Concerns raised as NHSX and NHS Digital folded into NHS England

Profile picture for user ddpreez By Derek du Preez November 24, 2021 Audio mode
There have been a number of digital wins - and controversies - for the National Health Service (NHS) during the COVID-19 pandemic. New plans to integrate digital into NHS England have raised some concerns.

Medic using healthcare technology on tablet © metamorworks - shutterstock
(© metamorworks - shutterstock)

Health Secretary Sajid Jarvis has this week announced a shake up with how digital functions are structured within the NHS in England. NHS England and Improvement (NHSE/I) will gain more powers at the center of the NHS, as both NHSX and NHS Digital will be folded into the organization. 

Concerns are already being raised over the timing of the move and what it will mean for digital capability and transparency going forward. 

NHS Digital was initially created to take charge of information, data and IT systems for commissioners and clinicians in health and social care across England. Later NHSX was established to support local NHS and care organizations to digitize their services, set standards, and connect health and social care systems across the country. 

Both NHS Digital and NHSX have played a crucial role during the COVID-19 pandemic, taking charge of developments such as the NHS app, supporting new technologies for NHS organizations and by using data to inform the government's response to COVID-19. 

As is often the case with COVID-19 there were both wins and losses in terms of the success of the organizations' pandemic response (the controversy over the GP data grab was a particularly low point), but it can't be denied that the usefulness of the digital functions really came to the fore during the health crisis. 

We've been particularly impressed with how NHSX has been thinking through setting standards and interoperability plans across the healthcare system. 

As such, a shake up at this moment in time  - when the pandemic isn't over and progress has been made - there will inevitably be worry from some about the motives of the government's reorganization. 

In terms of what has been outlined, the Department of Health and Social Care said that the move follows recommendations from Laura Wade-Gery, non-executive director at NHS England and chair of NHS Digital. The recommendations follow a commission by the Secretary of State in summer 2020 and intend to "improve cooperation between the key bodies of the NHS by bringing them under one roof for the first time". 

The Department added that the changes will better support the recovery of NHS services, address waiting list backlogs, and support staff, all the while "driving forwards and ambitious agenda on digital transformation and progress". 

The government is also folding education and training - currently managed by Health Education England (HEE) - into NSE/I. 

Secretary of State for Health and Social Care, Sajid Javid, said: 

To ensure our record NHS investment makes a lasting impact, I am bringing workforce planning and digital transformation into the heart of the NHS.

These reforms will support our recovery from COVID-19 and help us tackle waiting lists to give patients excellent care in years to come.

I would like to pay tribute to all our colleagues at HEE, NHS Digital and NHSX for the enormous progress they have made, which we will continue to drive forward with their help.

The response

As already noted, the response to the changes has been tepid, with concerns raised over the timing and the insight into how NHSE/I will manage digital going forward. However, NHSX chief executive, Matthew Gould, was upbeat in his comments, where he said: 

For the past 2 years, NHSX has been making the case for digital transformation in the NHS, and for digital to be integrated within the NHS rather than kept in its own silo. This reorganization is the culmination of that campaign. It is an excellent step - a more coherent structure that will allow us to accelerate digital transformation across health and care.

It comes after 2 years in which NHSX, NHS Digital and the NHS and social care frontline have together made extraordinary progress -  from allowing the NHS to move to remote working and consultations in the heat of the pandemic, to introducing virtual wards and remote monitoring of patients at home, to building the tech to underpin the vaccine rollout and the NHS COVID Pass. 

However, campaigners medConfidental, who played a key role in the government rolling back its plans during the GP ‘data grab' controversy, have suggested that the reorganization could lead to even further reduced insight into data privacy issues. The campaigners tweeted: 

A statement from the Academy of Medical Royal Colleges also called into question the timing of the move. It said: 

The announcement of the major reorganisation of Arm's Length Bodies (ALB) with the merger of HEE, NHSX and NHSD into NHS England/Improvement may not be a great surprise in terms of its content but it certainly is in terms of its timing and presentation.

The problem with all major restructurings is that, inevitably, they distract organisations from their core task, which for these ALBs is supporting the NHS. Staff will be anxious about their jobs, good people will leave and focus will be lost. While the rationale for these changes is understandable it has to be asked whether the extent of problems in coordination and collaboration across the national bodies currently actually warrants the level of overall disruption that will undoubtedly occur.

Chris Fleming, a director at Public Digital, an organization that was founded by the team that founded Whitehall's Government Digital Service (and as such, are all too aware of government restructures), took a more pragmatic approach and offered some advice to NHSE/I, now that it is responsible for the healthcare system's digital functions. He said: 

We have seen these kinds of reorganisations many times before, including in the NHS. All too often they are distracting, dispiriting and don't deliver the intended benefits.

But that doesn't have to be the case - providing you get off on the right foot. The reorganisation is not the story. What you do afterwards is.

It's worth reading Fleming's list of recommendations for building trust and continuing the momentum gained during the pandemic, but some of them include: 

  • Work in the open by default. Start by publishing the names of who's in charge and what they're responsible for.

  • Make an unambiguous, technically literate statement explaining what this means for patient data.

  • Explain which platforms are needed across the NHS, based on a thorough look at what exists now.

  • Show how this organisation change is meaningful by delivering something quick, visible and helpful to the system as a truly joint team.

My take

Fleming's advice is sound. People will now be looking to NHSE/I for clear and rapid examples of what digital outcomes are possible under the new set up. Peoples' backs are going to be raised and there will be increased scepticism about the motivation behind the changes (it wouldn't be the first time a restructure was carried out based on a power grab, rather than what's good for citizens/people). However, aligning all digital capability under one function, having everyone working together as one org, isn't fundamentally a bad thing (there's always been confusion about the different responsibilities between NHSX and NHSD). The concern will be whether NHSE/I is the right place to make that happen. Transparency, building a solid team, quick wins, communication - these are all key.