Eighth Report - Digital transformation in the NHS

Successive Governments have attempted digital transformation of the NHS. Progress has been slow and uneven, and there is now substantial variation between organisations. This attempt has the potential to be different, with clear intentions and funding to address factors that have frustrated progress in the past. These include the preponderance of “legacy” IT in the NHS, the skills of the workforce, and the challenges of building an inclusive digital health service. The Government will only succeed this time if it can respond robustly to all of these challenges. (Paragraph 12) Innovation in digital healthcare

The pandemic provided a unique incentive to download the NHS App, because it hosted the Covid-19 pass. The new version of the App should bring benefits in terms of functionality, integration and personalisation, but it will require people to download it anew. The Department and NHS England announced improvements to the range of services available via the App in May 2023, but they need to ensure that people use them. The Department and NHS England therefore need to demonstrate the continued value of the App, particularly to existing users, otherwise they may increase functionality while decreasing the number of sign-ups.

We recommend that the Department and NHS England set out in response to this report: (a) A timetable for introducing the new, “native” NHS App, and (b) Their plan for communicating the benefits and features offered by the new App to users of the current “portal” version. (c) Further detail of the proposed communications campaign on changes to the App announced in May 2023. (Paragraph 28) Systems and inoperability

We support the Hewitt review’s recommendation that the Department, NHS England and ICSs should work together to develop a standards framework to be adopted by all ICSs. This should improve interoperability and data sharing within and between systems. This should include working closely with sectors that could feed into shared records in the future, including pharmacy, mental health and community health, to ensure that what is put in place meets their needs. (Paragraph 37) 36 Digital transformation in the NHS Digital, Data and Technology (DDat) workforce

A shortage of skilled digital professionals working in the NHS has been a barrier to digital transformation to date. Digital specialists can often command higher wages or better conditions in the private sector. This makes recruitment and retention to the NHS challenging, and leaves the health service reliant on third-party suppliers.

To ensure that the NHS is able to recruit the best candidates and sustainably meet demand for DDaT specialists, now and in the future, we recommend that the Department apply to implement the DDaT Pay Framework for NHS England DDaT specialists, which would allow additional pay measures including bonuses/”capability based allowances” for staff.

Investment in the NHS’s specialist digital workforce needs to be matched by investment in the wider workforce’s forces digital skills. It is important that digital is understood as a thread that runs throughout healthcare, not as a specialist skill set that is only relevant to some staff and occupations. We recommend that when devising professional training, the Department work with NHS England to ensure that digital training is integrated throughout its wider learning programmes.

Without staff engagement in the entire process of introducing digital initiatives, digital transformation risks being perceived as an unwelcome, time-consuming imposition on an already over-stretched workforce. Co-designing digital initiatives with staff—including, but not limited to clinicians—is essential to ensure that these offer workable improvements to existing practices. The Department and NHS England must ensure that staff have the time and headspace to engage with this process.

There is a digital skills gap in social care that, if unaddressed, will hinder the digital transformation of the health and social care sectors. As with training for staff in the health service, it is vital that digital skills are integrated throughout learning and development for social care staff, rather than being presented as specialist skills sets. (Paragraph 58) Digital exclusion

Responsibility for promoting digital inclusion does not rest solely, or even primarily, with the health service, and we are encouraged that the Department recognises the importance of cross-departmental working to address digital exclusion from its services. We recommend that it sets out its approach to cross-departmental working in response to this report and in its action plan for addressing exclusion.

Many patients could benefit from encouragement and support to use digital services that might not initially be their first choice, but there will be some patients who continue to prefer physical channels. The Department and NHS England must ensure that non-digital channels remain available, especially as it develops and implements its digital offer. (Paragraph 67) Digital transformation in the NHS 37

The NHS is a universal service, and people should not be unable to access it because of wider challenges around access to technology, connectivity and digital skills. The Department should work with NHS England and other Departments to understand what models would work best for supporting patients to use and access technology in different settings both in and outside the health service (for example, in the community).

We are encouraged by the Department’s recognition that it needs to do better in both reassuring people about the security of data gathered by the health service, and communicating the benefits of digital healthcare. We need to see this matched with action that demonstrates progress. Specific communication over NHS data collection, and broader communications to encourage engagement amongst those less likely to use digital technology will require different approaches to target different audiences. Both should be underpinned by an understanding of who the people most likely to opt out are and why they do so.

Digital transformation can offer people more choice and control over their healthcare, and empower them to manage their health, and apps offer an accessible starting point for many. But whether peoples’ experiences with digital healthcare are positive depends in large part on whether they use an appropriate product. The Department and NHS England lack a systematic, consistent way of assessing and demonstrating whether a third-party health app reaches the necessary quality standards, and we heard that a majority of health apps currently available fail on aspects including clinical efficacy, security and cost. This is unacceptable: using an unsuitable health product can affect people’s health, and might make people less likely to opt for digital channels in future.

The Department and NHS England should work together to introduce a more comprehensive accreditation scheme for third-party healthcare apps, in addition to the current approach of recommending specific apps on some nhs.uk webpages. Within this scheme it should be easy for people to check whether a healthcare app that they are using or considering comes recommended by the NHS. This scheme should be supported by publicity and communications that both promote the benefits of digital healthcare and explain the risks of using unaccredited apps, providing a clear steer on why using an accredited product matters and where to find them. (Paragraph 84) 38 Digital transformation in the NHS