Laura Wade-Gery review and recommendations released by UK Gov

The UK Government has published an overview of the Laura Wade-Gery review into data, digital and tech in the NHS.

An overview of the independent report – which informed Health and Social Care Secretary Sajid Javid’s proposal to merge NHSX and NHS Digital into NHS England and Improvement, along with other reforms – is now available.

The document, entitled ‘Putting data, digital and tech at the heart of transforming the NHS’ can be read online, along with an official letter from Wade-Gery, who is the Non-Executive Director of NHS England and Improvement and the interim Chair of NHS Digital, to the Secretary of State for Health and Social Care.

The contents of the report explains the purpose and scope of the review, as well as covering topics such as patient and citizen-centred approaches, joined-up care, the organisational consequences of change, enablers for change, and possible next steps.

The report states that the goals of the review include building on progress made during the COVID-19 pandemic around collaboration and digitally enabled care pathways, as well as to “ensure the national NHS (defined as NHS England and NHS Improvement (NHSEI), NHSX (X) and NHS Digital (D)) can lead the transformation of the wider healthcare system, supporting integrated care systems (ICSs) to deliver better citizen health.”

Its emphasised that, “This is not about centralisation – it’s about empowering the centre to have the mindset, operating model, skills, capabilities and processes to provide the right leadership and support to ICSs, so that together the NHS delivers improved citizen and patient outcomes.”

The authors argue that, “The need is compelling. The NHS faces unprecedented demand and severe operational pressure as we emerge from the coronavirus pandemic, and we need new ways of working to address this.”

While praising many of the achievements of the past 18 months or so – such as the use of data analytics to support the roll-out of the vaccine programme, reaching 96,000 people with remote monitoring, and the joining up of 111 and accident and emergency departments through digital information – the report then goes on to outline the ‘current position’ and identify six areas of potential improvement.

Based on “extensive interviews” undertaken during the report’s “data gathering phase”, these include:

  • Transformation model – focusing on the “needs and experience of diverse users, including addressing inequalities” to facilitate transformation; a need for “greater clarity on the roles of national, regional and local in driving transformation.”
  • Funding and benefits – the review describes transformation funding that is “currently split between revenue and capital and dispersed across the organisations” and tech funding that is “variable, often diverted and not necessarily linked to strategy and outcomes, incentivising either monolithic programmes or small-scale initiatives.”
  • Leadership – “variable commitment, experience and interest amongst senior leaders in digitally enabled system transformation,” is suggested here, with “too few integrative leaders able to effectively bridge managerial, clinical and digital.”
  • Capabilities – the report states that there is an “insufficient focus on ‘soft’ levers including hiring and recognition, limiting the development of a digital culture which rewards iterative and step wise approaches.”
  • Data and technology – in this area, the review argues that the “separation of responsibilities for digital strategy and infrastructure results in a lack of clarity on target state data and technology architecture”, and that this, in turn, “creates friction for the sharing of data for administrative and planning purposes.”
  • Organisational responsibilities – the review states that “responsibilities across different central organisations are unclear” and that this results in “duplication of activity and issues with the commissioner-delivery partner model”.

With those points in mind, the publication states that, “the centre of the NHS (defined as NHSEI, X and D), as currently constituted, and despite considerable progress and the best intentions of many people, remains too far away from being able to achieve the goal of a digitally enabled health system that makes use of modern technology and data sharing to create joined up services to support all citizens and improve outcomes.”

Building on its findings, the report then provides nine recommendations, which are based around ‘mindset, operating model, organisational consequences and enablers for change’.

The nine recommendations include, in summary, advice to:

Commit to a patient and citizen centred organising principle for future service transformation – through being bolder in empowering people to manage their health and wellbeing, providing people with the tools to do so, and highlighting that citizens should “expect services to be designed with them in mind”. To achieve this, the document authors say that “the major axis for change” will be having care pathways centred around a patient or citizen view rather than care settings, and that this will require new capabilities and a cultural shift.

Consider and mitigate digital inequality in all service transformation. Expand the role of the SRO for Health Inequalities to include digital inequality – a recommendation that NHSEI should “develop national frameworks, guidance and best practice in designing and implementing digital solutions to reduce inequalities” and ensure that when new models of care are designed they give people a choice between remote and face-to-face care.

Commit to building patient and citizen trust and acceptance in the use of health data to improve outcomes. Provide more efficient access to data for analytics that ensures privacy and can be used to improve care delivery – the review adds that it’s “critical for the effective delivery of digitally enabled healthcare transformation that citizen trust and acceptance in the use of data is built”. It recommends this is achieved through ‘the centre’ working with other key national stakeholders to build awareness, and through clinician and management engagement and debate with the citizen, to build understanding.

Reorientate the focus of the centre to make digital integral to transforming care, with NHSEI overall accountable for executing digitally enabled service transformation. Provide clarity around the role of the centre, underpinned by a clear enterprise architecture and align with the ICS operating model.

Implement a new operating model across NHSEI, X and D to drive digital and data transformation – the introduction of a new, four-layer, more ‘modern’, operating model that will lead to more “closely linking digital and data delivery to the business while clarifying accountabilities for supporting technical delivery”.

Re-align organisational responsibilities to ensure delivery of the new operating model – creation of a new ‘Transformation Directorate’ that will operate “at the heart of the NHS”  and “drive transformation”. This is also set to include the establishment of a ‘Transformation Factory’. In regard to the mergers, the report states that “NHSX no longer needs a separate identity, and can become a key, integrated driver of the new approach to transformation”, while it suggests embedding “NHSD into NHSEI as its tech function and as the NHS centre of excellence for technology, with an intent to merge legally once legislation enables this”.

These moves will include the NHSD CEO being appointed as Chief Information Officer for NHSEI, and as a member of the NHSEI Executive Committee. A Chief Data and Analytics Officer will also be created for the NHS, to provide “professional leadership to the data community but nest activity as close to the end user as practicable.”

Undertake a fundamental organisational capability intervention across NHSEI and D to build and nurture the skill base to support data and digitally enabled transformation and adapt ways of working to support the new operating model. This will involve building basic data and digital literacy and capability at all levels and fostering a more agile and flexible workplace focused on meeting user needs.

Revise financial management arrangements both within NHSEI and between NHSEI and DHSC [the Department of Health and Social Care].

Re-prioritise NHSEI spend to lift the quantum devoted to digitally enabled system transformation. Assess the level of ‘technical debt’ across the wider NHSEI system and update estimates of technology spend required to enable the delivery of safe technology operations. In conjunction with DHSC, make the case for increased funding to deliver safe technology operations.

The report later acknoweldges, “The extent of the changes envisaged by this report should not be under-estimated; they get to the heart of how the centre of the NHS operates, and critically the culture, skills and capabilities, incentives and operating processes in place…the change management effort is significant and will require full-time resource and the determined sponsorship and commitment of the new CEO of NHSEI and the CEO of NHSD and their wider Executive Team and Boards.”

“The time for action is now. The need is enormous. The NHS faces unprecedented demand and severe operational pressure as we emerge from the pandemic. Now is the moment to put data, digital and technology at the heart of how we transform health services for the benefit of citizens, patients and NHS staff,” it concludes.

To read the report or letter in full, visit the dedicated section of the UK Government’s NHS publications.