The digitalisation of the NHS is a longstanding and well documented challenge facing healthcare organisations. Following the NHS Long term plan, which outlined the key role data and digital technology will play in delivering improvements across the NHS, NHSX (denoted NHSX) was born. Launched by Health Secretary, Matt Hancock, the joint organisation for data and digital technology has ambitious plans to transform the healthcare landscape.
But what is this new NHS function, what are its remits and objectives, and how will these be achieved?
In this article, we discuss what this newly formed department has been up to since its inception, and how its creation has been received within the health and social care sectors.
What is NHSX?
NHSX was set up in July 2019 to create a single decision-making entity for digital transformation, largely to resolve the ‘diffuse’ technology leadership which previously existed. Expanding on this, Matthew Gould, NHSX CEO during his keynote speech at the Digital Healthcare Show on 27th June 2019 stated , “the most important thing we will do is set the rules so our systems can talk to each other, so that our systems are secure and help keep patient data safe.”
Furthermore, during his presentation, he outlined the five real-world outcomes that NHSX is seeking to achieve:
1. To reduce the burden on clinicians and staff, enabling greater patient focus
2. To empower individuals with the tools to access health services and information directly
3. To provide clinicians access to information safely across the healthcare continuum system where
it is needed
4. To improve patient safety
5. To improve productivity using digital technology
Moreover, NHSX will continue to provide direction and oversight over NHS Digital – the national provider of information, data, and IT systems for the health and social care sector in England. This, therefore, means that the scope and functions of NHS Digital will be reshaped as NHSX take-up some of their existing leadership remit. In effect, it is believed that NHSX will be akin to a commissioner of digital technology projects, with project teams from NHS Digital and their technology partners undertaking the delivery and oversight of implementation projects.
The pillars for success
In order for NHSX to achieve its goals, it has set out plans which can be defined across three key pillars:
1. Interoperability – Connected healthcare systems need to be able to talk to one another, both technically, and semantically. This includes seven priority areas for interoperability, including NHS number, medications, staff ID, dates and scheduling, basic observations, basic pathology, diagnostic coding. To facilitate this, as well as to ensure patient data remains safe and secure, NHSX will be placing interoperability at the core of all frameworks and contracts going forward.
2. Decentralisation – NHSX aims to provide a platform that local NHS organisations can build on.
It will impose fewer blanket solutions and instead let organisational leaders make decisions locally, providing interoperability principles are met. To enable this approach, NHSX will focus on improving systems and upskilling workforces where required.
3. Platform for innovation – NHSX aims to provide more information for public use than ever before. For example, the NHS app will expose Application Programming Interfaces (APIs), enabling tech companies to innovate and add to the digital healthcare technology ecosystem. This approach has proven highly effective in many other sectors, including most recently in the financial sector which has seen the development and introduction of ‘open banking’; affording individuals greater and highly secure access to their financial data, in very much the same way as could be achieved with personal health and care information.
What are the potential challenges for the NHSX?
In his keynote speech at the Digital Healthcare conference in July, CEO Matthew Gould, stated, “We have a huge opportunity here, if we get it right I am sure we can make the lives of people better”, however, he acknowledged he was keen not to overpromise. Indeed, there are headwinds which will face NHSX as they proceed, not least:
• Interoperability is a slow burner – Typically, companies with systems in place currently do not have a desire to make their systems interoperable with others as this could lessen the value of their intellectual property (IP). This will take time to overcome.
• Contracts and frameworks – Reaping the true value of new contracts and frameworks to replace those currently in place will take time to come implement and for the benefits to be realised.
• Change Management – Digitalisation is one of the NHS’s greatest challenges. While there are clearly many benefits and efficiencies that can be realised through the use of cutting-edge technology and talent, it is important to align an organisation’s culture, structure and ways of working for successful adoption.
What has NHSX achieved so far?
Clearly, it is early days for NHSX having only been formed in mid-2019, but it appears that a great deal of work has been going on in terms of determining its structure, roles, and strategic focus areas. Some of the key updates so far include:
Renewed NHS Spend
In recent months, NHSX has reviewed the 30 or so existing digital transformation programmes and in an effort to remove duplication of effort, introduce new technology, or bring programme teams closer together, has rationalised the number of streams to 10, as follows:
• NHS app and citizen ID
• digital child health and maternity
• integrating community providers (including pharmacists, optometrists, dentists and ambulances)
• booking, referrals and appointments management
• standards (including medication standards)
• primary care
• urgent and emergency care
• social care
• local capability (including LHCR, HSLI, GDEs and Carter money)
Artificial intelligence is being taken very seriously by NHSX
Within NHSX, a brand-new AI laboratory is currently being set up in conjunction with the Accelerated Access Collaborative (part of the National Institute for Health and Care Excellence). Underpinning the seriousness of intent, this new team will receive £250m to develop new AI tools for the treatment of heart disease, dementia and cancer (among other serious health conditions).
The idea is to bring automation and AI-powered analytics to healthcare settings to increase clinical effectiveness and free-up clinical time to focus less on administration and more on face-to-face healthcare delivery.
NHSX have published a list of accredited suppliers for electronic patient record (EPR) solutions
Eight EPR solution providers have been added to a list of accredited suppliers under the Health System Support Framework (HSSF), by NHSX and NHS England. The apparent aim of doing so was to provide confidence to healthcare organisations that the chosen suppliers can provide ‘robust’ solutions and meet a wide range of core criteria, including that of systems integration.
There are concerns, however, that doing so may have the opposite effect, rather than open the market to innovative technology providers. Whether this approach continues with other digital healthcare technology types, and the impact this may have on enabling innovators to come into the market, remains to be seen.
There is no doubt that exciting but challenging times are ahead for NHS digital technology transformation. NHSX aims to be the entity which will bring much needed centralised planning and co-ordination to this transformation. As Matt Hancock himself has stated, there are too many bosses and decision-makers in the NHS technology area, and as such, NHSX must not just add another layer of complexity.
However, in order to reap the real value of such a transformation, healthcare organisations must invest time and money into the right systems, people and training.
It is our belief that given the clear strength of intent and the expertise available within NHSX, coupled with the success of the platform approach has had in other sectors, there is reason to be optimistic. Stakeholders, technology partners and industry players (including health tech SMEs and start-ups) should work together to make sure it happens, as the scale of the NHS presents a globally unique opportunity to not only pioneer but achieve broad adoption new avenues of digital healthcare.