have control and access over their own data.”

However, he also said that “one important factor that does need further consideration” is the “regular and consistent review of this framework and others like it, by health and technology experts to ensure it remains dynamic and fit for purpose, with sufficient flexibility to evolve alongside the monumental pace of technological change and ever shifting patients and health system needs.”

Chris Scarisbrick, Sales Director, Sectra UK and Ireland, added: “The NHSX ‘What Good Looks Like’ framework is an accessible reminder of good practice in digital transformation. Integrated care systems and healthcare providers examining the measures of success set out in the document are shown what is expected, based on what NHSX describes as “local learning”. Such learning can also inform ‘how’ good practice can be achieved – which for many leaders is a question equally as important as ‘what’ is required.”

What about data?

A number of replies also focused on data – or what some felt was the lack of focus on it within the framework.

Head of Healthcare, Glen Hodgson, GS1UK also said: “It is refreshing to see these programmes in place to support digital transformation in healthcare. ICSs and associated organisations now have a clear set of criteria to consider when scoping strategic digital plans and procuring new systems and technologies.

“The main points to highlight are the resounding references to interoperability, patient safety and efficiency, such as the call for systems that can efficiently review and respond to safety recommendations and alerts, and that enable staff to work efficiently at the point of care, while promoting the use of tools and technologies that support safer care i.e. barcoding.

“One fundamental point to bear in mind, is that there needs to be standardised/structured data used as the backbone to underpin these systems, otherwise the very interoperability these programmes strive for will prove unattainable. Data will forever be captured and held in proprietary systems, defeating the core objective to drive safer patient care.”

Better.Care’s Managing Director for the UK and Ireland, Matt Cox, also focused on data, and told us: “It is great to see a framework that directs with the success factor of transformation. It marks a promising foundation to help establish good practice and accelerate digital transformation both within individual healthcare organisations and on a regional level. We know from our experience that true transformation happens only when all stakeholders are aligned in their strategy. However, we feel the recommendations could have gone a bit further in terms of setting the expectation around the new data policies, the separation of data and giving data ownership to the healthcare providers and patients rather than vendors.

“Finally, though the recommendations cover the ‘what’ aspect, the ‘how’ hasn’t been addressed, instead leaving it to trusts and suppliers to figure it out. The NHS needs to build on its past practice of creating blueprint knowledge to be shared amongst healthcare community.”

Richard Strong, Managing Director and Vice President of Allscripts EMEA, commented: “Overall, I welcome the WGLL framework. It marks an important step forward in assisting healthcare providers move towards digital maturity, both internally and at ICS level. When considered jointly with Who Pays For What, I see a promising foundation being laid for the acceleration of digital healthcare in the UK. Additionally, with the date for the legislation of ICSs fast approaching, it is reassuring to see a focus on helping organisations become prepared.

“The framework does a good job explaining the ‘what’, but suppliers and trusts must work together to deliver the ‘how’. The success measures, particularly those for ICSs, will rely on open, connected systems. However, the reference to open data in the framework is conspicuous by its absence, which I hope is not a sign of backtracking on the positive commitments laid out in the draft Data Saves Lives strategy.”

Andy Meiner, Managing Director and Chief Commercial Officer, Silverlink Software, said: “The COVID–19 pandemic has shown us the importance of digital and data, and providing local NHS leaders with digital success measures is a good way to ensure that we continue to build on the progress we have made in terms of normalising the use of digital technologies across the health and care estate. After all, digital should be a core component to the way the NHS operates, and never seen as a luxury or afterthought. But even though the guidance represents a good starting point, it is critical that the NHS invests time and resource into identifying and training the right leaders to deliver upon its digital and data ambitions. Only then will we be able to maximise the potential of health and care service delivery.”

Impact for ICSs

A number of respondents also honed in on the impact for ICSs, with Jamie Innes, Inhealthcare’s Product Director saying it’s “great that NHSX are providing a framework for ICSs to develop a consistent and high quality approach to digital transformation in their regions and across England. We hope that ICSs will take this framework and use it to design future proofed solutions which can meet the needs of their populations now but also accommodate for future healthcare needs.”

Paul Lawrence, Ascom Managing Director, noted that “whilst it’s good news to see the thought processes applied to the consolidation of funding programmes and a clearer structure of access to funds to drive digital adoption,” it will also be “imperative that What Good Looks Like’ include for greater collaboration across ICS’s and the wider trust organisations, so that shared learning and best practice can effect better purchasing decisions based on solid references.”

Florence CEO Charles Armitage’s thoughts were also in this area: “What Good Looks Like is an empowering and ambitious vision of how ICSs create a digital culture across their teams. However, the piece too often reverts back to speaking about the NHS and leaves social care out of the equation. If we’re going to follow through on ambitious projects like ICS-wide Shared Care Records then involvement of the care sector is essential. Given that it is a larger and more fragmented beast than the NHS, this piece would do well to highlight the specific challenges that will be encountered there.

“It is also good to see the emphasis on ensuring high quality digital infrastructure and equipment. Getting rid of fax machines and ensuring basic Wifi coverage will be financially beneficial in the long run. However, the money required to enact that transformation is significant. At a time when care providers are on their knees, it will be hard to excuse spend on new computers without substantial government support.”

Thoughts on the Unified Tech Fund

With the simultaneous news about the creation of the United Tech Fund, as well as the guidelines on Who Pays for What, funding and finance were also popular topics among the responses. Nader Alaghband, CEO of Ampersand Health- Ampersand Health, said: “The fragmented and time bound nature of tech funding in the NHS routinely adds time, uncertainty and complication to the digital initiatives that NHS staff want to deploy. The combination of WGLL and the UTF will undoubtedly enable more effective collaboration across multiple healthcare organisations and services to provide more support for patients and clinicians alike.

“Not only that, against a backdrop of rapid tech development, it is an early indication of the important guard rails that are needed to protect patients, health care professionals and NHS organisations for the successful implementation and continued use of technologies.”

Martin Bell, Director, The Martin Bell Partnership laid out three points for consideration. He stated: “The announcements last week around the ICS Digital Strategy are welcome. If ICSs are a main delivery vehicle, they need to have a framework in which to operate, and their constituent organisations need clarity on where they fit.

“Although changes are mentioned for April 2022 onwards, the initial take on the Unified Tech Fund, is, it’s not very unified – there are lots of initiatives, written down in one place, all requiring effort to bid for.

“With a (crude) average of around 2 per cent of revenue turnover spent on NHS IT, health tech and digital, given all it covers it is but a quarter to a third annually by international good comparison.”

He did, however note that it’s “impressive so much is achieved by digital leaders” and made three suggestions, including that: “all NHS organisations be required to spend a minimum of 3 per cent of revenue versus turnover on IT; they reduce central ‘initiative funding’, and put it into the local baseline to top the IT spending up, as new money, not top slicing; there should be transparency around national, regional, and local organisation funding of IT published each year in each organisations’ annual report’ and accounts, so they can be held accountable.”

Will Smart, Global Director, External Relations, Dedalus Group, said he also believed that “these two documents clarify the landscape for digital investment in healthcare in the English NHS. In some ways, the Who Pays for What is the more important, signalling a welcome simplification and localisation of digital funding in the service, with increased clarity around how the most appropriate part of the system will invest to maximise value and impact.  ICSs will, rightly, play a fundamental role in directing investment within their local system.”

Dr Kit Latham, Co-founder and CEO, Credentially added: “Overall, simplifying funding for NHS digital transformation project is a great opportunity for NHS organisations. As CEO of an SME software provider to the healthcare industry, I know first-hand how lengthy these tender processes are for these frameworks, so I can empathise with the feedback on “funding for technology is too complicated”. Our experience of these processes is that they offer a very high barrier for smaller, innovative providers of market-leading solutions without the support of a very large enterprise to complete lengthy and at times potentially overly burdensome framework and tender application processes.”

A few suggestions…

Far from simply saying what’s right or wrong with NHSX’s framework, many industry experts shared suggestions on how to improve the guidance, explaining what they thought was missing or could be done to improve the literature further.

Dr Latham of Credentially continued in this vein, adding: “It’s great to see that NHSX are providing a focused framework on digital transformations. Improving patient safety and services is at the forefront of the framework – and rightly so, however, I feel there is still the underlying issue of staffing levels and the people who are carrying out this framework daily missing from the conversation.

“Often, the main problems that cause issues and delays with appointments and patient care is down to the bottleneck that is experienced when hiring clinicians and ensuring compliance. Adding a focus to the workforce and wellbeing is crucial to the building blocks for the future of the framework.”

Dr Anas Nader, an NHS doctor and co-founder of Patchwork Health, meanwhile, acknowledged that “the new What Good Looks Like framework and Unified Tech Fund both spotlight several important areas for investment and development in our health service, and I feel confident that they will help to drive impactful change at this pivotal moment.”

However, Dr Nader said: “Digital tech has huge potential to solve embedded workforce problems – from recruitment to burnout. So, it would have been encouraging to see this made a central focus of the new guidance. For example, although it’s encouraging to see Success Measure four emphasise the importance of promoting digital systems that ‘enable frictionless movement of staff across the ICS – allowing staff from different organisations to work flexibly and remotely where appropriate’, it’s difficult to see how this translates to real change. Staff are currently trapped within rigid workforce systems; we urgently need to build frameworks within which all staff feel empowered to work flexibly and across institutional boundaries.

“If we are to make NHS careers more sustainable and attractive, we need dedicated funds and ambitious, focused targets to release workforce capacity, restructure outdated systems and put real people back at the centre of staffing policies. From doctors and nurses to porters and admin teams, people are absolutely central to the NHS, and their wellbeing deserves to be prioritised as such. We’re in the midst of an unprecedented burnout crisis, but we have the digital solutions with the power to fight the flames. The implementation of any new frameworks and funds must reflect this.”

Nicola Hall, founder and COO at Ingenica Solutions, added: “The NHS is certainly behind the adoption curve for technology, and slow to adopt cost saving technology due to the funding cycles.  We welcome these initiatives from the centre, they are certainly required as the NHS adopt technology and implement digital programs. There are more areas that need addressing, key areas that we see trusts grappling with currently are building business plans for application of funding for digitisation programmes and how to evaluate and select solutions. Further guidance on these areas for trusts would be beneficial. Technology changes at a fast pace and NHSX advice to trusts will need to keep pace with the speed technology moves as trust adoption levels increase.”

Will Smart of the Dedalus Group also revealed that “where we feel the guidance is lacking is in the area of supplier engagement.”

“It is clear,” he added, “that successful digital transformation also requires healthy supplier partnerships that harness the skills and experience of both the NHS and the broader technology industry. By working together, we can deliver what we all desire – improved outcomes and safety, better patient experience, and more productive services.”

Robin Stern, Chair at Future Perfect (Healthcare) stated: “I can see that the report’s objective is to encourage and enable local healthcare leaders to work out what digital means to each ICS in its own context. That’s fine, if the infrastructure needed is made available for this to happen. It’s easy to ignore infrastructure. It’s historically been a blind spot, and it will be an issue to recognise, to tackle and to get right.

“There is also the challenge that digital could fail to support emerging complex care models that rely on large geographies of hub-and-spoke services – especially cancer or stroke services, and possibly long-Covid as we start to see these new specialist services emerge.  It’s important to be aware of these potential pitfalls.

“Economising on infrastructure will never work, and that needs to be addressed in addition to the report’s great commitment to open standards and digitisation of care.”

EPR Consultant David Kwo, meanwhile, picked out that “WGLL is silent on data quality and data management.”

“Good data quality is pivotal to any ICS digital strategy,” he continued. “For instance, shared care records (SCRs) depend on subsets of data from a variety of source clinical systems. They are therefore at risk of poor data quality due to the underlying real-world diversity of data definitions and data models.”

His recommendations included: “ICS digital systems should report on data quality regularly and in a standard format, using metrics agreed by NHSD and relevant professional bodies; ICS digital business cases should include a fundamental criterion for demonstrating improvements in clinical data quality and associated patient safety alongside other Value for Money criteria; and that NHSX should answer questions such as – who is responsible for data quality in ICS systems in particular the shared care record system? If a clinician makes a clinical decision that causes patient harm based on poor quality data in the e.g. the shared care record (e.g. conflicting allergies and medications data), who is responsible? Who is responsible for monitoring clinical data quality and associated patient safety events within the ICS digital governance model?”

Dr Ruby Bhatti OBE, a public contributor who supports lay views at NIHR, NHS England and at various universities, also provided plenty of food for thought through her focus on inclusivity. She stated: “The success measures are clear but as a lay member/public contributor from a minority background, for me it is imperative that we are inclusive and able to ensure we reach out and fully support those who are unable to embrace the digital world due to say English not [being] their first language, disability or [being] based in a rural area where it is not possible to even connect to the Wi-Fi.  It is even more imperative for ICS’s to ensure this is at the heart of any digital decisions and evidence that place base intelligence is being used. It will be important to ensure that place-based intelligence and those from seldom heard communities are not missed out when centralising programme funding at ICS level.”

Her advice included that “drawing on local learning and partnership working with different organisations must continue…through CCG’s a lot of that work has taken over six years to build and we must ensure this is continued and not re-invent the wheel with funding that is provided.  In this way we are building on the digital work that has already been done and taking it to the next level.”

She also added that: “More training is needed to ensure we empower all walks of life to be involved in the digital journey including using platforms like schools and colleges.  Use funding to use better translation tools which are currently used in schools to be inclusive. Literature can be converted into different languages and accessibility is also included for those with disabilities. Funding is imperative to support these cohorts otherwise it will only benefit the usual cohorts.

“It would also be good for patients and carers to lead some of the programmes within their communities as they have a better understanding and able to reach out to the seldom heard communities and have great networks which may not have been accessed by the usual vehicles. Throughout the pandemic the community members were accessing digital platforms to reach out to the communities they live in to ensure that the vaccine messages were getting out.  We must learn from the last 18 months and use the grassroots intelligence we have gathered of what worked well. “

Also focused on users – be it patients or providers, Suzanne Henderson, Programme Manager, AMaT, asked “what does good look like? The only way for us to answer this is to look to our users, specifically in how they are working to improve care by embedding digital, data-driven solutions in clinical audit.”

And finally, our last comment was from Ewa Truchanowicz, Managing Director, Dignio UK, who stated: “NHS leaders have been given consistent guidance on What Good Looks Like in the vision from NHSX. The tech unit has rightly tied this to integrated care delivery, with a visual focus on empowering citizens in the middle of success measures.

“But for this to deliver real patient-centric impact, the framework’s application in practice requires leaders to think beyond issues like digital maturity. Leaders must find ways to create a spirit of collaboration locally to allow digital adoption to support drastic changes in care delivery. We need to build digital integrated care pathways around the person receiving care – rather than around individual diseases. It is not enough to use technology to optimise existing care silos.

“The critical point of the NHSX document is measurement. That measurement must be ongoing: not just at the point of a contract signing or rollout. The impact of co-design and the reality of user friendliness, for example, must be tested after adoption to make sure digital tools work for the people who use them – citizens and professionals. Three months post deployment, providers should ask if and how technology is being used. And questions should be asked of real users – not just panels.”

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