NHSX exercises spend control powers and reduces NHS transformation programmes from 30 to 10

NHSX is wasting little time in exercising its new central powers and has completed a major review of NHS tech spending, where it has now reduced centrally funded tech programmes from 30 to 10.

In a blog post, recently appointed CEO Matthew Gould said that the spending review was carried out with three questions front of mind:

1. What are the priorities for technology in the NHS?

2. How can the NHS make sure that is aligned with the tech vision and the NHS Long Term Plan?

3. How does the NHS live within its means?

Of the 20 or so closed programmes, some have already gone live and are no longer part of the remit, others are just being shut down or absorbed by other areas.

NHSX was announced in February by Health Secretary Matt Hancock, who has made it his aim to overhaul technology use across the National Health Service. Gould, previously Director General for Digital and Media at the Department for Digital, Culture, Media and Sport, was announced as CEO in April.

Hancock has also released a technology strategy for the NHS, which focuses on open standards, interoperability, user-led design and a cloud-first approach.

The Health Secretary has said that vendors that don’t comply with the new playbook for NHS tech will be phased out in the coming years and has pitched a NHS-as-a-Platform model.

The Department for Health and Social Care this week reaffirmed that commitment and said that NHSX will be responsible for mandating the user of “international recognised technology and data standards across the NHS to ensure all systems can talk to each other”.

Unsurprisingly comparisons are being made between the Government Digital Service (GDS) and NHSX, given that GDS also began as a central function, with a mandate to set standards and improve the use of technology across Whitehall.

Delivery missions

Gould’s blog post runs through much of what has been discussed previously - interoperability requirements, clinicians suffering the use of clunky tech, and citizen demand for easier to use NHS apps. However, he also revealed the top delivery missions that have been agreed by NHSX. These include:

• reducing the burden on clinicians and staff, so they can focus on patients
• giving people the tools to access information and services directly
• ensuring clinical information can be safely accessed, wherever it is needed
• aiding the improvement of patient safety across the NHS
• improving NHS productivity with digital technology

Gould argues that NHSX needs to remain as ‘thin’ as possible - not building too much and allowing others to create on and use its platforms. He said:

First, we’re going to focus on standards and platforms, keeping the centre as ‘thin’ as possible. This is how the internet works and it’s the only way we will ever be able to be able to transform an organisation as large as the NHS.

Standards are the common technical and semantic rules that everyone agrees on in order to participate in a system. Plug sockets are a standard, URLs for web pages are a standard. In the NHS standards are essential for delivering interoperability, so essential diagnostic information gets to where it’s needed. Standards also mean we can more easily ‘plug in’ new digital services once they’ve been invented.

But we don’t want to build many digital services ourselves. There are plenty of clinicians, charities, start-ups and NHS trusts that can do a much better job of designing new services than we can at the centre. Instead, as I’ve previously blogged, we will focus on creating platforms that other innovators can build on.

However, he recognises that capability across the NHS will be key to this. As has been the case with central government, the NHS needs to train and hire talent that can enable this across what is a very fragmented system. Gould said:

To make it all happen, we need to help the whole NHS to become more digitally capable. It’s no good dreaming up grand digital projects from the centre if hospitals and GP surgeries don’t have the equipment, the skills or the capacity to see those plans through.

So we need to put a large part of our effort and resources to helping the system get the capability it needs. And not just on the medical side - our efforts in this space will focus as well on the social care system, where digital capability is mixed.

And that’s the hard part.

The programmes

So, as noted above, Gould and the NHSX team have undergone an extensive review and found that the NHS centrally ran about 30 different digital transformation programmes. Gould said that some of these began years ago and the review has allowed NHSX to “cut down on unnecessary duplication, incorporate new technology, move some programmes to live services and bring teams closer together”.

The remaining 10 major transformation pieces of work, are:

1. NHS app and citizen ID

2. digital child health and maternity

3. integrating community providers (including pharmacists, optometrists, dentists and ambulances)

4. screening

5. booking, referrals and appointments management

6. standards (including medication standards)

7. primary care

8. urgent and emergency care

9. social care

10. local capability (including LHCR, HSLI, GDEs and Carter money)

Programmes that will be closed include:

• NHS Wifi, which was delivered in March 2019

• Access to Service Information: which is moving to live on the basis that the team will deliver a Directory of Services that will function as a canonical data register, as well as a bookings and referrals management system

• Digitising Community Pharmacy: which is completing the Electronic Prescription Service and moving to live

• Medicines Data and Integrating Pharmacy Across Care Settings: these programmes are stopping. Their aims will be incorporated into NHSX’s work on interoperability, as well as a specific piece of work on linking pharmacists, optometrists and dentists into mainstream NHS processes  

Gould concluded by saying:

There is more spending to look at and we will never stop trying to find ways of smarter working. We’re not done yet. For now though this process has been a hugely valuable exercise, bringing together the entire tech leadership of the NHS to thrash out agreement in exactly the way that NHSX was designed to do.