News of plans for NHS Digital and NHSX to merge into NHS England and NHS Improvement, bringing all of the National Healthcare System’s tech, digital and data expertise together under ‘one roof’, has dominated the headlines this week.
As well as covering the latest developments, following the release of the Laura Wade-Gery review, which informed the proposals, and Twitter discussion on the topic, HTN decided to dig a little deeper and find out the views of our contributors and readers.
We sent out a call for comment and the merger plans proved to be a popular topic – with many of you sending in your views and perspectives. Below is a curated selection of just some of the replies we received from health tech experts and care professionals across industry, the NHS, and beyond…
“This move has been expected for some time”
For some, the news was not a surprise, with David Newey, Deputy Chief Information Officer at Royal Marsden NHS Foundation Trust, writing: “This move has been expected for some time, particularly with the ongoing development of the Integrated Care Systems. NHS Digital and NHSX have had distinct portfolios that were very easy to identify and have been vocal advocates for digital health. I think it’s important that we don’t lose that leadership and the distinct identity that digital has with all its challenges as part of the amalgamation.”
“There is nothing new in NHS re-organisations, ditto for the digital elements,” added Martin Bell, Director of the Martin Bell Partnership.
“NHSX’s demise could be predicted to coincide with Matt Hancock’s departure from office…in some respects, NHS Digital having its own name meant that there was a national agency that symbolically held the digital ring. Despite flaws, it has done some really great things over the years and has many great people. Those things and people need to not be lost.
“However, on paper – and if you didn’t know the back story, context, etc – having a single, central digital function, integrated with the overseer of actual care delivery makes sense. IT/Digital should be part of mainstream care delivery, not something ‘over there’.
“What matters most – only in fact – is what happens now. I’d like to see a new era of transparency and openness; a concerted effort to involve digital leaders from across the country in policy making; a simplification of funding, removing time consuming processes and “lotteries”; simplify/reduce frameworks and procurement; enforce standards; fix the basics – and ask the question: “Does this improve patient care?” every step of the way. If it doesn’t, stop doing it.”
Joana Franca, Clinical IT Facilitator for University Hospitals of Leicester, felt the merger was a natural extension of the progress made: “The NHSX and NHS Digital merge with NHS England and Improvement seems and feels only like a natural progression for the workforces to join efforts and work towards the shared goal of digital transformation of care, this being social care or health care. By working together under the same governance, digital transformation across the NHS will move more swiftly and allow for more rapid transformation, which can improve patients’ outcome and delivery of care – always aiming for excellence and harm free care. Digital transformation is the key enabler.”
In a similar vein, Richard Wyatt-Haines, Director of HCI Digital, also noted that the move makes sense, commenting: “I welcome it. We are beginning to move to the point where digital is integral to everything that’s delivered in the NHS and therefore it’s only right that digital decision-making and delivery is located right in the heart of the NHS. Individual units might have been appropriate at the beginning of this journey but if we are now going to accelerate the role of digital and make even greater impact then we can’t risk these two important units being on the sidelines.”
Lloyd Humphreys, Managing Director of ORCHA, the Organisation for the Review of Care and Health Apps, welcomed both the proposals and the Wade-Gery review, although he also felt the report could have “gone further”.
He said: “The language of this report is welcome, with its clarity and sense of purpose. The author, rightly, says that the time for action is ‘now’.
“The strategic re-think is welcome, too. Just as technology shouldn’t be bolted onto health and care services, nor should the relative departments. Integration of the technology teams across the NHS into NHSEI reflects this thinking. We are inspired by this move and many of the review’s recommendations. We very much hope this will help the NHS to move away from identifying point solutions, to a system wide approach to technology. This will enable technology to scale and achieve greater impact.
“The report gives particular reassurance on two key points: the recognition of digital exclusion as an issue and the need for formal training in digital. However, it should have gone further and paved the way for key infrastructure developments, such as the support for digital formularies and reimbursement models.”
Lord Victor Adebowale, CBE Chair and Co-Founder, Victor, also shared: “Digital transformation of the NHS is what is needed to ensure that care is accessible and equitable for everyone. I am pleased to see that a more united front is being encouraged, and I hope that this is the key to accelerating that transformation.”
“I really sympathise with the people involved”
Aside from the pros and cons at an organisational level, Rachel Murphy, CEO, Difrent (becoming TPXimpact) and a former Digital Delivery Director at NHS Digital, also focused on the human element of news, commenting: “Merging the three organisations makes so much sense, and is a positive step in the next phase of digital transformation in the NHS.
“While I really sympathise with the people involved going through the uncertainty of more organisational change following what’s been an unprecedented 18 months, there is an opportunity to redeploy much needed structured project management talent closer to the front line to help deliver and support the transformation that the health service needs. As the dust settles, I hope supporting diverse leadership with the conviction to drive digital projects that have users at their heart is given priority.”
Rachael Grimaldi, Co-Founder and CEO of CardMedic, wished to pay tribute to the support that both NHSX and NHSD had previously provided, stating: “As a start-up company launched during the pandemic, we have been very grateful of the support we’ve received from NHSX, NHSD and the AHSN network. However, as a practising clinician I see how much impact is making its way to the frontline, and on the whole, my clinical colleagues do not differentiate between the various organisations – they care more about having the right tools to do their jobs. I hope that through the merger, innovation at pace will continue to be given the priority it deserves.”
Darrell Bailey, Vice President Sales EMEA, BridgeHead Software, also struck a thankful note, explaining: “I believe the proposal to bring together the knowledge and experience of both NHSX and NHS Digital, under the wing of NHS England and NHS Improvement, should be viewed as a positive step forward regarding the future acceleration of digital transformation throughout the NHS. The current organisational structure is somewhat fragmented, with ‘grey areas’ pertaining to the specific roles and responsibilities of each body. It’s often unclear as to which NHS organisation is setting the strategy at local, regional, or even national level.
“Having said that, the current mix of NHSI, NHSX and NHSD has had a profound beneficial impact on driving the NHS digital transformation agenda, especially with regards to improved patient journeys and outcomes. However, I believe now is the right time to remove ‘digital’ as a siloed and disconnected entity, operating independently of NHS England; in favour of a single, joined-up organisation with a clear focus on digitally enabling our amazing healthcare system.”
However, the CEO felt that, “for innovation in general the multiple entity landscape was more of a hindrance than a help. My hope is that streamlining the bodies will help them to work out a more joined up approach to driving the adoption of digital innovation in the NHS.”
Providing an Academic Health Science Network (AHSN) perspective was Dr Rishi Das-Gupta, Chief Executive of the Health Innovation Network, South London.
“The merger of NHSD/X/E offers a great opportunity to accelerate the transformation of healthcare. Digital services in health and care today require a mixture of skills from running everyday technology operations and reimagining clinical services with clinicians and patients,” explained Dr Das-Gupta.
“Hence, lots of organisations have tried various combinations of Clinical, Operational, Digital and Transformation teams. Having these separate across NHS organisations created additional difficulties and so the merger is a great opportunity to bring these together. However, the challenges of integrating the different views of the work needed to improve services is huge and will set the tone for local digital transformation across the country. As an AHSN focused on digital innovations, we are hopeful that it will help accelerate the spread and adoption of solutions that work across health and care.”
“We support the change, not taking away anything from NHSX and D, technically the challenges in making digital transformations are not technical; they are clinical and cultural. Combining these entities providing a collaborative approach with a shared agenda could accelerate digital transformation, providing the transformation directorate empower and fund the local teams to do so,” shared Liam King, Managing Director, Healthcare Gateway.
“I think this merger is necessary to avoid the chaos of having so many organisations”
A number of the comments we received suggested that they felt the move was necessary, or even overdue.
Dr Marcus Baw, GP, Developer and Chair of the RCGP Health Informatics Group, told HTN: “In short, I think this merger is necessary to avoid the chaos of having so many organisations, each guarding its territory, and to reduce the waste of each org having its full stack of C-level executives, its own branding, and web presence. Perhaps now we get onto fixing some of the very real problems that frontline clinicians face using NHS tech, every day.”
“This is a good move. A radical simplification in chain of command is massively overdue. As we all know, transformation is all about people, process and technology – and changes need to take account of all three, or expect failure,” said Tony Bowden, CEO of Helicon Health.
Sheena Pirbhai, Stress Point Health CEO and Founder, commented: “The merger is a long overdue correction of the way these organisations are structured, coming at a time when healthcare services are under enormous stress to respond to exploding costs for healthcare and increasing staff shortages.
“The consolidation should allow further concentration of excellence and hopefully clearly laid out objectives. A single organisation has the potential to further accelerate much needed digital transformation of the NHS and focus on levelling health inequalities…hopefully we’ll see an acceleration and expansion of this transformation in the coming year – towards digital and virtual services.”
Lynette Ousby, the UK Managing Director of Alcidion, stated: “The news that NHS England and Improvement is going to incorporate NHSX and NHS Digital makes complete sense to me. I have never been sure why the NHS had overlapping bodies attempting to set digital policy while developing infrastructure, standards and products for the frontline.”
However, there was also a note of caution over the changes, with Lynette adding: “The new structure should streamline policy and delivery, and make sure that technical decisions are aligned to organisational and clinical priorities; to ensure that technology can deliver on its promise of transformational change. There are some really good initiatives out there at the moment, such as the Digital Aspirant Plus programme, which has just been launched to support NHS trusts that still need to implement core administrative and clinical functionality. We don’t want to see that stall.
“Nor do we want to lose momentum on interoperability, just as integrated care systems come on stream. NHSX had been leading on work to separate data from applications. Alcidion is a huge fan of that approach, and we want to see it continue.”
Mark England, CEO, HN also shared his thoughts on what he hoped would remain in-focus: “Digitally-enabled transformation needs to become even more embedded in both mainstream NHS thinking and delivery. This consolidation of NHSX/D and E has the potential to move that forward. However, I also hope it doesn’t dilute the NHS’ focus on more disruptive transformation such as machine-learning and AI where NHSX has been a strong advocate and stimulator of innovation.”
Sam Shah, Chief Medical Strategy Officer and Silver Buccaneer, also shared his hopes for what the change could mean. “There have been times when it has been difficult to understand what strategy NHSX was delivering against and where the delineation of responsibility was between the various organisations. During the pandemic NHS Digital demonstrated their capability and ability to respond sensitively. I hope this change means a new approach to addressing a wide range of digital needs across the health system and a more inclusive approach to digital health leadership. It may also help offer clarity on responsibility for areas such as innovation, which can sometimes be confused between the other AHSNs and NHSX,” he said.
Focusing on the potential benefits, Alistair King, Partner at The Clarity Practice, highlighted: “It seems the concerns are less about the ‘rationale’ but more centred around the timing and the operational impact it could cause.
“Both NHSX and NHSD have played key roles throughout this pandemic, from enabling the government to make data-led decisions through to building patient-centred applications to help navigate services and manage vaccination certifications.
“Combining these authorities should help streamline processes for critical programmes and provide clear lines of governance enabling service providers to deliver their strategies. I also expect these changes will aide the vendor and supplier community, bringing clarity to the blurred lines of who best to consult and engage with.”
“Does anyone believe that standalone or merged, NHS Digital and NHSX would achieve anything?,” questioned Brendan Dunphy, CEO at C-BIA Consulting Ltd. “Right or wrong, the NHS is a very decentralised organisation and though there is a role for central bodies they should be clearly focused on helping to solve the very real digital challenges faced by trusts, especially those too small to manage on their own.
“This means ditching the policy…and building teams of seasoned practitioners willing to get their hands dirty, work directly with trust management and local IT and their vendors to accelerate projects, capture and re-use what works across the NHS to accelerate take-up. By all means keep a slimmed-down centralised policy unit but use the savings to start a shared digital resource focused on action and working with a handful of needy trusts to build re-usable assets and credibility. Fewer words and papers, more action and digital results.”
Dr Owain Rhys Hughes, founder and CEO of Cinapsis, also added: “As someone who spends a lot of time working closely with all three NHS bodies on digital transformation projects, news of their unification is very welcome. Currently, the lines of responsibility and chains of command within these organisations are blurred. This can lead to inefficiencies, breakdowns in communication and project delays. It can be frustrating for external tech partners to launch their solutions where they’re needed owing to a triple-layered barrier with no defined means for navigation.
“Therefore, bringing NHSX, NHS England and NHS Digital together under one umbrella and one leadership structure is a timely and savvy decision. When the merger is complete, I anticipate that it will become easier for NHS organisations to access support, bid for funding, and launch innovative projects and partnerships.”
“The way forward is embracing the merger”
Offering a crucial patient-centred perspective, Dr Ruby Bhat OBE – Public Contributor, explained to HTN that, “Change is always difficult for the workforce and organisations and I feel we should not take this as a negative move. Having all the important organisations under one umbrella will avoid duplication, [provide] better communication, better decision making, [be] cost efficient and avoid organisations working in silo, which is such a problem for patient and carers at the moment.
“The merger will allow patients and carers to benefit from better decision making which will empower us to take better control of our healthcare. It will allow more improvement at a faster rate, which will ultimately have a greater impact on patients, carers and the NHS for the future.
“The way forward is embracing the merger and I feel that this is a great opportunity for all those involved, especially in light of the recent pandemic. Having digital, operational and improvement skills working together will definitely make our NHS more efficient. All that expertise under one roof – wow!”
Jenny Camaradou, Knowledge Exchange and Patient Expert, also focused on what these mooted changes may mean for patients: “For any true transformational change in innovative digital healthcare services, patients need to be listened to as equal stakeholders, in a way that has meaningful results for them. The merger of NHSE, NHSX, NHSD, coupled with technology can enable this to occur quicker through usage of data driven analytics, incorporating patient preferences and fostering shared decision making, but there also needs to be a better way of measuring the effectiveness of patient engagement in a way that can both support diversity, reduce health inequity but also provide adequate return of investment for both pharmaceutical companies, funders, healthcare professionals and government.”
Chris Barker, CEO, Spirit Health Group, added: “The merger of NHSX, NHSD and potentially HEE into NHS E/I has to be seen as a positive move in sustaining the changes that have been made during the pandemic through digital innovation. Appropriately utilising technology to deliver proactive health and social care needs to be an integral part of ‘normal’ NHS care and not seen as something additional or separate.
“Alignment of organisations should help with this – especially HEE as a key component of this work is ensuring that all NHS staff are equipped with the digital skills to ensure all patients can benefit from this opportunity. The challenge as always is timing and ensuring that the transition is as smooth as it can be for all the people involved and retaining talented people and minimising disruption to ongoing work streams.”
“We hope that the talent is not lost”
Among industry suppliers, many of the comments we received, indicated that the plans for NHSX and NHSD were warmly welcomed. While others raised issues and questions that they felt also needed to be taken into account. Another common theme that cropped up was a hope that tech talent would not be lost during the merger…
“We welcome the review of NHS IT organisations by Laura Wade-Gery and its key recommendation that NHS England and Improvement take over responsibility for digital and data within the wider transformation agenda for the national health system,” said Ian Carr, Head of Health Systems at Silvercloud Health.
“We believe it is important to recognise the positive contribution of the NHS Digital and more recently the NHSX teams in driving the digital transformation agenda of the NHS and we hope that the progress achieved thus far and the focus does not lose momentum with the transition to a single and much larger NHSE&I organisation as recently announced by Amanda Prichard, NHSE&I CEO. We hope that by implementing the core recommendations of the Wade-Grey review that we are now a step closer to realising the key goal of for all stakeholders of a digitally enabled national health system that makes use of modern technology and data sharing to create joined up services to support all citizens and improve outcomes.”
David Hancock, Healthcare Executive Advisor, InterSystems, shared: “The merger could deliver positive outcomes but there are issues that need to be addressed to set the new entity up for success. First, we need to ensure the skills, experience and expertise built up by these organisations are preserved. An important, short-term priority needs to be clearly defining roles and responsibilities and communicating those broadly. This will avoid uncertainty over missions, a challenge for NHSD and NHSX, and help establish patient trust.
“The merged entity needs to urgently prepare for the creation of Integrated Care Systems and determine what support is needed from an IT operational perspective and encourage collaboration. Additionally, there’s a need for clarity on intentions concerning building new digital capabilities in-house versus buying solutions. Is the NHS also going to consider buying and not just building central systems? Buying can have many advantages and there are examples where building has perhaps not delivered the best results.”
Meanwhile, at DrDoctor, CEO Tom Whicher’s thoughts on the merger were: “What an extremely positive step in truly integrating digital care rather than having a fundamental function operating solo. As some of the top talent that created NHS Digital and NHS X was sought from within NHS trusts, we hope that the talent is not lost during the merger.
“We also hope that the great work NHSX has done to create a more open platform for suppliers to deliver innovation at pace is not impacted at a time when the NHS needs it most to tackle the growing backlog at scale. We must remember that patients and healthcare staff are often not aware of the difference or even existence of NHSD and X. They just want to have the right digital tools to improve care. We cannot let this merger reverse or slow the high levels of digital adoption we have seen in the past 18 months but instead use it as a catalyst for more change.”
From Novartis UK, we heard from Rob Hastings, Medical Director, Research and Life Sciences, who mentioned, “We welcome the rationale for the integration of NHS Digital and NHSX within NHSE to provide a unified approach to ensure digital and data become a core part of healthcare and population health. This has the potential to deliver improved outcomes, more efficient use of resources including workforce, reduce inequalities, and facilitate more patient centred care.”
Melissa Morris, Founder of Lantum, added: “The announcement of the incorporation of NHS Digital and NHSX into NHS England is important, and has the potential to drive significant digital transformation across the NHS in a more joined up and cost effective way. By unifying their digital teams, the NHS will be able to move forward with one approach to digital transformation, with less fragmentation and duplication.”
While, according to Dr Dan Bunstone, NHS GP and Chief Medical Officer at Push Doctor, “This integration will allow for greater alignment across the healthcare system, enabling these once siloed teams to come together in pursuit of a common vision.
“To create a sustainable future for primary care specifically, NHSE/I must ensure that digital strategy is kept at the forefront. If executed successfully, these reforms will not only accelerate progression, building on the transformation seen in primary care over the last 18 months in the form of remote work and digital consultation, but will also support the recovery of GP services, as well as improvements in patient access and the working conditions of NHS practice staff who worked so tirelessly during the COVID-19 pandemic.”
Over at Civica, Executive Director for Health & Care, Steve Brain, said: “From reliable, real-time patient data at the click of a button, to paperless meal ordering in hospitals, we’re already seeing the positive impact of digital technologies right across our health and care services. But digital transformation of healthcare is not about solving individual challenges; it’s a wider journey towards a future where our health & care services are better, smarter, safer and more responsive to the changing needs of patients and the wider community. The Health Secretary’s commitment to put ‘digital transformation at the heart of the NHS’ signals a strong commitment to that journey of transformation.”
Juliet Bauer, Managing Director, Livi, said: “The pandemic has proven that digital healthcare is central to the future of the NHS and will play a crucial role in how we scale services efficiently and improve access for patients. This coming together is an opportunity to build on the successes of NHSD and X by reuniting digital with core commissioning functions, putting the patient at the centre of how healthcare services are designed”.
“Placing the Digital directorate under the NHSE umbrella is a signal of firm commitment to digital first. By bringing NHSX/D into the fold, the NHS has recognised that to build back better, it must place Digital, Data and Technology at the heart of its transformation strategy,” said Brian Painting, UKCloud Client Director.
“We are cautiously optimistic about the suggested merger”, shared Michelle Lea, CEO of Deontics, while Erkan Akyuz, CEO of Lyniate, noted that, “Now more than ever is the time to tightly align and focus to realise the improved outcomes that come from digitizing healthcare delivery.”
While, Vijay Magon, Managing Director at CCube Solutions, concluded: “The recently announced merger between NHSX and NHS Digital is great news for the NHS. This will go a long way to improve care, centralise and coordinate NHS objectives, and accelerate service digitisation which is seen as key to transforming the NHS to tackle, not just the short term issues like the backlog, but also deliver the Long Term Plan announced a while back. A centralised and co-ordinated NHS will be a lot more cost effective and be able to deliver its goals.”
Thank you for your comments!
We received so many insightful comments that it was a (grateful) struggle to fit them all on the page. The HTN team says a big ‘thank you’ to everyone who shared their thoughts with us, even if we ran out of space!
