Panel discussion: supporting the NHS workforce with digital skills and digital careers

For a panel discussion this week on digital careers and digital skills, we were joined by Martyn Perry, acting chief digital information officer at Midlands Partnership University NHS Foundation Trust (MPFT), and James Freed, deputy director at NHS Digital Academy. Martyn and James chatted through topics including supporting the workforce with digital skills development; recruitment for digital roles; digital skills needs and assessments; and putting resources in place to ensure the NHS workforce can meet digital skills requirements in the future.

By way of introduction, Martyn shared that since starting as acting CDIO with Midlands Partnership in December 2023, he has taken on the responsibility of overseeing the organisation’s digital transformation teams, including clinical systems support teams, programme and project managers and business architects. He is also the senior stakeholder for the trust’s shared informatics service.

James also introduced himself, sharing how he originally tried his hand at being a scientist before going into change management in cancer services in hospitals in South West London. From there, he joined the National Programme for IT and then worked for a range of organisations including the Health Protection Agency, Public Health England, Health Education England and NHS England, always in digital roles.

“I learned a lot about digital strategy and how the NHS works. Now, I run the NHS Digital Academy, which is there to support people in the NHS and many people outside it. We have a responsibility for people in the devolved nations and in social care to a degree, even if our primary responsibility is to NHS staff in England. We work on all sorts of digital skills development programmes, whether it be digital literacy, digital leadership, digital skills, or what I call digital competence; the sorts of skills that people need if they’re running a service and making decisions about buying or implementing technology.”

Supporting the workforce in developing digital skills and confidence in digital

Moving on to discuss current projects, Martyn highlighted how launching the trust’s digital strategy in 2021 offered an opportunity to conduct a baseline survey on digital skills and confidence in digital amongst staff.

“That really informed what we needed to do, and we established a Digital Angels Service, which trains both staff and members of the public. This broadened the scope of the existing digital skills team to highlight a wider range of skills and confidence gaps, such as in cyber security training. We also do site visits to support staff in their own environment.”

Martyn shared that drop-in and one-to-one sessions have proven helpful in developing skills and identifying where individuals needed more support, including for those who needed help with basic digital capabilities such as screen sharing.

“Things like that can really alienate and isolate people working remotely,” he noted. “We’ve helped those individuals and avoided some premature retirements with people who were feeling under pressure, because the skills team has supported them in becoming confident and capable with digital. We also support with service user training, we’ve got the local community services, and we work in partnership with GP practices to support people in registering and using the NHS App.”

Martin also highlighted the importance of the 482 digital champions at the trust, explaining how they help to build “a fantastic culture of peer support, learning and sharing”, as well as “reducing the reliance on the service desk” by answering common queries.

James then shared some of the work underway at the academy, including 15 education programmes across digital literacy, digital competency, digital educators, digital leadership and digital professionalism or expertise.

“We just concluded a learning needs analysis, which hasn’t been published yet, where we interviewed 65 people from within the NHS,” he said. “We held focus sessions and conducted a survey with another 550 participants. From that, five times more interest was suggested in digital and data literacy than in any other element of learning. That isn’t surprising when you consider that there is research indicating that in the NHS as many as 63 percent of the workforce don’t have all 20 digital skills deemed essential for work, such as the ability to access their payslip online.”

Anecdotally, James said, this insight suggests that there is “quite a high degree of overlap between digital literacy and general literacy, English language and numeracy skills”, which may mean that things like the academy’s digital self-assessment tool might be more challenging or time-consuming to complete.

“That’s one of the reasons we want to focus this year on that digital confidence and digital literacy agenda, making sure that our products are fit for purpose, and for people like Martyn’s Digital Angels to use, adopt and share. Secondly, on the educator agenda; there’s a huge number of health and care organisations frustrated with the lack of central resources. They are developing their own capability frameworks, signposting or assessment tools, which is causing quite a lot of duplication. So we want to try and convene a community for educators to address those issues.”

James said that it is “our job to try and make sure that digital education is no longer the ‘blocker’ that it has been in the past, as we estimate that 95 percent of change nowadays is underpinned by digital or data to some extent, and that 70 percent of those digital initiatives will fail, or will not have the expected outcome.”

60 percent of those projects “fail due to cultural and skills deficits, or things that we could address through education programmes,” he added. “If you add all of those percentages together, that means that the education agenda could potentially turn 40 percent of all change activity in the NHS from failure into success. That’s one hell of a prize if we can get it right.”

Digital: a ‘need to have’ or a ‘nice to have’?

We asked our panellists whether they thought that current monitoring was sufficient around digital capabilities, and whether digital should be embraced as more of a “need to have” than a “nice to have”.

James provided us with his insight first, talking about how in his experience, empowering people to embrace digital provides better results than simply “making everyone do it”.

He said: “The innovation agenda can’t succeed if you’ve got one CDIO making all of the technological decisions for the whole organisation. There’s got to be a way of helping more people to make sensible and safe decisions about how they use digital in their day-to-day work. However, if you do that, and you don’t give them the right skills, then you create more risk; you create more safety issues; you create more usability issues.”

Mandating digital, James went on, can be “exactly the opposite of empowerment” when it comes to encouraging mindset change.

“Rather than assessing people annually and having punishments for those who don’t make the standard, we could have much more facilitative, engaging approaches, like incorporating monitoring as part of annual or six-monthly appraisals, to support people to develop. The NHS is still quite a hierarchical institution; I think in the digital world, part of the change needed is the mindset in how we develop and implement the policies that we have, as much as the digital skills themselves.”

Martyn agreed with James’ points and also raised the importance of balancing out the safety issues which may arise from “letting someone loose on care systems without the basic competency and understanding on how to use them”.

He emphasised the importance of starting with inductions and getting “those basic competencies in place about how to use the system properly, and making sure they can spot alerts in there, so we can keep staff and service users safe. But also, James’ points about mandation are very true. You have to be careful about what becomes mandatory, because there are risks involved on the other side, such as disengagement, demoralisation, or exclusion.”

Martyn talked about the importance of “not just setting targets for the sake of it”, but rather performing quality assessments on the outcomes from training compliance. “The worst thing you can do is assume that your organisation is safe because you’ve got the compliance target met,” he pointed out.

James built on this sentiment, stating that in his experience, “those sorts of targets encourage people to hit a target, but miss a point.”

The approach to trying to tackle this, he said, is in itself a digital skill; ensuring that the focus is on the outcome of how safe your organisation is and how much knowledge individuals within the organisation have, rather than how many people have been on a training course. “That for me is what data literacy is at its core; it’s recognising what you’re measuring, what’s making a difference.”

Securing staff buy-in around digital

Discussing what concerns staff may have around using digital within their role, and how best to tackle them, Martyn likened the situation to having an unreliable car that can be trusted at times but other times won’t start. “I think that that analogy is exactly what staff struggle with most with traditional technology. It should be consistent and reliable; you should be able to apply your skills in a consistent way and get the same results. But the unreliability often means you don’t.”

Across the workforce, he continued, that is “a very frustrating part of their lives on a daily basis. Technology can be the saviour or the productivity gain, where you can really get amazing value, benefits and insights to enhance the quality of care. But on the other hand, it can also be the most deeply frustrating, unreliable, inconsistent thing. Then they’ve got to start having skills as digital support technicians, to start troubleshooting their fault. Fundamentally, confidence can only be gained when reliability and consistency improves.”

This is reflected in his current priorities, Martyn shared, as he tries to make technologies as “consistent and reliable, and as usable as possible” to make sure that the “benefits of all that upskilling and growing in confidence” can actually be leveraged.

James also discussed some of the findings from his work and research in the area, around the current challenges and difficulties relating to staff use of technology within their role. He highlighted a learning needs analysis exploring the biggest challenges for staff at present with regards to the digital world getting in the way of their job. “We identified a page full of challenges, some of which existed two decades ago, and many of which could be addressed through education. The focus was on foundational challenges like access to hardware, access to training, and usability.”

Looking at other areas, James highlighted “shadow IT” as another challenge with digital within the NHS. He described this as “when information systems spring up because someone has a budget and has purchased something, managing to circumvent the governance process, and people can’t use it – it doesn’t connect into anything and they’ve not looked at architectural standards.”

A typical hospital might have 250 and 400 systems, he added, and “many of those will be due to shadow IT. Our learning needs analysis identified a group of people who’ve got a budget and responsibility for a service, but who have got no formal digital training. Often they’re making poor decisions about digital, not because they want to, but because they’re frustrated with how long it takes to make those decisions. If we can help these people to better understand what’s happening here, that’s one way of tackling this.”

Recruiting staff for DDaT roles

On the topic of recruitment into digital, data and technology roles, Martyn talked about the benefits of working in the NHS which may help attract this type of talent, including a “stable career” and “a good pension”. He considered that perhaps a mistake in the “sales pitch” for NHS recruitment might be missing the chance to highlight the purpose of the NHS and how rewarding this can be.

“We need to attract new talent, and if we’re doing the hard work in terms of sharing our successes, recognising those across the team, then we stand ourselves in much better stead to attract that talent. It’s about making that sense of purpose evident, and showing the impact that we’re having on care, looking at how we celebrate that, as opposed to being motivated by someone else’s profit margin.”

Martyn also shared some of what he thought would be the most attractive benefits for someone looking to work in the NHS, including flexibility around hybrid and remote working, skills frameworks and opportunities for progression.

James talked about some of his insights around recruitment for DDaT, including that his team predict a 75 percent increase in both basic and advanced digital skills over the next five-to-ten years as a result of the impact that tech such as artificial intelligence and automation.

“Our modelling indicated that CDIOs were expecting, collectively, to be recruiting around 17,000 whole-time equivalents by 2030, from 2020 levels, so expectations are high,” he noted.

“In terms of salary, we pay on average 10 percent less for our digital roles; but we’re still pulling people into the NHS, and there are things that we can do right now to help with this. HR departments can support recruiters, for example, with using recruitment and retention benefits, which might add 10 percent onto a salary that you’re able to get through Agenda for Change.”

There will always be a pressure, he acknowledged, because if you may more for a software developer or an IT specialist, you will have fewer doctors and nurses.

However, he continued: “Martyn’s point around how you make an organisation more attractive is really important, and we need to up our game. One of the things industry has over the NHS is that it’s a lot easier to hire. In the NHS, it’s not unusual to have a three-month period of time between seeing an advert and starting a job, and that does not attract people. The more we can take that user-centred approach for our corporate services, and the more we’re able to give them work that’s fun and rewarding, the more chance we’ll have to recruit and retain.”

The future of digital skills and careers

To close the session, we asked Martyn and James what conversations they hoped we’d be having in five-to-ten years on this topic, and how they thought the challenges may have changed.

Martyn shared his hopes that the NHS would still be around in five-to-ten years, noting that in his view, “the current pressures and uncertainty are the reason there’s so much pressure on digital, particularly in terms of the efficacy of care and innovation”.

He considered that some of the biggest challenges for the future will probably lie in how the benefits of innovative technologies are leveraged in a safe and compliant way. He called AI a “fantastic opportunity” but noted that its safe application in health and care “feels like a long way away.”

If we could get something in place around AI guidance, Martyn continued, then “in five years’ time it could be a rapidly different conversation, and we could achieve those goals of enhanced productivity, enhanced use of data to inform decision making. We could do some enhanced predictive modelling with digital twins.”

James voiced his hopes that we would move away from using the word “digital”, and that we would “talk less about the tools and more about the outcomes”.

From an education standpoint, James also considered that he would like to see a workforce that “feels trusted because it is enabled by induction and appraisal processes, curricula and higher education institutions”, so that they feel confident about modern ways of working and the digital tools they will be using within their role.

“Also, I’d like to see a destigmatisation of failure, as we learn most from failure, and we make things better because of it. Let’s start taking those failures and using them to talk about how we can do things better.”

We’d like to thank Martyn and James for their time in sharing their insights with us on this topic.