Paperless 2024 target a 'stretch' – NHSX CEO

In his first series of interviews in the job, NHSX chief executive Matthew Gould told HSJ he believed the commitment was “doable” but would require a shift in investment from the most advanced digital trusts to those that remain heavily reliant on paper and ageing IT.

“It’s a stretch target, it’s not going to be straightforward. It will require some quite sharp progress with bits of the system on the far left of the bell curve.”

Mr Gould said hitting the 2024 target would require moving beyond NHS England’s global digital exemplar programme of the past three years, which has focused investment on trusts with the best IT already.

He said: “The GDE programme was well conceived. If we didn’t have it, we’d need to do it.” 

“But there are bits of the system of that are at a level of digitisation, a level of capability, that they are not being helped by this programme. We need to work out what the programme is that brings them along.” 

The government has previously set a target for NHS providers to be “fully digital” or “paperless” by 2018, 2020, and 2023. 

The health secretary Matt Hancock announced the formation of NHSX in February, to bring together the powers over NHS IT strategy previously held by different central agencies, into a single tech unit. Mr Gould, who worked with Mr Hancock at the department of digital, culture, media and sport, officially starts in the role today.

In a speech at a health tech conference in London on Thursday, Mr Gould said he was nervous about “over-promising” on tech, especially as progress partly relied on convincing a “sceptical” treasury to part with more money.

Speaking to HSJ afterwards, he said the improvements in staff and trust board training and universal enforcement of new IT standards would help but digital transformation could not be achieved with “air and fumes”.

“I’ve been to trusts where they are using kit that is ten years old, where no amount of me talking about interoperability on the stage is going to change the fact that ten-year-old kit is going to be slow and clunky and crash. There is going to an irreducible cost of getting the technology to the level we want it to be across the system.” 

Mr Gould said he believed centralising powers over NHS IT would help NHSX make the case for investment to the Treasury more effectively than in the past.

“It will allow us to marshal the evidence and be part of the bid process and talk to the Treasury which might not have been possible when it was disaggregated into several organisations.”

NHSX’s takeover of powers included the central approval of trust spending on IT projects, previously held by NHS Improvement. Mr Gould said this power to approve or block projects would key to lifting the standards of IT across the service.

“We need to find a way to exercise the control but in the lightest way possible.

“I’ve had complaints from numerous people around the country about stuff that has been stuff in byzantine processes in a number of places, the centre being one of them. I want a simpler, but more effective set of controls.”