Edinburgh University submits full independent GDE report to NHSX

The University of Edinburgh has submitted its independent report on the Global Digital Exemplar Programme (GDE) to NHSX.

NHSX recently published a summary of the document, which the university had completed earlier this summer, to share the findings on the outcomes from the project, to date.

Entitled ‘The Full Report of the Independent Evaluation of the Global Digital Exemplar (GDE) Programme’, the document is considered as still ‘evolving’, despite publication, as the GDE Evaluation team continues its work.

Subtitled as ‘Beginning a joint digitally enabled transformation and learning journey in the England National Health Service’, the publication explains the background to the programme, which is described as ‘ambitious’ and ‘first-of-its-type’ in its attempts to advance digital service transformation in selected NHS England ‘exemplar’ organisations and to create a national learning ecosystem.

Explaining that the 2016 Wachter Review into digitising England’s NHS had recommended the creation of a ‘cohort’ of digitally advanced organisations, who would then share their learnings with ‘less digitally-mature’ Fast Follower (FF) healthcare providers, the review details how those shortlisted were instructed to propose and implement digital change over a period of two to 3.5 years.

The programme selected 52 providers overall, including three ambulance organisations, 33 acute care providers, and 15 from mental health, with a split between GDEs and FFs to ensure providers could be paired up and enable the passing on of knowledge. The review explains that the exemplars and Fast Followers each received a portion of the £302 million in funding for the programme, with shares decided by organisation type and GDE or FF status. Although, the report states that “this represents a relatively small share of the total NHS digital transformation budget between 2016-17 and 2020-21 of £4.7 billion.”

It also adds that the independent evaluation by the GDE Evaluation team – which also comprised members from University College London, and the NHS Arden & Greater East Midlands Commissioning Support Unit – helped shape the programme throughout.

The summary presents the GDE Evaluation Team’s findings so far, stating that, “overall, our work shows that the GDE Programme largely achieved what it set out to do, namely stimulating digitally enabled transformation and the sharing of knowledge between participating provider organisations and with programme managers.”

It adds: “It also helped organisations to develop a roadmap of digitally-enabled transformation (and achieve international standards of excellence), engage clinical users, and establish baselines of digital maturity against which they could assess progress (defined by nationally developed measurements including the Definition-of-Done). The Programme was also seen to have demonstrated the safe delivery of digitally-enabled outcome-driven transformation at pace and lower cost.”

Specific findings include that “the provider organisations implemented ambitious programmes of digitally enabled transformation”, such as “major upgrades in core information infrastructures” like Electronic Health Records (EHRs). Other examples given were the implementation of multiple projects as part of a “bigger integrated care agenda.” This, the report says, has led to a “wide range of benefits are materialising and feeding through into improved care delivery and outcomes including significant unanticipated benefits – most strikingly an enhanced capacity to respond to the challenges posed by COVID-19.”

The evaluation also notes that, “several inter-related features of the GDE Programme have contributed to its success in achieving digitally enabled transformation.” It lists these success factors as: high-level ownership at board, divisional and clinical levels; multi-year external funding matched by internal funding; governance structures for securing executive commitment and creating internal structures to manage implementation; status benefits of winning the competition to join the programme and associated prestige impact on motivation and vendor leverage; growth of digital transformation expertise through roles such as Clinical Information Officers; development of internal vision and strategy.

On helping to establish the “foundations for a learning ecosystem”, the review finds that the GDE Programme achieved this by “establishing formal knowledge transfer through GDE/FF partnerships”, circulation of Blueprints, funding for formal GDE Learning Networks, creation of informal networks, and knowledge transfer promoted through national initiatives.

The report also covers the programme’s challenges – such as difficulties around digital maturity targets, outcome monitoring, long-term planning and market management – before concluding with next steps.

Lessons to carry forward it says, include building “long-term organisational memory around large-scale digitally enabled transformation initiatives”, addressing the digital divide, “early involvement of participating provider organisations and cumulative development of programme management tools”, the need to train and develop transformation expertise. It also highlights the need to ensure that “digital becomes mainstream, operationally and in terms of health and care strategy and policy”. The latter, it suggests, can be done through aligning with other existing change programmes and transformation initiatives and through “assessing and monitoring digital maturity of organisations”.

To read the full report from the GDE Evaluation team, click here.

If you would like to find out more about the programme, and the GDE Evaluation team, watch our recent live webcast on the topic below, which was a key part of our agenda for the recent HTN Now September 2021.