For a session exploring best practices around building workforce digital literacy and skills, HTN was joined by an expert panel from across the health sector, including Shanker Vijayadeva, GP lead – digital transformation in primary care, London Region, NHS England; Neill Crump, associate director for innovation and partnerships at The Dudley Group and Sandwell and West Birmingham; and Rebecca Ellis, associate director for education at Moorfields Eye Hospital.
Our panellists started out with some introductions. “This topic is really close to my heart,” said Neill, “because I see digital skills as part of innovation. When I eventually leave the NHS, I’d also like to have a legacy that I helped not only my own local teams, but also nationally and regionally helped to embed digital skills within the workforce.”
Rebecca told us about her background as an optometrist, as well as her current role taking responsibility for the education of nursing, AHP, and non-clinical colleagues across Moorfields. “I’m also SRO for the training workstream of our upcoming EPR programme, which is launching in October,” she explained. “That’s really driven me to think more about how we can support our workforce with a change in practice and moving toward a much more digital way of working.”
“I’m a GP by background, and currently have a couple of roles in the London region as digital transformation lead in primary care for NHS England and as a GP IT lead in North West London ICB,” Shanker shared.
Defining digital literacy
“Digital literacy could mean absolutely anything, to anyone, and the biggest thing is how we define it,” Shanker considered. “And then, even if we can define it, the chances are it is going to constantly change.” The key thing is speaking to staff and finding out what it means for them, he went on, which is likely to vary by role and the range of things they need to do with software or IT systems. “We also need to consider patients – if we’re thinking on one level and patients are thinking on another, we may not be able to communicate, in the same way as with language literacy. Also, we should reflect on the diversity of our staff population, what our starting point is, and how we can co-design what digital literacy looks like.”
Rebecca agreed that digital literacy is often very role-specific. “I like to think about it in four ways: devices, access, competence with software, and using apps relevant to the role,” she said. If you go to people and ask what they think of digital skills, it doesn’t mean very much. It’s not very tangible, especially to people who aren’t far along the digital journey.” This realisation led to the decision to break it down, and the trust carried out a digital skills confidence survey across the organisation covering those four elements. “That didn’t give us much detail, but gave us a feel for where we are with digital maturity,” she added.
“There’s definitely scope to look at which roles are using an EPR, or email, or collaboration tools, getting pretty specific on those,” Neill noted. “My former role was grounded in information and better use of data, so I think the importance of that for patient care, whether that be entering it into the system or understanding how that feeds into AI models, is key.” Dudley has worked a lot on cyber skills, and another key area is communication, he told us. “People are using digital all the time now to interact with patients, and it’s the ability to understand what those tools do, how they communicate, and what their impact is. Digital literacy needs to be part of that core professional standard when we bring new people into the NHS.”
What works for digital skills in practice?
“The precursor for this project for us was our EPR,” Rebecca reflected, “and during that, it came to light that there were a number of people in our organisation who were struggling, not just with that project, but with even accessing emails, or keeping up with communications.” In response, the trust launched a programme in collaboration with London South Bank Colleges, targeting to those people identified during the survey process as needing help with digital skills. “We had face-to-face meetings and digital champions going out to sites with paper forms or iPads, talking to people, and about 30 came out with scores revealing they needed support,” she said.
The Colleges and the team at Moorfields then worked together to co-create a 14-week programme, according to Rebecca, delivered in-house through the education hub three hours per week. “We provided people with laptops bought through our EPR programme, and the sessions focused on things like email, Microsoft products, typical software programmes, using our internal applications for imaging, and so on.” Confidence surveys helped measure impact, and the project’s success has meant it has now been rolled out to users beyond the trust, with two of those completing the programme now super users for Moorfields’ EPR.
Neill talked about something similar at The Dudley Group, where a skills framework developed using the Skills for the Information Age helped map out 100 digital roles to improve understanding of professional development and career pathways. “That’s given us the confidence to start with our AHPs, focusing on digital in their role and the future of the profession. At a workshop last week, it was great to see how engaged people were in the process, and I’m excited to be able to take that through to other roles as well.”
Neill has also been working with NHSE on taking this to a national level, he explained, creating a national blueprint which is currently in draft format, compiling work done at The Dudley Group over three or four years. “We’ve developed this approach where in 12 weeks we can take cohorts of staff through the skills framework, make sure they’re linking digital skills to clinical practice. We’re also working with NHSE’s cyber team to establish the cyber skills required for the future, taking ten standardised, banded roles from NHSE, and putting a Skills for the Information Age profile over the top. For each cyber role, that covers the five key important skills needed to be successful in that role.”
For Shanker, it’s also important to consider those who may not want to engage with digital or digital skills. “I have a patch of around 70 GP practices, and we always want them to increase NHS App uptake or usage, and Plan A is that I run around each of those doing the training, or Plan B, as thought up by one of the practice managers, was to work with Age UK to help us with that. It’s also a two-way learning curve, because you’re learning about the users, and you feel more empowered when you see the benefits from a patient perspective – maybe you’ll feel like you want to understand the app more.”
Overcoming barriers to digital skills
Rebecca shared some details of using the practice educators network and the EPR rollout team to make the best of existing resources. “The other thing I would encourage others to do is we had our own in-house IT trainer who works in our L&D team, that supported the London South Bank trainer, which meant that resource was available all the time,” she said.
“We’ve got a group chief AHP to provide that leadership, and she wanted to bring us in and have a multi-year commitment to digital skills, rather than just a moment in time,” Neill noted. “That’s music to the ears in terms of making change happen. And if you can embed it with AHPs, there’s nothing stopping you lifting and shifting it to engage others. Then, to Shanker’s point about the NHS App, that’s really going to have an impact on the community, helping those closest to patients to drive adoption.”
When looking at digital inclusion, there’s a need to leave preconceived notions of who might be at risk of digital exclusion at the door, Shanker highlighted. “I believe you can’t stereotype those who can be excluded, and also that you need to take into account things like the time required to complete training, or that most of the time the training for digital literacy is actually digital, which is never great!” One of the things introduced in his patch has been giving staff a training laptop they can take home.
“We managed things like time constraints by splitting up cohorts and running them mornings and afternoons, so more than one person from a department wouldn’t need to come at once,” Rebecca agreed. “It’s about having delicate conversations and figuring out what the barriers are, because what happens if a person doesn’t get the capabilities they need in time for EPR rollout? Not only that, but if they can’t access emails, join online huddles – those things will have an effect.” Often, people might be afraid or ashamed to come forward and ask for help, she shared, “and we took time to target them carefully”.
DDaT literacy and emerging technologies
Having a product owner in place for DDaT helps ensure there is someone taking responsibility for the delivery of a project, Neill discussed, setting out details around requirements and governance. “They need to go through all that information governance, design with users, communicate the benefits, and then talk about how to replicate and scale. That’s where a lot of digital literacy skills come in, making sure you’ve got a sustained approach to having the right skills and solutions.”
Looking at how training is being managed in primary care when it comes to rolling out technologies like Ambient Voice, Shanker offered his honest opinion. “It tends to be total chaos, because we’re smaller organisations, smaller teams. You can’t release frontline teams, you have contractual pressures, you have to be open for online consultations at all hours. When we deploy something, we might underestimate the resources for change management – it might just be talking one person through something for two minutes, because something is better than nothing when trying to put that change in.” The solution is to collaborate, work together, and help spot risks and issues by sharing, he added.
“We are lucky to have a very active research department, who have mainly been in charge of things like AI,” Rebecca said, “and we have tried to tap into what they’ve learned from their research in that space to apply in some of our clinical areas. We’ve also got an AI steering group with involvement from IG, our digital clinical safety teams, and education – the right stakeholders in the room to have the right conversations about the way forward.” The trust is working on a strategy based on what training and education is needed to support staff with AI, ranging from basic knowledge to the much more advanced. “Some NHSE guidelines in terms of this capability framework and the training that should be mapped to each level of practice on AI, would be gratefully received, because otherwise we’re reinventing the wheel.”
While national guidelines would be useful, ownership at a local level is key, Neill put forward, to be closer to the patients and the staff. “That ownership should be on a local level, so a bottom-up approach, not only because of that closeness, but also because there’s so much innovation happening, and things are changing so quickly, that national is sometimes too far removed from that.”
“I do differ on that opinion slightly, because from a primary care perspective we’re small organisations, and we tend to have more similarities than differences in how we use products and systems – the biggest blocker is training due to lack of resource,” Shanker highlighted. “I think if we could do it once nationally, I appreciate it wouldn’t meet all local needs, but it would mean not every local level person having to reproduce that whole process.” Doing it at national level could make it more sustainable and help with the resource and budget cuts looming, he noted.
Key takeaways
“We should treat digital capability as a core professional standard,” Neill reiterated, “which is key, in my view, to moving forward, and which is why I’m so passionate about the Skills for the Information Age. I’m doing a course next week for the Digital Skills Development Network on the use of that framework within the NHS.” One of the ways the team at Dudley measures success is using the data quality maturity index, which can be a great way to understand digital literacy as it looks for completeness of records, accuracy, timeliness, and so on. “You also want to be going to the frontline and looking at things like whether paper notes are still in circulation, how structured fields are being completed, and how people are using things like dashboards.”
Neill also talked about introducing Multiverse to help people with an interest in AI or data to gain a deeper level of understanding. “That’s either an apprenticeship for about 13 months, or through to a degree-level qualification,” he said. “We’ve got it rolled out across Sandwell and Dudley, and we’re encouraging people to do it, because I think if we can get a small subset of people from the frontline through, they can then talk to their peers about things like AI in the future. It’s important that we build that understanding that AI will be an advisor in the future, used as a support tool, rather than a replacement tool.”
“I think it’s understandable that staff might worry that their job as they know it may not exist any longer because of AI or other problems,” Shanker said. “And we have to show them what would be the other options if we didn’t do this – workload is our biggest issue, and our jobs will soon become unmanageable if we don’t do anything. It might be that we wish we could employ three of them, but we don’t have the budget, and if we can use AI or digital solutions, we can manage without employing more people.”
Looking ahead, there’s a need to address challenges relating to ring-fencing resources required for this type of work, Shanker noted, as well as to work out more efficient ways of doing things, having discussions at national and local level on how to instil digital skills in the right way across the NHS.
Rebecca offered some advice for anyone looking to progress with digital literacy, but worrying about not having the resource required to support it. “Use your existing departmental leads, and share resources with them – use your education teams, because they’re used going out and reaching all of your staff. Use existing networks, and make use of morning huddles to share things.”
In a years’ time, Rebecca highlighted that she would love to be able to have a clear capability framework in place for digital skills at all levels of practice. “That would help people understand what is expected and how they can gain those skills or access those education programmes, because at the moment there are so many different things available that they’re having to wade through lots of information. It’s our responsibility to make that more digestible for them.”
One key focus for digital literacy
Each panellist suggested one key focus that they thought was important for moving forward with digital literacy, with Rebecca pointing to the need to be clear about what we mean when talking about digital skills, and about what the expectations are for different staff groups.
Having the confidence or willingness to step in and stop using digital tools or solutions that are making things worse is a key focus for Neill. “There are lots of examples of where digital is implemented and doesn’t give us the outcome we were looking for; it takes a really confident and competent leader to identify and then take steps to prevent that.”
“I’m a great believer that if you’re a leader, no matter how high up you are, you’ve got to be connected to the actual product and to your users,” Shanker told us. “You’ve got to experience what they’re experiencing, rather than being in an ivory tower – you might have seen the demo, but try it, test it, don’t expect your staff to do anything you wouldn’t be prepared to do yourself. If we want to take our users on that journey, we’ve got to stand up to the challenge of fighting the system higher up, because often problems are attributed to users, and you’re going to have to fight to get those development requests and that improvement.”
We’d like to thank our panel for joining us, and for taking the time to share these insights.
