Interview: “It’s up to ICBs to prioritise community services and make the digital funding that they need available” David Williams, NHS Providers

In our latest interview, we spoke with David Williams, head of policy and strategy at NHS Providers, the membership organisation for NHS hospital, mental health, community and ambulance services that treat patients and service users in the NHS.

To begin, we asked David to share a little bit about his background, and what had brought him to his current position within the organisation. He shared that in his role, he helps to run the policy team who work on various portfolios relating to health and care. David also oversees NHS Providers’ work on system working, and on regulation and governance issues.

On how the NHS could effectively transition its workforce to further embrace digital tools and technologies, David commented: “I think the workforce totally understands the prize and the improvements that a more digitally enabled service offers. I think the barriers to adopting more digital ways of working don’t sit with the workforce – they sit around funding and prioritisation at a national and system level. From what we hear from our members, it’s not true to say that the NHS would be embracing technology faster were it not for the workforce.”

Funding and prioritisation

Elaborating on the barriers relating to funding and prioritisation, David continued, “When you talk about the NHS, you have to think about three tiers – trust level, system level and national level. What you need at all levels for digital transformation, particularly community services, is appropriate prioritisation and funding. At the moment, we are seeing that community services are well suited for becoming more digitally enabled, but we are seeing lots of variation in how far along in the journey these services are. The reason for that is a historic variability in the way that community services in general have been prioritised for development and funding, and also the availability of funding specifically for digital. For example, when national funding pots have become available for digital transformation in the NHS, too often they haven’t been available for the kinds of projects community providers would benefit from.”

In addition, David noted, “Digital transformation requires both capital and revenue spending; and too often community services haven’t been prioritised in funding decisions for either. So now it’s up to ICBs to prioritise community services and make the digital funding that they need available, and to see that as a priority. If we keep diverting the national funding for digital toward some sectors and not others, then you’re going to miss out on the opportunities that exist in community services.”

Adding value and efficiency

Asked about the ways in which digital technologies could add value and efficiency to community health services, David raised the example of how technology could support a community nurse by enabling them to update a patient’s digital care record while on a visit, rather than having to write notes on paper and collate them at the end of the day.

“Technology can also help make that shift toward a more preventative model of care,” he said. “Success in that area looks like, over time, a healthier, better supported population that is less likely to incur more severe costs through the exacerbation of their long-term conditions.

Remote monitoring is key in that area. So as an example, you can get a patient set up with the right tech and the right support so they can monitor their own conditions and enter their own data for clinicians to monitor. That means they don’t have to be in hospital or visit too often, and as a result you’re making better use of the clinician’s time, and you’re using your resources to help that patient stay well rather than waiting until there’s a problem that they have to come into hospital for. It’s a different type of efficiency, but it is really valuable, both for the local system and more importantly for the patient.”

Digital and face-to-face care

David highlighted the importance of ensuring that digital does not take the place of the more familiar face-to-face model of care that has historically existed within community health services.

“People shouldn’t view the use of technology as being an alternative to face-to-face care. What it should do instead is help target the face-to-face care to where it is going to be the most effective, and help healthcare workers to support patients in the most effective way.”

The face-to-face element of community care, in particular, is “absolutely essential”, David commented. “We shouldn’t be arguing for that investment in technology on the grounds that it will remove face-to-face care. That’s not the aim.”

Funding for digital

David raised a key consideration for funding when it comes to digital community healthcare.

“If you’re going to maximise the opportunities for digital in community services, you do need to think about ways of making capital and revenue funding for digital available both to trusts providing community service and also to community interest companies,” he pointed out.

David acknowledged that considerable challenges lie ahead, with integrated care systems still relatively new but facing “pressure that hasn’t been seen in the NHS within the working lives of most leaders that you speak to”. He concluded, “It’s a really difficult task, and going from where we are, where we have extreme variation in digital maturity within systems and between systems; turning that around is going to take a lot of time”.

Many thanks to David for joining us.