- Nuffield Trust report finds multiple concerns about current NHS IT strategy
- Agenda for Change pay rates exacerbating tech skill shortages
- Model Hospital metrics blocking trusts’ investment in digital technology
- Significant policy changes are needed to digitise trusts
The national strategy for improving trusts’ IT systems has been plagued by unrealistic targets, conflicting policy priorities and funding given to the wrong places, the Nuffield Trust has said.
A report, published by the health policy think tank on Friday, recommended widespread policy changes. It said the current NHS IT strategy lacked central coordination and had made patchy progress on digitising trusts.
It said: “We consistently heard examples of central bodies setting unrealistic timeframes for solutions to be implemented – which often reflected a poor understanding of the supplier market or NHS organisations themselves; reporting requirements which did not clearly articulate anticipated benefits; lack of communication about national work and how it may impact on local plans.”
Hundreds of millions of pounds have been spent over the past three years on improving IT systems in NHS trusts, most of it through NHS England’s flagship global digital exemplar programme.
However, the report specifically raised concerns with that programme and recommended policymakers consider alternative ways of improving IT systems at digitally immature trusts.
The think tank’s findings were based on conversations with 72 digital leaders at NHS trusts and central bodies. It also drew on trusts’ 2017 digital maturity self-assessment, which NHS England has repeatedly refused to make public.
Summary of the report’s main findings
Poor standards: The report said there was “widespread frustration” among trusts about the centre mandating poorly thought-out IT standards and pressuring trusts to adopt them within unrealistic timeframes. Researchers cited the example of one standard that all hospital trusts were required to use by December 2018. The standard was still being developed and using it would make the information unreadable for GPs. Not a single trust met the deadline.
Lack of central coordination: Researchers said a consistent message from people interviewed in all areas was poor central coordination, including unrealistic deadlines, conflicting messages from different agencies, and demands that showed a poor understanding of how local NHS organisation work with the health IT supplier market.
Workforce: Researchers were told efforts to retain and recruit staff with digital skills have been severely hampered by Agenda for Change pay rates, which do not recognise IT skills not linked to formal qualifications. This had exacerbated already severe tech staff shortages. Some trusts said they had resorted to hiring IT staff as contractors to circumnavigate these rules while others are sharing roles across multiple organisations.
Carter confusion: Several trust digital leads told researchers that the Model Hospital tool, with its focus on efficiency, had made it harder to convince boards to invest in IT, as it often requires a big upfront investment and usually takes years to create efficiencies. The researchers noted: “Reports of the Model Hospital initiative undermining board-level buy-in to digital investment serve as a good reminder as to why a cohesive policy approach is needed”.
Money: Researchers were told the lack of central investment is the biggest impediment, equalled only by workforce, to improving NHS trust IT. In addition, most of the central money was still handed out as one-off capital grants, which was “short-sighted” when IT increasingly requires ongoing revenue funding. The report noted “large amounts of money have been invested in digital transformation, both locally and nationally” but there had been little evaluation of whether it had been well spent.
Most people who spoke to researchers said the policy approach of the past few years had been useful in spreading trust digitisation, and a vast improvement on the disastrous National Programme for IT, but central coordination was lacking.
The report recommended a central focus on setting IT standards, but in closer consultation with the service and with more realistic expectations. It also advised changes to Agenda for Change pay rules that would make it easier to put IT staff into higher bands.
On funding, it said: “The need for ongoing national and local investment to achieve digital maturity cannot be underestimated” and the centre needed to be “realistic” about the funding required.
It said, while people were overall positive about the GDE programme, many felt it hadn’t spread its knowledge beyond the original groups of trusts involved, contrary to the original intent. While the programme would likely spread some digitisation, the report recommended policymakers “look beyond” the programme to other models.
The report comes as control of the NHS IT strategy passes from NHS England to NHSX, a new central tech unit set-up by health and social care secretary Matt Hancock.
Senior sources have told HSJ that NHSX is already planning significant changes to how the centre runs the IT strategy and some existing programmes will likely be dropped to fund new ones. HSJ reported earlier this month that the GDE programme is among the likely casualties.
The NHS long-term plan stated secondary care must “fully digitise” by 2024.
Nuffield Trust digital programme lead and report co-author Sophie Castle-Clarke said, while Mr Hancock had given digital technology more attention in the NHS, progress will “grind to a halt without people who can actually design and use it on the ground”.
She added: “While the digital leaders we spoke to were often happy with the general direction of national policy, the new NHSX needs to be better at communicating what it is doing and setting realistic timescales.
“Making an NHS that really uses technology to its full potential isn’t an overnight job, and we need to get the basics right before we worry about becoming world leaders.”
NHS England referred HSJ to NHS chief information officer Will Smart’s foreword to the report when approached for comment.
He said the report recognised the good progress that has been made but also that “digitising healthcare in practice is difficult”.
He said: ”I’m pleased to see this report recognises the positive impact the programme is having and highlights the need for more investment to achieve the same outcomes across the rest of the country.”
This story was updated on 31 May to reflect comment by NHS CIO Will Smart
Interview with HSJ, Nuffield Trust report