NHSX launches ‘what good looks like’ digital guidelines for NHS Trusts

The NHS's central digital unit - NHSX - has this week launched a new set of digital guidelines for NHS Trusts on ‘what good looks like', both for whole integrated care systems (ICS) and individual organizations. 

As has been noted previously on diginomica, central intervention in digital or technology upgrades across the NHS has historically been disastrous. Whilst people refer to the ‘NHS' as a single entity, it is far from it. The NHS provides a wide range of services from a myriad of organizations, all catering to a variety of local needs. 

You only have to look at the failed multi-billion pound National Programme for IT to see how badly things can go wrong when the ‘center' mandates a ubiquitous technology upgrade across the NHS. 

However, it appears that some lessons have been learned and the latest guidelines release from NHSX provides a ‘framework for success', whilst allowing for local organizations to cater to local needs. 

The guidelines are just part of how NHSX is attempting to drive change. In addition, NHSX has said that it will also do the following: 

• Provide tools to support Trusts' digital transformation journey

• Include an assessment framework to help measure Trusts' level of digital maturity - with the aim of identifying gaps and prioritising areas of local improvement 

• Frontline support will be made available in the form of funding, digital expertise and an online knowledge base 

• Provide blueprints, standards, templates and best-practice

NHSX says that the goal of the central organization is to ensure that Trusts have the "right information, tools and support to digitally transform services and provide better care". 

Commenting on the guidelines for ICSs and organizations, chief executive of NHSX, Matthew Gould, said: 

These two documents will give frontline leaders the essential guidance they need to plan their digital transformation. They set out what they should be driving towards, and how they will need to pay for it.

They have been produced following extensive consultations with the frontline, and will continue to change as we get more feedback. They are designed to be helpful, empowering and clear.

NHSX also said that it is bringing together multiple existing funding pots into one national application process, with the aim of making it easier for local organizations to bid and for central bodies to ensure funding is allocated fairly. 

But in future years, NHSX wants to see a move away from national funding programmes, with funding for local technology spend allocated to ICSs. 

What does good look like? 

The guidelines offer guidance for both ICSs - partnerships between the organizations that meet health and care needs across an area - and individual organizations within those ICSs. 

Both sets of guidelines follow a framework that has seven success measures. These include: 

• Well led

• Ensure smart foundations

• Safe practice

• Support people

• Empower citizens 

• Improve care

• Healthy populations

It's worth reading the guidelines in full, and many elements overlap, but some of the key points for ICSs include: 

• own an ICS-wide digital and data strategy that drives ‘levelling up' across the ICS and is underpinned by a sustainable financial plan

• identify ICS-wide digital and data solutions for improving health and care outcomes by regularly engaging with partners, citizen and front line groups

• have a system-wide strategy for building multidisciplinary teams with clinical, operational, informatics, design and technical expertise to deliver the ICS digital and data ambitions

• make sure that all projects, programmes and services meet the Technology Code of Practice and are cyber secure by design

• promote the use of systems and tools to enable frictionless movement of staff across the ICS - allowing staff from different organisations to work flexibly and remotely where appropriate

• develop a single, coherent ICS-wide strategy for citizen engagement and citizen-facing digital services that is led by and has been co-designed with citizens

• make consistent, ICS-wide use of national tools and services (NHS.uk, NHS login and the NHS App), supplemented by complementary local digital services that provide a consistent and coherent user experience

• make data available to support clinical trials, real-world evidencing and AI tool development

For individual organizations, some of the key guidelines include: 

• build digital and data leadership expertise and strong board-level accountability for digital transformation - this would include having a CIO or CCIO (or role within this function) as a member or attendee of the board

• ensure that your digital and data strategy has had wide input from clinical representatives from across the organisation

• have a plan and move to cloud data hosting and management

• maintain a central, organisation-wide, real-time electronic care record system

• develop a single, coherent strategy, in conjunction with your ICS, for citizen engagement and citizen-facing digital services that is led by and has been co-designed with citizens

• use data and digital solutions to redesign care pathways across organisational boundaries to give patients the right care in the most appropriate setting

• use data to inform care planning and decision making in your organisation

Commenting on the release of the new guidelines, Health and Social Care Secretary, Sajid Javid, said: 

Over the past 18 months we have all appreciated the immense value of technology.

This is particularly true for the NHS with digital technologies freeing up hospital beds and allowing clinicians to continue seeing patients remotely - and it will be invaluable in meeting other health challenges in the long-term.

This new guidance from NHSX provides a clear direction to all NHS trusts on how to drive digital transformation forward and transform organisations, which will improve patient care and save lives.

My take

This is a promising step in the right direction. Yes, it needs more meat on the bones, both in terms of funding mechanisms and broader support from the center, but these guidelines provide a strong framework to help organizations understand what they should be aiming for. The key is that the framework leaves room for manoeuvre for organizations to cater to local needs. As we have seen time and time again during the pandemic, local organizations understand their local users far better than the center does. Providing an outline of ‘what good looks like' and allowing local entities to get their on their own terms has a far better chance of success than the top-down approaches we've seen in the past.