The Download: What happened to digital maturity?

In the NHS, a metric attached to a carrot and/or stick is a go-to for incentivising behaviour at scale.

Hence control totals, four hour accident and emergency targets, colour coded Care Quality Commission reports, etc.

The creation of sustainability and transformation partnerships also meant rating STPs against one another, likewise the single oversight framework.

However, halfway through the NHS’s billion pound digitisation push, there remains a paucity of data on how NHS providers use digital technology and how they compare to their peers.

The centre is pushing hard for better technology to collect richer patient data to improve care and planning. But we know comparatively little about how that technology is used now in the NHS.

This makes the case for publishing the second digital maturity assessments pressing and ongoing delays difficult to fathom.

The first round of these self assessments of NHS trusts had plenty of critics when they were published in April 2016.

It was claimed (fairly) that trusts were being asked to mark their own homework and were incentivised to either downplay or overplay their digital maturity to secure central funding.

However, the assessments still provided the clearest picture yet of the NHS’s digital maturity and revealed significant variation across the system.

At the time, NHS England said the assessments would be “refreshed, audited and published annually”.

As a metric, it would help decide which trusts would receive central technology funding, we were told, and measure progress towards a more digital NHS.

But more than two years later we are still waiting for the second round of digital maturity assessment.

The Download has been told questionnaires were finally sent out to secondary care providers in late 2017.

They included a more detailed set of questions than the first, covering specific functions such as electronic prescribing, and with more external input.

Late last year, NHS England said publication was expected in January 2018. Last week, a spokeswoman told The Download publication was now expected in November.

The assessments were completed and shared individually with trusts more than six months ago and there is evidence that national analysis has already been done.

Furthermore, NHS sources have told The Download they can only access data about their trust and sometimes their neighbours. They are not able to compare themselves nationally (in marked contrast to almost every other NHS performance measure).

The longer this information is withheld, the less relevant it becomes. Plans for an annual audit and refresh seem distant.

NHS England has offered no explanation for the delay in publication or why the full data set is being withheld (the 2016 assessments in full are available here).

However, a recent document, sent out to the system last month, may offer a clue.

The document outlines how STPs can access a new £412m digital fund but also makes passing reference to the assessments.

The comments make for mixed reading.

It noted that latest round of digital assessments show “that the last two years have delivered some increase to overall levels of digitisation, but that there are still significant gaps which this funding can help address”.

There are, of course, some narrow measures of the use of digital technology in the NHS.

NHS Digital publishes figures on e-referral use (76 per cent in June this year).

There are also some figures about GPs providing patient online services and how patients are using (or not) these services.

For the more digitally mature trusts, the US-based HIMSS measurement has long been used as a yardstick in lieu of a robust local option.

But compared to the level of detail reported regularly on finance, performance, care quality, and workforce in the NHS these are not nearly enough.

With £412m to allocate for digital projects through to 2020-21, and possibly more in the 10 year plan, a clearer national picture of digital maturity in the NHS is urgently needed.

Even if parts of it don’t make for pretty viewing.