The must-read stories and debate in health policy and leadership.

Signs of a shake-up

The Nuffield Trust’s report into digitising NHS trusts in recent years, and what lessons should be drawn for the future, contains few surprises, but its timing is significant.

It lands as control of NHS IT strategy passes from NHS England to newly formed tech unit NHSX, which is already up and running and will take full control in July.

The transition effectively gives central policymakers a chance to change course on NHS IT and how it invests the remaining half a billion or so pounds (exact figures are elusive) left in the tech vault until the end of next year.

First, the report, based partly on interviews with 75 senior NHS IT folk, finds the strategy to digitise trusts – and, specifically, the global digital exemplars programme – has had some success.

The approach of giving some trusts money to become “digital exemplars” for the rest of the NHS to follow is far more popular than the National Programme for IT’s top-down approach (although that’s not a high bar to clear) and has led to some real gains for trusts involved.

But there have also been significant shortcomings.

A constant complaint across all areas is a lack of coordination from the centre, with some policies, such as Agenda for Change and the Model Hospital, unintentionally undermining efforts to digitise. Often this demonstrates a basic lack of understanding of what it’s like to develop and deploy digital technology in the real NHS world.

Unsurprisingly, there is also widespread concern that there is neither the money nor the digital workforce to digitise trusts at anywhere near the pace being demanded by the centre (now by 2024, previously by 2023, 2020, and 2018).

Significantly, the report says the “digital exemplar” trusts have had limited success in spreading their expertise to other providers and the centre should consider alternative mechanisms.

As HSJ reported in May, the GDE programme is already facing a shaky future under the new NHSX regime. This report may further hasten its end.

It is less clear whether it will help shake money free from the Treasury for NHS IT or plug the digital workforce shortage.

A hastier response

NHS England seems to have learned from the political backlash it faced over the presence of the private sector within the (now taboo) “accountable care organisations” era.

It took the national regulator a long time to respond to the strong opposition it faced over the “Americanised” ACO model, so long that it was forced to drop the acronym all together and make it clear they could not be run by a private provider.

NHS England has recently faced a similar backlash over the inclusion of private providers within its mental health new care models, to which it has responded with much more haste.

At the beginning of May, HSJ revealed the national regulator was planning a major expansion of its mental health new care model programme, which delegates specialised commissioning budgets to provider collaboratives.

These budgets primarily cover specialist inpatient services, a market in which private sector providers have a significant presence. With this in mind, it would be near impossible for the provider collaboratives to exclude the independent providers altogether.

An immediate backlash followed the news, with NHS campaign groups and MPs raising concerns over the apparent conflict of interest of having a private provider commission its own services. The presence of private providers within learning disability inpatient services has become particularly sensitive following the exposure of abuse at Whorlton Hall by Panorama last week.

Although there was never really a suggestion independent providers would be able to lead on commissioning decisions, the fact that the potential conflict of interest wasn’t immediately addressed by NHS England was enough to trigger concern.  

NHS England this week has answered those concerns by making clear private sector providers will not be the lead provider within the collaborative and will not hold the contract – this will have to be a nominated NHS organisation.