For a recent HTN Now webinar on the topic of building digital literacy, confidence, and skills, we were joined by Neill Crump, digital strategy director at The Dudley Group NHS Foundation Trust; Sue Ottley, digital capability transformation manager at Leeds Teaching Hospitals NHS Trust (LTHT); and Tony Green, lead UX designer at Aire Logic.
Our panellists considered what digital literacy looks like for the NHS workforce, outlining current gaps and debating what kinds of digital skills are likely to be required of the NHS workforce of the future. We also discussed different approaches to engaging staff with digital, building confidence around the use of digital tools, and encouraging the development of digital skills.
Firstly, we started out with some introductions to our panel, with Sue talking about her role as digital capability transformation manager at LTHT and her background. “I’ve worked in the healthcare sector for 30 years in a number of different roles within digital projects and training,” she said. “In my current role I’m responsible for identifying where we can make best use of our digital tools and systems, using different technologies and techniques.”
Neill spoke about his 25 years’ worth of experience in commercial, public, and third sectors. “I’ve been with the NHS for four years now, and every day is a learning day,” he considered. “My remit at Dudley includes the design of our digital plan, architecture, cyber governance, analytics, and cross-portfolio working – that very much covers skills and building digital literacy, which is why I was so keen to join today, to share where we are and also to learn from others on the panel.”
Tony also shared his background in fintech, healthcare, and e-learning, adding: “Now I’m UX lead for Aire Logic, a low-code solution consultancy in Leeds that mostly works with healthcare and government agencies. Mostly, my remit is to take complex ideas and make them simple, so people can understand them and make better decisions.”
Current digital projects
“In NHS organisations, from my experience, digital capability is just an afterthought,” Sue told us, “and we’re constantly in a bit of a reactive state.” This often means upskilling on the go, she continued, “and I find a lot of digital transformation projects don’t necessarily address the digital skills gap in the workforce. Instead, the main focus is on implementing new processes or new digital equipment.”
Whilst digital skills haven’t always been at the forefront, the NHS long-term workforce plan emphasises building digital literacy and digital leadership across the health and social care workforce, Sue explained. “I’m yet to see a blueprint for that, however. There are many toolkits out there and frameworks to assess digital capabilities and skills, but there’s no real plan as to how we address the outcome of those.”
LTHT is currently collaborating with Leeds City College, which offers an EDSQ course around digital skills, Sue shared. “That’s being piloted by our estates and facilities team, and we’re going to monitor progress and see if there’s the appetite there for more cohorts, with the possibility of making it a more regular intervention.” Whilst the course itself is free, the site and equipment to offer it to staff is still a challenge, she considered, “so that’s a bit of a downside”.
At Dudley, the Skills Framework for the Information Age (SFIA) has been introduced across the DDaT team as a whole, Neill said, with the aim of maturing how the team operates across the board. “From a clinical, operational, and corporate perspective, you’ve then got all of the different roles, which might have some commonalities but which also have key differences, and we’ve tended, as Sue said, to tackle that on-the-go on a project-by-project or three-year digital plan basis.”
SFIA has been a three-year journey, Neill elaborated, beginning in 2022 with a foundational learning stage to map the roles across the DDaT team to the framework. “What that does is allow us to develop tools so we can then map those roles to specific career pathways, and we can actually start then to look at job descriptions, to simplify and be very clear on what skills are required for each role.” That helps identify skills gaps, he said, “and people can then look at that to work out what gaps they need to work on and how to develop themselves to be highly effective in their role”.
Now, the direction of movement is toward using that framework more for some of the clinical and operational roles at the trust, Neill shared. “We still need to do a lot more testing, but over the last couple of months we’ve outlined what these skills are for key roles like nursing, consultants, AHPs, and so on. The next stage is bringing it together so we’ve got a joined-up approach across the whole organisation.” One of the things his team would like to do next is to establish a user group, he went on, “and I would ask people to join us on that SFIA journey. We’ve got someone who’s going to chair that user group, and we’ve done so much learning in this space over the last three years I think we can help accelerate that, and we’re looking to create a national blueprint for others to follow.”
“I agree that digital skills in the recruitment process are either non-existent or very outdated,” Sue said. “I think that digital skills need to be mapped out for new and existing staff, potentially with specific KPIs that can then be monitored during the appraisal process. That can be incorporated into PDPs and job plans because staff are already given time to do that and it seems like the ideal way to incorporate this kind of upskilling and training.”
COVID-19 forced many people to access a lot of new digital skills, Tony considered, “and I think what has happened is that we now have quite an uneven set of skills across the board”. Even those who wouldn’t consider themselves to be very digitally literate can book a flight, order on Amazon, or use WhatsApp, he continued, “but it’s leveraging those skills to build confidence to allow people to explore new ways of working, new solutions, or new processes”.
That is going to be an ongoing process within the NHS, Tony went on, unless it is dealt with in education prior to joining. “We need to ensure we have got that base level in place and have a baseline of skills, like digital problem solving – getting those skills will build confidence to explore tools and solutions without as much fear of breaking something or something going wrong.”
Identifying existing skills gaps
Tony noted skills gaps around cyber security, talking about how constant messaging to people about potential phishing scams and clicking on links has created “stress” around using new tools. “They need to have the ability to identify what is safe and what isn’t,” he said, “and also to know what to do when things go wrong, because that will happen, and it’s not something to worry about.”
An important way of tackling this is working with and engaging people in the design process, Tony told us. “It needs to work with their solutions, and if we don’t do it the right way, people will learn to bypass, which we’ve seen across the board, and that’s where we start hitting problems. So co-design, cybersecurity and what to do when things go wrong would be the key things to tackle first.”
Sue outlined three core elements of digital skills: basic digital literacy, clinical digital literacy, and data analysis literacy. “Those cover everything from basic use of core IT to data analysis with large datasets for health research,” she said. “I don’t think everyone possesses one or all of those; there’s a lot of disparity between the core elements, and I think there needs to be top-down focus on upskilling staff purely in digital literacy, giving them the time to harness those skills.”
With this in mind, LTHT has developed a digital confidence review, Sue explained, which has been piloted in a variety of different services. “That’s helping us identify digital confidence gaps, and using the results we’ve created a learning resource centre, which sits on our intranet to enable anyone to access it, and that’s a repository of learning resources and guided learning paths.” Whilst still in its early stages, that has had great reviews, she continued, especially relating to Microsoft training materials.
Neill told us how a trainer at Dudley is just starting to go through Digital Learning Solutions (DLS), an e-learning platform provided by NHSE. “As part of the Dudley Improvement Practice, we’ve been rolling that out, and it has different modules, learning pathways, a learning management system, and so on. That has a capability framework and is linked to digital staff passports and those kinds of things, so we see that as a way to use SFIA and map that onto this tool to train up our people.”
That will also enable staff to take responsibility for their learning and see progression across a learning pathway, Neill considered. “Since we work in a large organisation, I think it’s important for us to be able to set these frameworks up, so that each of the key roles within that organisation can take their own responsibility for making sure these sorts of skills are adopted.” Dudley also has a digital steering group made up of a mixture of clinical, operational, and DDaT roles, he said, “and we need to do more as part of that to talk about the skills and the different ways people can access learning resources”.
Designing digital literacy and skills training
When it comes to designing digital literacy and skills training to ensure relevance and engagement, it’s essential that it be grounded in real-world activities, Tony shared. “We can try and simulate a lot of different things, but spending 10,000 hours in a flight simulator doesn’t mean you can be trusted behind the controls of a real plane,” he explained. “Real-world application helps make those connections in the brain, and people learn by doing. If you learn it and teach it, you’re going to remember how to do it, so it’s about making that training meet people where they are, so they don’t have to go off somewhere, and it fits into their daily working life.”
“In my experience, especially at organisations with upwards of 20,000 staff, it can be difficult to develop bespoke training skills because it’s just not cost effective,” said Sue. LTHT is currently looking at YouTube as a platform, creating short videos to help staff learning, she shared, “and there are certain ways we use animations to cover different angles”. Whilst there is no one-size-fits-all approach when it comes to learning, that has been well received by teams, she explained, “and lots of other teams across the board are then joining with us and using the same learning style as well, so that’s great, because if we could standardise that across the trust that would be amazing”.
Partnering with others is key to having the capacity to deliver all of the different types of training required, Neill told us. “One way we’re doing that at Dudley is through the Digital Skills Development Network. It requires you to pay a fee each year but that’s relatively small for what you get out of it. It allows everyone in the organisation to access training on a large number of different topics around digital, in the form of e-learning or bringing in companies like Microsoft to deliver training on our behalf.”
The network also undertakes an annual census to find out from trusts what roles they have for digital and takes this forward to join them up into job families, allowing organisations to start to understand the capacity and capabilities required, Neill shared. “One of the journeys we’re on at Dudley is around converging – our CEO has taken over the CEO position at Sandwell as well, so that’s an example of where, in the future I think we can start scaling things and doing this better. Coming together and using the census to understand where our skills gaps are, like in enterprise architecture, and I think the network, along with SFIA, will help us do that.”
Neill also mentioned the Digital Maturity Assessment, noting how for the first time, this year it includes two aspects within the workforce domain: workforce capacity and capability, and workforce digital and data literacy. “These are on a scale of one to five, where one is low, and the average is something like 1.4,” he went on. “Whilst I think that shows where the NHS is as a whole, it’s at least being recognised so we can do something about it in a more coherent way.”
The role of emerging technologies
On one hand, there’s the potential for emerging technologies such as AI to introduce more complexity and the requirement for new skillsets, Neill considered, whereas on the other hand, AI tools can have the potential to simplify processes and tasks. “An example is our analytics informatics team,” he said, “where we have data relationship managers in place to work with the organisation on how to use data effectively to make clinical and operational decisions, and that is a very much needed role. Often clinical and operational staff require support in order to make the right decisions.”
Dudley is also currently looking at a new tool to see how natural language processing could be used to help people ask the questions they want to ask in their own natural language, Neill shared. “That then becomes a skillset that I need to build within the analytics informatics team, in how to prepare and organise data so that those clinical and operational teams can retrieve the information they need, and the tool can present the data in an easy-to-use format.”
Neill also shared details of an ambient AI rollout at his trust, which allows transcription to be done automatically and offers a series of tasks that need to be completed, tests that need to be ordered, and so on. “For clinicians, it’s doing all of that for them, but you’re still going to then need that upskilling to allow critical thinking, make actual critical decisions about whether to act, and whether the AI has made the right decision. That human-in-the-loop element is going to be absolutely vital, as is training to make sure people are ethically aware and know how to use AI safely.”
Tony agreed with Neill’s point about AI potentially being a double-edged sword, saying: “It can help us with managing processes, making suggestions as people go through, checking the data; but we also have to be aware of its limitations. It’s about how AI tools can streamline processes, making it easier for our staff members filling in forms, and maybe making a suggestion when data appears to be entered in the wrong field, for example.”
The opportunities are larger when we start to look at big data, Tony continued. “It can highlight areas where there are problems or inequalities. There are amazing uses for AI and other emerging technologies around e-learning and things like gamification.”
Tony also reflected on findings from one of Aire Logic’s research fields, where nurses were recording everything on paper and then the site manager was doing all of the digital processing alone at the end of each day, rather than simply giving nurses access to iPads to record for themselves. “It’s about making sure that leadership gets that understanding that something is OK to use, it’s fairly simple to use, and nurses should be able to do it in about ten minutes. If leaders can get that message to flow down, their teams and people are going to work around the technology. It’s leadership who we need to get on board as our advocates for pushing these kinds of digital changes across the board.”
Sue highlighted the skills gap that is often presented by emerging technologies. “It’s whether people can actually use those systems or tools to their full potential or whether they can use them safely,” she said. “It can also lead to decreased delivery of care and missed opportunities of revenue streams for healthcare providers if we’re not using systems correctly. An example from another organisation is where devices such as iPads associated with EPR systems are locked away in cupboards, and instead you’ve got ten nurses around a single workstation because they’ve just not been provided the effective training needed to understand it.” This skills gap could widen over time if not addressed, she concluded.
Measuring success and ensuring progress
“Progress is usually measured by other metrics of productivity, efficiency, or staff morale,” Tony said. “If you’re not feeling stressed about using digital solutions, everything else starts to flow much more easily. You can track when people have taken a course or do spot checks of how comfortable they are with a particular piece of technology; but we find that these tend to be the key KPIs. They’re using them faster, with fewer mistakes, and they’re making their lives easier.” When training, these benefits are important to highlight, he continued, “as we need to show our workforce that these tools are here to make their life easier to achieve buy-in, and allow them to feed back when something isn’t working as it should”.
Sue’s team tends to focus on initiatives or mini implementations, she explained, “so how we measure success depends largely on what that is – there’s no one-size-fits-all approach”. The trust does use tools like Microsoft forms to capture feedback and evaluation information, she elaborated, “but that can only gauge certain things”. For an ongoing piece of work around referral to treatment targets, her team are focusing on capturing before and after data validation figures, she said, “but it ultimately comes down to what matches the intervention”.
Focusing on moving forward and where next for building digital literacy and confidence, Tony said: “I think it’s a leadership question. We need people in positions of power to push technology as much as they can and also to create that environment of trust where it’s OK to learn. It’s not a race, it’s a lifelong learning, and everybody should feel comfortable in what they do, even if it takes a little extra time to learn a new system.”
Sue agreed with Tony’s point about needing a top-down approach. “I would like to see some kind of minimum digital skills requirements addressed at onboarding or appraisal level,” she said. “I think that would enable us to push that out on a wider scale, so we’re not just looking at digital literacy in pockets across projects or different areas or services; its organisation-wide.” Not only would that help improve digital literacy and confidence, but it would also help staff build their portfolio and progress with their development, she considered.
“I also agree on the leadership aspect of it,” Neill said, “and I would make a plea to everyone who wants to come and join the SFIA to get in touch, so that we can actually work together because I think a leadership approach is actually lots of different organisations coming together, sharing their resources and getting better outcomes.”
We’d like to thank our panellists for taking the time to join us and share their insights on this topic.
