nhs digital transformation case study

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• Department of Health & Social Care

Putting data, digital and tech at the heart of transforming the NHS

Published 23 November 2021

Applies to England

© Crown copyright 2021

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

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This publication is available at https://www.gov.uk/government/publications/putting-data-digital-and-tech-at-the-heart-of-transforming-the-nhs/putting-data-digital-and-tech-at-the-heart-of-transforming-the-nhs

Purpose and scope of the review

Digital technology is transforming every industry including healthcare. Digital and data have been used to redesign services, raising citizen expectations about self-service, personalisation, and convenience, and increasing workforce productivity. The pandemic has accelerated the shift to online and changed patient expectations and clinical willingness to adopt new ways of working. In addition, it facilitated new collaborations both in the centre of the NHS and wider local health and care systems. Together, these changes have enabled previously unimaginable progress in digitally enabled care pathways.

The goal of this review is to build on this progress and ensure the national NHS (defined as NHS England and NHS Improvement ( NHSEI ), NHSX ( X ) and NHS Digital ( D )) can lead the transformation of the wider healthcare system, supporting integrated care systems ( ICSs ) to deliver better citizen health. This is not about centralisation – it’s about empowering the centre to have the mindset, operating model, skills, capabilities and processes to provide the right leadership and support to ICSs , so that together the NHS delivers improved citizen and patient outcomes. 

The scope is deliberately focused, based on the hypothesis that having the right capabilities and set up at NHSEI , X and D is a necessary, albeit not sufficient condition, for the task of transforming the NHS. Both a highly functioning national and local leadership of ICSs are required – in essence 2 sides of the same coin. 

The need is compelling. The NHS faces unprecedented demand and severe operational pressure as we emerge from the coronavirus pandemic, and we need new ways of working to address this. Now is the moment to put data, digital and technology at the heart of how we transform health services. The challenge is to both get the basics right while capitalising on the momentum created by today’s circumstances to rethink radically how health is maintained and care is delivered. This is the case that NHSX has been making since it was established, and the momentum behind the report owes much to their work.

Progress has been made, with some outstanding delivery from national teams as well as the frontline – the vaccine programme, supported by so many brilliant volunteers and staff, was only possible through the use of advanced data analytics to drive the risk stratification, population segmentation and operational rollout. We reached 96,000 people with remote monitoring at home or within a care home, sustaining their quality of life whilst not taking up unnecessary hospital beds. The join up of 111 and accident and emergency (A&E) departments through digital information has helped keep A&E departments safe by enabling 111 to directly book GP, pharmacy, and outpatient appointments. There are many other individual examples of success.

The current position

The review conducted extensive interviews during its data gathering phase and identified 6 areas where the current situation could be improved.

Transformation model: the NHS is organised to focus on disease areas or settings of care, rather than the health and care journeys of citizens. Greater focus at the centre on the needs and experience of diverse users, including addressing inequalities, would facilitate transformation. Transformation is split across multiple different teams and is often overshadowed by requirements of the day-to-day. Many senior leaders see digital as a separate not embedded enabler and there needs to be greater clarity on the roles of national, regional and local in driving transformation.

Funding and benefits: transformation funding is currently split between revenue and capital and dispersed across the organisations. Tech funding is variable, often diverted and not necessarily linked to strategy and outcomes, incentivising either monolithic programmes or small-scale initiatives.

Leadership: variable commitment, experience and interest amongst senior leaders in digitally enabled system transformation, with too few integrative leaders able to effectively bridge managerial, clinical and digital.

Capabilities: there is insufficient focus on ‘soft’ levers including hiring and recognition, limiting the development of a digital culture which rewards iterative and step wise approaches.

Data and technology: the separation of responsibilities for digital strategy and infrastructure results in a lack of clarity on target state data and technology architecture. This separation also creates friction for the sharing of data for administrative and planning purposes.

Organisational responsibilities: the responsibilities across different central organisations are unclear, resulting in duplication of activity and issues with the commissioner-delivery partner model.

It is therefore the review’s conclusion that the centre of the NHS (defined as NHSEI , X and D ), as currently constituted, and despite considerable progress and the best intentions of many people, remains too far away from being able to achieve the goal of a digitally enabled health system that makes use of modern technology and data sharing to create joined up services to support all citizens and improve outcomes.

The review has 9 recommendations, under headings of mindset, operating model, organisational consequences and enablers for change.

Mindset: a patient and citizen centred approach

Recommendation 1: commit to a patient and citizen centred organising principle for future service transformation.

The NHS must be bolder in stating that the health and care system should empower citizens to manage their health and well-being and give them the tools to take ownership. The citizen should expect services to be designed with them in mind. The best organisations, both public and private sector, have deliberately put citizen needs at the centre of their decision-making and service design. In healthcare, such an approach not only improves patient experience, but also results in earlier engagement from patient with their health and over the long-term improved health outcomes and associated economic and societal benefits.

Whilst this recommendation may seem obvious, its importance cannot be overstated. There are significant implications for organisational design and technical or data architecture, standards, governance and policy. This approach will require the major axis for change to be care pathways centred around a patient or citizen view rather than settings of care or disease states and will require new capabilities (akin to commercial organisations’ customer insight functions) as well as data to flow across settings of care, with increased data interoperability and common technical standards facilitating a seamless experience for patients and staff alike. Effective implementation will require a significant cultural shift away from the current siloed approach in the centre with conscious management to ensure intentions translate to reality.

Recommendation 2: consider and mitigate digital inequality in all service transformation. Expand the role of the SRO for Health Inequalities to include digital inequality

There are undoubtedly ways in which digital approaches improve access to health care services, for example, for individuals who are immobile, who cannot afford to travel, those experiencing anxiety in health care settings, or people who wish to remain anonymous and don’t want to be seen by other patients. However, digital approaches can have unintended consequences, such as excluding those who are less digitally literate or who do not have access to the most advanced telecommunication services. It will take focus to ensure the push for digital ways of working can help tackle these health inequalities rather than exacerbate them.

NHSEI should develop national frameworks, guidance and best practice in designing and implementing digital solutions to reduce inequalities. When designing new models of care, these should include a choice for citizens between remote and face-to-face care.

It is important this issue is managed actively. As such, the responsibility of the NHSEI Health Inequalities team should be expanded so that digital exclusion is seen as another lens within health inequalities.

Recommendation 3: commit to building patient and citizen trust and acceptance in the use of health data to improve outcomes. Provide more efficient access to data for analytics that ensures privacy and can be used to improve care delivery

The NHS has a long and proud history in using data to improve individual and population health outcomes. Recent examples including machine driven diagnostics in eye care and the delivery of the vaccine programme demonstrate the power and potential of the use of advanced data analytics.

The field of data science is undergoing a revolution as new tools such as machine learning transform our ability to gain insights and improve outcomes. These advances, combined with the explosion of new data driven commercial business models, have caused citizens to be concerned about the privacy of their individual health data and the controls in place over its dissemination and use. It is beyond the scope of this review to consider issues of the technical means by which we both improve the NHS’s ability to use data and respect data privacy; this is being considered separately by the Goldacre Review.

However, it is critical for the effective delivery of digitally enabled healthcare transformation that citizen trust and acceptance in the use of data is built. Given its convening power and role in setting the national direction, the centre should work with other key national stakeholders to take active steps to both build awareness of the value of data to improve individual and population health outcomes, and to take action to improve the use and management of data within the healthcare system.

Clinicians and management will need to further engage in the debate with the citizen in order to build understanding of the benefits of using data, both for individual patients and for local populations, and the safeguards in place to protect privacy and confidentiality.

This review is being conducted in parallel with the Goldacre Review, the purpose of which is specifically to make recommendations on the more efficient and safe use of health data for research and analysis for the benefit of patients and the healthcare sector. Part of the way this can be achieved is through technology - specifically controlled data environments allowing permissioned access to data in a safe and privacy preserving way. These modern data platforms are key to how the NHS can achieve more efficient access to data to improve care delivery in a way that is privacy protecting and secure.

Recommendation 4: reorientate the focus of the centre to make digital integral to transforming care, with NHSEI overall accountable for executing digitally enabled service transformation. Provide clarity around the role of the centre, underpinned by a clear enterprise architecture and align with the ICS operating model

The pandemic has shown the potential of digitally enabled transformation as a transformative lever. Service recovery following the impact of coronavirus (COVID-19) and the next phase of the Long Term Plan delivery must integrate digital, data and technology. This encompasses the shift from basic digitisation to service transformation.

Over the past 18 months, NHSEI has been developing a new operating model that describes how different parts of the NHS work together to deliver nationally agreed and locally owned priorities to improve health and patient care. The NHSEI operating model now needs underpinning with a clear enterprise architecture – in simple language, what are the business capabilities needed to deliver care and what is the broad technology map and principles that deliver these. The NHS today is comprised of thousands of different IT systems, many of which do not easily talk to each other in the way that joined up integrated care requires. Interoperability is a key priority – but is not sufficient to address this fragmentation.

This enterprise architecture will need to build on the excellent work done by NHSX and NHSD in this space and determine more clearly the respective roles of the centre and local systems in digitally enabled care pathway transformation. It should develop a national framework articulating the conditions under which certain tech-enabled transformation should be done once, the benefits of this, and how this aligns with the prioritisation powers of ICSs . Such conditions may include:

• where the purchasing power of the NHS as a whole can be leveraged
• where interoperability across ICSs is critical
• where there is niche expertise that resides in the national team
• where removing unwarranted variation in process is a priority

Operating model: a joined-up centre driving digital and data transformation

Technology Operating Model practices are undergoing fundamental change as new digital, data and cloud-based standards and technology, ‘devops’ methodologies, agile development techniques [footnote 1] and other innovations in technology development and management upend traditional ways of working. Equally, the twin challenges of changes in ways of working and a riskier external environment are driving significant innovations in the ‘hard basics’ of operational resilience, cyber security, system management and technology productivity. The NHS needs to fully embrace these developments.

The NHS’s current operating model, with responsibilities split across the teams at NHSEI , NHSX and NHSD , together with the fragmented and uneven technology capability in the wider service, reflects previous practice and does not support the nature and scale of the transformation ahead of the NHS. Furthermore, the role and capacity of the national bodies in supporting technology delivery in ICSs , trusts and other healthcare organisations is not clear and not sufficient relative to the transformation agenda facing the health service. Significant change is therefore required to the aggregate business and technology operating model if the centre is to support transformation to a digital and data enabled NHS that delivers improved outcomes against the ‘triple aim’ objectives.

Recommendation 5: implement a new operating model across NHSEI , X and D to drive digital and data transformation

This new operating model pivots the NHS to a more ‘modern’ operating model, more closely linking digital and data delivery to the business while clarifying accountabilities for supporting technical delivery. Leaders from across NHSEI , X and D have been engaged in discussions to review alternatives, share perspectives and identify the optimal operating model for the NHS. This new operating model has 4 layers, as follows:

‘System’ leadership for transformation

The centre of the NHS has a critical role in providing leadership for transformation. This encompasses all the levers of value owned by NHSEI – from setting strategy, to building capability, to creating financial incentives, and supporting implementation. This builds on the work that has been undertaken by NHSX with a digital and tech focus, and places it firmly into holistic transformation, based predominantly around citizens and care pathways. The NHSX approach – of looking at all the available levers and using them to drive change – should drive the new approach to transformation more widely.

This system leadership should be responsible, in a partnership model between the centre and ICSs , for setting out the business and technology capability requirements of ICSs and the centre with the roadmaps to realise these, and for determining the appropriate high level technical standards, and blueprints for transformed care pathways. It should provide professional leadership to Chief Clinical Information Officers in the wider system, ensuring alignment to a shared vision of clinical change and encouraging shared learning in individual systems’ transformation journeys.

Transformation Factory

To achieve the Long Term Plan aim, and respond to the rapid acceleration in digital adoption, NHSEI needs to ‘transform the way it transforms’ and improve how it supports innovation in the delivery of care. At the core, this involves the creation of a scalable capability that integrates clinical, operational and technological resources to transform patient pathways and service delivery.

This capability builds real expertise in the art and science of transformation, learning continuously from experience. It needs to embed modern digital and transformation tools and techniques, and adopt a user, patient and citizen centred approach. It will use ‘agile’ change methodologies and operate through small, focused multi-disciplinary ‘service’ teams whose missions have longevity to build the right experience and continuity and technical solutions. Individuals will be part of service teams with day to day oversight from the Transformation Factory leadership but will be drawn from other functions (for example technology, operations, clinical) who will be responsible for their professional development and competence.

The focus is relentless on delivering improvements in outcomes based on rapid deployment and continuous improvement rather than large scale traditional system programmes, although supported by underlying data and technology infrastructure. Examples of core initiatives could include the likes of digital triage for the elective backlog, or transformation of a clinical pathway such as at-home remote monitoring for the frail elderly.

Creation of this capability, which mirrors the practice across leading public and private organisations, is challenging as it requires significant changes to ways of working, culture and behaviour, resource allocation, and funding. Building a Transformation Factory will require investment in skills and capabilities. These resources are in high demand, so to be successful in attracting and retaining key individuals, NHSEI will need to create a rewarding environment where individuals can make real and lasting contribution to health improvement and grow professionally. Focused leadership and alignment of intent across all functions within NHSEI will be critical.

Technology strategy, infrastructure and operations

Core technology, similar to transformation, is undergoing a revolution as cloud technology, ‘devops’ methodologies and software as a service and security-by-design standards change fundamentally target architectures and system design and management practice. The boundaries between traditional technology organisations and the wider ‘business’ are being increasingly blurred as more services are delivered through data and digital tools, and traditional programmatic software development is replaced by agile methodologies and rapid, continuous improvement. System resilience and system security and privacy expectations are rising and increasing focus is required on end-to-end risk management and control, including down the supply chain. It is therefore critical the NHS has a core capability, operating close to the service, that can lead the system wide technology capability and ensure adherence to common architectural principles and minimum standards, as well respond to evolving security and privacy needs.

Therefore, the Technology Strategy, Infrastructure and Operations layer of the Operating Model should have overall responsibility for the technology architecture, standards and policies adopted by the central and wider NHS system. Working in tandem with the Systems Leadership capability, it would influence (and where necessary enforce) the adoption of common architectural principles, minimum standards in areas such as cyber security and privacy and promote interoperability and reuse. It would also have responsibility for the professional leadership of digital and technology resources operating within the NHS. And all this will need to align closely with the wider transformation strategy, to avoid recreating a digital silo separate from the needs and focus of the wider organisation.

Key priorities for this central capability include efficient operations and delivery of core infrastructure, the enablement of the Transformation Factory through use of common componentry and tools, the creation of a coherent data architecture and infrastructure to meet the needs of different user groups, and the design of core infrastructure and standards that make it easier to scale solutions across different parts of the NHS.

To power this operating model, data and analytics must become a core capability for NHSEI and the wider healthcare system going forward. This will be essential if the vision outlined in the NHSX Data Strategy published in June this year is to be achieved. Currently, this capability is split across NHSEI , NHSX and NHSD and, as a result, is being underutilised with duplicated activities, investments and capabilities. This crucially also includes developing necessary cloud-based data infrastructure to enable leading-edge digital and analytic solution development, foster data interoperability, and enable an easier scaling of solutions once developed. The current set-up is not as effective as it could be and bringing it together will improve decision making and better enable digital transformation.

While the pandemic has significantly accelerated the use of data within the centre of the NHS, there has been no clear single plan and potentially duplicative investment. The centre of the NHS must bring together its data efforts, pool and strengthen its expertise and talent, and create a coherent data architecture and infrastructure that operates at the centre to meet the needs of different user groups. There must be a single agreed investment and implementation plan.

Organisational consequences

The establishment of NHSX in 2019 has been a very successful catalyst of change. NHSX has improved focus, faced into critical architectural and technical standards, increased resources devoted to the tech agenda and driven innovations such as COVID-19 home monitoring or vaccine data on the app. Critically it has brought together the levers of both NHSEI and the Department of Health and Social Care ( DHSC ), setting the tech foundations for a more joined up health system, establishing a System Design Authority, and using data to drive a greater connection to social care. Most importantly, NHSX has pushed the agenda of integrating digital with the wider transformation effort.

The successful conclusion of NHSX’s push for integrating digital into the whole is the institutional change recommended in this review. Now is the time to take this initiative to its logical conclusion and embed digital into wider transformation, creating the right capability to support the NHS and its ICSs . The legacy of NHSX is in building the conditions for this evolution and leading the journey to a more modern fit for purpose operating model at the centre. As a separate identity its role is complete; its skills and remit become part of the Transformation Directorate, which will continue to contain the tech policy directorate of DHSC to ensure it can provide the system leadership role described above.

NHS Digital has demonstrated the criticality of having national digital platforms to support the delivery of population-scale health services with high availability. It has proven the value of enabling a different way of delivering digital services to the citizen, for example in the vaccination programme where teams were fully embedded within the NHSE service delivery, and delivered everything from the national booking service to the data flows that underpin the operational, clinical and citizen-facing systems such as COVID Pass. NHS Digital developed services (such as NHS.uk, NHS login, the NHS App, and 111 online) are increasingly acting as the ‘front door’ to the healthcare service, providing an important foundation from which to build.

The current organisational divide has meant that data and technology have been too separate. Without a more profound consolidation, digital will remain in its silo, and the essential interplay between the tech function and the wider business cannot happen to the degree necessary. The NHS’s tech function needs sufficient influence over, and be sufficiently influenced by, the strategy, prioritisation or resource allocation decisions taken in the centre of the NHS and in systems and trusts.

Adoption of the proposed operating model demands the centre ‘joins up’ and works seamlessly to enable the overall goal of delivering a digital, data and technology driven NHS, orientated around the citizen. This will require significant change in organisational responsibilities, and ways of working.

Recommendation 6: re-align organisational responsibilities to ensure delivery of the new operating model

Create a new Transformation Directorate at the heart of the NHS to drive transformation, including the establishment of a ‘Transformation Factory’.

Evolve NHSX into the strategy function of the new Transformation Directorate, with NHSX’s delivery teams integrating into the wider technology and transformation teams. Having successfully advocated for the integration of digital into the whole, NHSX no longer needs a separate identity, and can become a key, integrated driver of the new approach to transformation.

Embed NHSD into NHSEI as its tech function and as the NHS centre of excellence for technology, with an intent to merge legally once legislation enables this. The CEO of NHSD should therefore now also be appointed as Chief Information Officer ( CIO ) for NHSEI , and be a member of the NHSEI Executive Committee. Clarify detailed responsibilities and eliminate current duplication between the new Transformation Directorate and NHSD . ‘Join up’ Board governance between NHSEI and NHSD in the interim, for example through Committees in Common, to align priorities and resource allocation whilst maintaining and respecting current statutory accountabilities. Move sponsorship for NHSD away from the digital transformation and tech policy directorate of DHSC to be aligned with other arm’s length bodies.

Replace formal ‘internal commissioning’ between NHSEI and X and NHSD with joined-up business planning and a more iterative dialogue that navigates between business needs, technology considerations, and budgetary constraints.

NHSD ’s separate technology and data services provision to other organisations (such as NHS Test and Trace and Public Health England, now both the UK Health Security Agency), should continue to be served by NHSD (and later the combined entity), with separate funding, appropriate service level agreements and management information.

Empower the Transformation Directorate, drawing on the expertise of the embedded CIO Directorate, to provide digitally enabled transformation leadership to trusts and healthcare delivery organisations within the scope of NHSEI . Use all NHSEI and DHSC ‘levers of value’ to work with trusts and the wider system to define the business and technology capability requirements, clarify the role and responsibility of the centre, ICSs , trusts and other NHS delivery organisations, and promote innovation, reuse, and the adoption of best practice.

Retain the dual mandate that has been held by X in the Strategy and Policy function of the Transformation Directorate, so that the Strategy and Policy function is also the digital transformation directorate of the DHSC . This will allow it to use all of the levers required of system leadership including supporting ministers to set direction, policy, legislation, regulation and a voice in cross-government policy and decision-making, while at the same time being an integral part of the centre of the NHS.

Consolidate data analytics capability. Create a Chief Data and Analytics Officer for the NHS to provide professional leadership to the data community but nest activity as close to the end user as practicable. Create a data plan that recognises the heterogeneity in its source, type and user (for example, individual patient care data for clinical decision making; operational and system performance data for planning; financial performance data; population health management data; data for research) and design a suitable data strategy, architecture, data models, tooling and permission rights to support effective data driven insight and decision making

Ensure the data privacy, information governance and official statistics publication arrangements in the combined NHSD and NHSEI entity are appropriately robust, and in the interim maintain the independent responsibility and accountability of the NHSD CEO and Board for its statutory functions on data. Continue the use of expert advisory and professional groups as part of the sign off processes for data access, as well as the continued publication of details of what has been approved.

Ensure that the research and life sciences communities continue to receive priority attention in accessing NHSD collected data to serve their needs. This includes the need to understand the extent to which the underpinning data architecture is shared between NHS data users and those from the research community, and the extent of efficiencies in data collection and curation.

Implementing the organisational re-alignment, consistent with the Operating Model will require significant changes to the ‘engineering’ of how NHSEI (including NHSX) and NHSD operate.

Enablers for change

Organisational change is necessary but not sufficient to drive digitally enabled service transformation. Skills, capabilities and ways of working need to change if the opportunity is to be grasped.

Recommendation 7: undertake a fundamental organisational capability intervention across NHSEI and D to build and nurture the skill base to support data and digitally enabled transformation and adapt ways of working to support the new operating model

Build basic data and digital literacy and capability at all levels.

Understanding the importance of data and digital and being able to use them effectively must become a requirement for staff at all levels in NHSEI and in the wider NHS, increasing alongside their seniority. This expectation of broad digital and data literacy needs to be set in all aspects of career development and should be achieved through a combination of on-the-job training, peer support and mentoring, and formal training. NHSEI should be responsible for developing the right curriculum and that competency frameworks be updated to include levels of data and digital literacy.

Develop and where appropriate recruit into NHSEI leaders who can lead integrated teams that combine managerial, clinical, operational, and digital and data experience. The NHS has many years of creating leaders who combine managerial and clinical perspectives; it also has some strong technology and digital leaders. However, there are too few leaders and a limited pipeline of future talent who combine both. This should be done through a mix of recruitment, training and secondments – both within the wider NHS, across government and with the private sector. One model, piloted during the review, has brought an NHS trust CEO into the centre at an early stage in their career to lead a discrete transformation project for a defined period. This should be expanded into a programme.

Expand and strengthen technical capability in data, digital and technology, starting with a zero-based skills audit and capability mapping of existing teams, to create the right environment and remuneration to attract the most able.

Brilliant technologists, software engineers and data scientists are essential, and in high demand in the wider economy. As the technology centre of excellence for the NHS, the new CIO function will need more of this talent to drive up its overall capability. The ability to do work at scale that saves lives is a significant attraction for recruitment but must be complemented by creating an empowered working environment and suitable remuneration. Working closely with the new Chief Digital and Data Office in the Cabinet Office, NHSEI and D must make the case for appropriate career structures and pay arrangements, particularly for exceptional talent. This should include specific work to ensure clear digital career paths and roles are incorporated within NHS Agenda for Change frameworks.

Foster a more agile and flexible workplace focused on meeting user needs

A modern digital culture prioritises agility and multi-disciplinary teams, focused on user needs. The COVID-19 pandemic created the imperative for fast new services and capabilities which spawned new ways of working – nearly half of NHSEI operated in cell structures and joint programme teams with short lines of command and rapid decision making. This gave a taste of working differently, with very positive outcomes in terms of speed and outcomes for the front line. This approach needs to be embedded into the organisation more permanently. This will require significant change to people processes. Focused interventions will be needed to ensure that those in decision making positions are constantly aware of the day to day reality of the citizen experience, and make real the commitment to a patient and citizen centred approach.

Recommendation 8: revise financial management arrangements both within NHSEI and between NHSEI and DHSC

Simplify and align funding streams across nhsei and dhsc . ensure the right alignment of technology and other spend to support service transformation..

Currently revenue funding for digital transformation and live services comes partly from DHSC and partly from NHSEI , with capital solely from DHSC . As part of NHSEI taking ownership of the digitally enabled transformation agenda, all revenue funding from DHSC for NHS digital activity should be routed from DHSC to NHSEI , via the NHSEI CFO, and remain ring-fenced to ensure no diversion for other activities. This will help ensure full alignment of digital spend to overall NHSEI transformation priorities.

Furthermore, DHSC and NHSEI should consider whether capital for digital activity should also be managed via NHSEI given the industry trend towards greater shifts to more revenue-based models.

Adopt a more flexible business case approach for digital transformation in line with processes adopted elsewhere in government.

Digital transformation is a multi-year endeavour. Adopting the approach taken by the Government Digital Service and HM Treasury, the NHS should use a more agile approach to business case development and approval. The goal should be for this process to allow funding requests to be iterative, multi-year and aligned to both strategic and technical ambitions.

Review the way benefits are measured and tracked for digital initiatives across the NHS, in particular looking at the way ‘downstream’ benefits of national digital investments are measured; the lines of accountability in instances where the spend is national but benefits local; and developing more robust ways to assess benefits in business cases.

Align financial, payment and other mechanisms to incentivise digital transformation within the wider NHSEI system.

NHSEI set the frameworks for commissioning and payment of services in the wider NHS. A systematic review of how these may act as barriers to digital transformation should be undertaken and establish how they should be adapted so they actively incentivise digital transformation. This work has begun in NHSX as part of its development of ‘Who Pays for What’ but needs to be expanded.

Strengthen NHSEI ’s commercial expertise and influence so that it can better support ICSs and develop a single, multi-year strategy for market development.

Procuring technology solutions is often expensive and infrequent, meaning local teams do not always have the commercial expertise to provide adequate support. The centre should actively support local systems during this process as well as leveraging the purchasing power of the national team to support supplier management.

In addition, there is a need for better management of the complex digital, technology and related provider market, to avoid over-reliance on a few key suppliers and provide more clarity to industry around the direction of travel and areas of investment.

Recommendation 9: re-prioritise NHSEI spend to lift the quantum devoted to digitally enabled system transformation. Assess the level of ‘technical debt’ across the wider NHSEI system and update estimates of technology spend required to enable the delivery of safe technology operations. In conjunction with DHSC , make the case for increased funding to deliver safe technology operations

The requirement for digital transformation in other sectors has driven up the proportion of their spend on digital and technology. Benchmarking the overall spend against other industries is extremely challenging, not least because there is currently no solid data available on total technology spend across the NHS, since the vast majority is spent by local organisations. NHSEI estimate that trusts spend less than 2% of total expenditure on IT, while Lord Darzi and the Institute for Public Policy Research suggested this should be nearer 5% by 2022. Informed third parties have also queried whether the level of funding proposed is sufficient to enable secondary care to digitise. NHSEI should therefore as a matter of urgency determine the levels of spend on IT across the wider system and seek to re-prioritise spend from within the wider NHSE budget to support accelerated digital transformation.

In addition, audits of the wider NHS indicate that there is a very large legacy ‘end of service’ technical debt, creating significant additional cyber and operational resilience risks to the NHS as a whole. NHSEI should update their estimate of the likely costs and work with DHSC to make the necessary case for additional funds to address this risk over time.

Implementing the enablers for change, consistent with the Operating Model will require significant changes to the culture, skills, capabilities, people processes and financial process across NHSEI (including NHSX) and NHSD .

Implementation and next steps

The timing of the review being finalised is good. The pandemic has shown both the need and the opportunities for making digital core to what the NHS does. NHSEI is completing work on a new operating model, which will clarify roles and responsibilities between the centre and ICSs . The introduction of the NHS Bill to Parliament provides an opportunity to clarify the operating model, and to establish a simpler, more powerful set of governance arrangements. And there is a new Chief Executive for NHS England.

This Review is intended to inform the decisions the new CEO will take about how to deliver against the future objectives for the NHS together with the DHSC , but not to prescribe in detail how this should be operationalised. There will be much work to be done by the new CEO and her team to develop a roadmap for delivery of the recommendations in this report to ensure that digital and data move to the heart of how the NHS transforms itself.

Why this is worth doing

The future tech-enabled citizen centred healthcare services is not hard to imagine. It means getting your questions answered by a trusted source at any time, day or night, using your phone. And you choose if the source is a customized webpage or a live person. You see your options for scheduling an appointment or a diagnostic test and you choose what works for you. You renew your prescriptions online and they are waiting for you at the pharmacist within hours. And you always have access to your complete healthcare records. And even more is possible – your data, securely stored and properly curated, will be used to alert you and your doctor to changes in lifestyle, medications or testing suggested by the very latest research based on information that is specific to you. And you will be able to enrol in research studies that give you access to the most innovative therapies. A few people already have access to some of these services, but every citizen needs to have access to all of them.

And the tech-enabled NHS is also about making the work lives of our clinical staff more sustainable, enabling our clinicians to spend more time with their patients and less time on administrative tasks. In addition to personalized decision support – using the power of data and computers to make specific suggestions on ways to improve the delivery of care - this future includes ambient documentation: using voice interactions to generate the records so our busy clinicians don’t have to. Our local administrative teams based in ICSs will have continuous access to real time data on our operations, maximising the flow of patients and enabling early identification of emerging issues, and so smooth our patients’ care journeys. Our information systems will be more joined up, allowing patient information to more freely flow to the right clinicians, in support of holistic decision making. The NHS will continuously assess the experience of its patients in receiving care as well as its outcomes of care, so it has the information necessary to continuously improve. Providers will be able to use technology to work on larger geographical footprints, to provide more specialist care close to peoples’ homes. Providers will access the most cutting-edge technologies for their patients through research protocols and biotech collaborations accessible to all.

All ICSs will understand what they can expect from the centre and be clear on the standards to which they must adhere. They should be able to rely on it for support and guidance, whether with transforming specific care pathways, implementing a significant EHR system or the sharing of promising digital innovations. They will be able to buy technology solutions with more confidence and better terms, benefitting from central expert commercial support to help them negotiate and procure.

Concluding remarks

The extent of the changes envisaged by this report should not be under-estimated; they get to the heart of how the centre of the NHS operates, and critically the culture, skills and capabilities, incentives and operating processes in place. It will be tempting to focus on the organisational consequences. However, implementation will fail unless the accompanying enablers for change are followed through. As such, the change management effort is significant and will require full-time resource and the determined sponsorship and commitment of the new CEO of NHSEI and the CEO of NHSD and their wider Executive Team and Boards. Engagement to date has revealed strong support for the proposed changes.

The time for action is now. The need is enormous. The NHS faces unprecedented demand and severe operational pressure as we emerge from the pandemic. Now is the moment to put data, digital and technology at the heart of how we transform health services for the benefit of citizens, patients and NHS staff.

‘Devops’ is the breakdown of traditional barriers between software developers and IT operations and the introduction of more automated deployment, in order to deliver code releases both more rapidly and more reliably. ‘Agile methodology’ is a way of working that focuses on discovering requirements of users and developing solutions through collaboration, with techniques including adaptive planning, evolutionary development, early delivery and continual improvement.  ↩

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Digital transformation in the NHS and social care

19 April 2022

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DigitalHealth.London connects health and care staff, digital health companies and academics, and equips them to improve the NHS and social care in London through digital technology. As part of supporting this vision, DigitalHealth.London runs a 12-month Digital Pioneer Fellowship programme that supports up to 40 NHS and social care staff from all levels to design, lead and deliver innovative digital transformation projects within their organisations. The programme has so far supported 97 fellows from 45 NHS organisations across London and the South East and was shortlisted for the HSJ award for Workforce Initiative of the Year 2021.

Key benefits and outcomes

• 97 NHS staff across 45 organisations in London and the South East have been supported so far.
• All projects undertaken by Fellows have led to improved patient care or experience either directly or indirectly.
• 32 per cent of Fellows said that their project was not just more successful but was delivered more quickly.
• All Fellows surveyed in cohorts 1 and 2 were confident that being part of the Fellowship was of benefit to their career.

What the organisation faced

Five years ago, using digital solutions in healthcare was less common, and there were fewer digital roles in the NHS and social care. Many people were asked to step into digital roles, however, there was often a gap between their experience and what was being asked of them. Without a network of digital colleagues to share learning, those roles were difficult. It was also hard for organisations to set clear key performance indicators (KPIs) for digital staff, or to identify what skills they needed.

DigitalHealth.London recognised that the successful implementation of digital innovations required NHS and social care staff to have support, guidance, and space to develop new skills, form collaborations and manage change. Focusing on building the capabilities of staff to bring about digital transformation would significantly increase the success of introducing technology into the NHS.

While digital leadership programmes already existed for clinical staff, CIOs and NHS leaders, the Digital Pioneer Fellowship was created to support NHS staff both clinical and non-clinical, and across any organisational level. This approach aimed to create a strong network across London and a truly digitally enabled workforce.

What the organisation did

The Digital Pioneer Fellowship programme was launched in 2018 to support innovators within the NHS to lead and deliver digital transformation projects and was promoted in NHS trusts across London and the South East . In the first year of the programme over 80 per cent of the Fellows surveyed, reported that they gained specific technical skills or had met an individual challenge thanks to the Fellowship.

DigitalHealth.London is a collaboration between MedCity, CW+ and two of London’s Academic Health Science Networks – UCL Partners and the Health Innovation Network. Through sponsorship, the Fellowship is free to both the Fellow and the organisation they work for.

The goal of the 12-month Digital Pioneer Fellowship is to support up to 40 people employed by NHS organisations in London and the South East. The type of digital project the Fellow works on can either be the adoption of technology (for example, implementing a digital health app) or it could be a transformation project (for example, introducing digital vaccine passports, or making a process paperless).

The individuals taking part attend six learning days across the year, where they access expert-led workshops, resources and taught modules on key topics. The Fellowship is designed to equip the fellows with new skills and knowledge, from building good business cases and using Agile as a project delivery technique, to structuring a good evaluation, and implementing change management principles.

The programme also provides the Fellows with peer-to-peer support through action learning sets , which allow the Fellows to support one another, share issues, create solutions and challenge one another to develop their leadership skills.  Finally, each Fellow can select a mentor from a number of high-profile leaders in business, the NHS and the health and care sector.

Results and benefits

The programme has, to date, supported 97 members of NHS and social care staff across 45 organisations in London and the South East . DigitalHealth.London saw a 48 per cent increase in applications for the 2020-21 Fellowship programme, suggesting the reputation and impact in the sector is renowned and the need for the programme is growing.

All 97 projects undertaken by Fellows so far have led to improved patient care and/or experience either directly or indirectly.

Mark Needham, Programme Director at Digital First, led a health and care team to build a digital bridge to connect 195 GP practices with 500 care homes during the Covid-19 pandemic. At the end of his year as a Fellow, 500 homes were estimated to have benefited, including 25,000 members of the workforce who support 12,000 residents. Going into the autumn of 2021, the project was half-way to its target of digitally monitoring 6,000 patients.

You can read more about Mark’s project here .

When surveyed, 32 per cent of Fellows said that their project was not just more successful as a result of the Fellowship but was also delivered more quickly. This meant patients saw the benefits sooner and it allowed trusts to start saving money much earlier.

“The insights from the Digital Pioneer Fellowship programme have been incredibly valuable to my development. The peer groups organised by the programme were particularly valuable to share learning and focus on delivering better outcomes for people.” Mark Needham, programme participant.

Overcoming obstacles

The benefit of a London-wide programme is the network it provides and the learning opportunities between different organisations and ICSs. To maximise this benefit and make the Fellowship available to as many members of NHS staff and organisations as possible, there are a number of factors that challenge delivery:

The number of applications received each year for a limited number of spaces.  

Each year the programme can support between 30 and 40 Fellows but for the 2020/21 programme, 98 applications were received . Most of these additional applicants would benefit from support but spaces are limited and not all projects can be included.

Ensuring role and Fellow diversity

Diversity is crucial to not just the programme’s success, but also the wider peer learning of the Fellows. Some groups of NHS staff are more often underrepresented and are less likely to put themselves forward for the opportunity, so wide-scale outreach during the application process and diversity in the selection is important.

Sponsorship

For this programme to continue delivering benefits, sponsorship from public and private organisations who support this initiative and see mutual benefits are vital.

Alumni network

Fellows keep in touch with each other regularly, but it is also important for DigitalHealth.London to help maintain these relationships so both the organisation and the Fellow can keep up to date with the developments in digital health. This will become more of a priority as the network grows, and the DigitalHealth.London team focuses on embedding the Fellows into as many other DigitalHealth.London programmes of work as possible, for example giving the Fellows the opportunity to support selection of the companies on the DigitalHealth.London Accelerator programme or to mentor for the Horizon Fellowship .

Takeaway tips

• Try to mix learning levels and abilities for group work.
• Having a mentor is very important for individuals leading change on the ground but the mentors themselves also gain helpful insight through the relationship.
• Peer-to-peer learning is one of the most useful aspects of the programme and highly valued by NHS and social care staff.

Future plans

DigitalHealth.London will open applications for NHS staff to apply for the next cohort to grow their skills and support digital transformation later this year.

In the meantime, the DigitalHealth.London team is delivering the Horizon Fellowship. Due to the success of the Fellowship and the positive experience some staff had, DigitalHealth.London was approached by CW+, the charity of Chelsea and Westminster Hospital, to deliver the Horizon Fellowship , a programme incorporating the learning days from the Digital Pioneer Fellowship with additional ringfenced project time and funding for staff across their two sites, Chelsea and Westminster Hospital and Middlesex Hospital.

Contact details

For further information on this case study please contact Dr Katya Masconi-Yule, Senior Programme Manager via [email protected]

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Case studies

August 2024

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Cheshire and Merseyside (C&M) Endoscopy Network commissioned the NHS Transformation Unit (NHS TU) to produce a NHSE short-form business case. The business case aimed to support the network in securing capital funding to transform endoscopy services across C&M and was…

We were commissioned by Staffordshire and Stoke on Trent (SSOT) Integrated Care Board to support the Infrastructure Strategy Lead by providing high quality analytics to deliver a 10-year estates strategy investment projection for Primary and Secondary Care. The Challenge The…

Treatments for head and neck cancers (HNC) commonly affect a person’s ability to speak, use their voice, swallow, smell and breathe, significantly affecting quality of life. Speech and Language Therapists (SLTs) are core members of the head and neck cancer…

The NHS Transformation Unit (TU) were commissioned to develop a five-year workforce strategy and education and training plan for the health and care system across Lancashire and South Cumbria. Looking at the entire workforce across health, social care and voluntary,…

We have significant experience in diagnostics ranging from pathology, imaging, endoscopy and community diagnostic centres. Recently we worked with the Greater Manchester Community Diagnostic Centre (CDC) Programme and local acute healthcare providers to design, develop, articulate, and pilot diagnostic pathways.…

Introduction The NHS Transformation Unit supported the development of a HM Treasury green book compliant business case for implementing electronic bed and capacity management systems (eBCMS) and care coordination centres across acute trusts. The Challenge The challenge in urgent and…

January 2024

The NHS Abdominal Aortic Aneurysm (AAA) Screening programme aims to reduce AAA related mortality by screening men aged 65. The Challenge A significant challenge for the AAA screening programme is the lack of skilled workforce – a national issue also…

December 2023

We reviewed the Walton Centre’s approach to transformation and its governance between October 2022 and March 2023. The Challenge The Walton Centre had recently set up a Strategic Programme Management Office (SPMO) to align and coordinate larger-scale change programmes. They…

Over 20 million people in the UK have an MSK condition, which ranges from minor injuries to long term conditions. MSK conditions can affect your bones, joints, muscles, tendons, and the spine and are a leading cause of pain and…

November 2023

The NHS Transformation Unit were contracted to support the Physiological Measurements Network in Cheshire and Merseyside (C&M), with a primary focus on improving Echocardiography services. We worked across C&M to design and deliver the Echocardiography Recovery Plan for the C&M…

October 2023

In December 2022 NHSE England’s Cancer Programme required support to design and deliver an approach to help Cancer Alliances. Their focus was to understand the key ingredients to success and to identify their collective development needs. The TU were commissioned…

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Global Digital Exemplars case studies

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• Mobilising the Workforce – Northumberland, Tyne and Wear NHS Foundation Trust

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Softcat FinOps empowers NHS Digital’s drive for improved efficiency and cost control

Solutions Provided

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NHS Digital is driving transformation across the UK’s National Health Service (NHS). Its Cloud Centre of Excellence (CCoE) plays a critical role in the wider strategy of developing new and more efficient ways of working with IT. It aims to innovate, promote best practice, and drive high-value, sustainable solutions based on Cloud hosting arrangements. The NHS Cloud strategy aligns with the government’s overarching Cloud First policy. The CCoE is there to ensure consistency and efficiency through promoting clear policies and standards that enable teams to upskill and become self-sufficient. It offers wide-ranging support to guide multi-Cloud adoption, simplify service deployment and increase agility and responsiveness.

• Key driver of Cloud adoption across the wider NHS
• Providing support and guidance around Cloud best practice
• Innovating and implementing high-value, sustainable Cloud-first solutions

The Challenge

“As the NHS embraces a Cloud-first strategy, it’s important that we are able to understand the implications and opportunities of doing so,” said Chris Squibb, CCoE FinOps Lead, NHS Digital. “While everyone recognises the advantages, it’s difficult to truly understand the cost impact of pursuing, what is effectively, a decentralised approach. With our previous on-premise technologies, we had a very clear view of up-front and ongoing costs. Adopting a Cloud-first approach has removed that certainty.

“With cloud solutions, being able to validate real-time costs with original spend forecasts is an essential baseline for ongoing cost optimisation. The decentralised model enables individual business units to create their own assets, and this can lead to increased billing complexity and avoidable costs. We needed an effective way to monitor usage, which helped us make sense of what we were being billed for and understand the actual ongoing costs of delivering Cloud services. Softcat has been a long-standing technology partner. We approached them to learn about potential solutions that would provide the visibility and opportunities for cost optimisation we needed going forward.”

Critical success factors

• Access technology capable of providing oversight and usable, granular data
• Simplify billing information to effectively monitor usage, and costs, whilst enabling optimisation
• Providing cost transparency for services and programmes

The Solution

Softcat has a strong track record of providing high-quality Cloud-focused solutions. This includes a market leading FinOps capability, delivered using Softcat skills and experience from many previous engagements, and underpinned by CloudHealth by VMware. 

Chris Redding, Datacentre & Cloud Specialists at Softcat, said, “Our FinOps capability has been the cornerstone of our Cloud capability for many years.  We knew it would provide the visibility and data NHS Digital needed to simplify financial management, streamline cloud operations and bolster security and compliance.  

“But the technology only represents one element of our solution. While it’s a powerful tool in itself, the real value is our experience to integrate, analyse and report on the cloud usage to provide meaningful intelligence and results for our clients.”

Softcat’s specialists worked closely with the NHS Digital team over a number of months to ensure the correct configuration, understand the data being produced and use it to highlight where cost and operational efficiencies could be achieved.

“The monthly workshops with Softcat were particularly valuable,” said Chris Squibb. “They helped us understand exactly what was being spent on both Amazon Web Services (AWS) and Microsoft Azure services. It enabled us to consolidate and simplify billing, as well as providing accurate information to fully understand usage across more than 70 business units.

“We’re a relatively small team and the ongoing support Softcat provided made all the difference. Where we had limited knowledge, Softcat provided the expertise. It was literally a case of reaching out to Softcat and saying, “can we do this?” We’d quickly get an answer highlighting what was possible and the best way of configuring the solution to achieve what we wanted. That ongoing support helped to generate highly valuable data to facilitate trend analysis, identify where cost savings could be made and highlight opportunities for operational optimisation.”

Solution highlights

• Ongoing FinOps service including close collaboration and support to ensure alignment with business needs
• High-value, granular data generation to facilitate cloud visibility, cost optimisation and improved governance
• Continuous improvement and review of all cloud usage including security posture.

The Benefits

“Although we initially set out to find technology to help us to simplify billing, we’ve quickly discovered that the solution has evolved over time into a strategic decision-making tool,” said Chris Squibb. “Yes, it’s helped us consolidate multiple invoices into just two, but it’s delivering the real-world intelligence to help us make significant cost savings and optimise future service provision.

“We now have the capacity to break down individual cost centres to accurately assess spend and rein in costs through technical and commercial optimisation. Through ongoing analysis, we can see in real time where cost is being accrued and can then make informed decisions about future cloud strategies based on that analysis.

“Since implementing the solution, the Cloud CoE have been able to make commitments on behalf of the organisation by analysing our cost and usage data, alongside taking advantage of the inbuilt recommendations within the toolset. As an example, this has enabled us to make significant commitments on AWS Savings Plans and Azure Reserved instances, which are currently saving us in the region of several hundred thousand pounds per month. This represents a 25% saving on what we would otherwise be paying.

“The data helps us to easily identify and retire zombie assets and right size technology provision to correspond to ongoing and emerging business needs. For instance, during the COVID 19 pandemic NHS Digital had to scale up services like NHS 111, the NHS app and Covid pass to cope with increased demand. With Softcat’s help, we were able to monitor the capacity implications of the demand quickly and purchased cost effectively.

“All in all, the solution represents a one-time hit that’s brought much needed clarity to our cloud operations. Softcat has been there to underpin our own due diligence and provide the rock-solid data that enables us to monitor usage and spend challenge invoices and drive down costs.”

Benefits at a glance

• Significantly simplified billing – multiple invoices from 70+ cost centres rationalised into just two monthly invoices
• Real-world, timely information to facilitate informed decision making and rationalise unused assets
• Opportunity to rationalise unused assets, reduce ongoing costs and secure discounts on future provision
• Monthly cost savings of 25%

Why Softcat?

“Working alongside Softcat on this implementation has been hugely successful,” said Chris Squibb. “We’ve managed to achieve big financial savings, learned how to control costs when rolling out innovative services and have a solution in place that helps ensure our forward-looking strategy is grounded in achieving the best value.

“Softcat’s direct relationship with both AWS and Microsoft Azure has eliminated the billing complexity associated with multi-cloud implementations. Softcat is effectively an extension of our IT team and acts as an independent layer between us and the cloud providers. It hasn’t just empowered our team, it’s helping to empower the whole organisation through a long-term, productive partnership.

Transformation Directorate

Digital productivity

Accelerating the adoption of evidence-based digital tools to improve productivity across the NHS and social care

Welcome to the Digital Productivity programme

Digital productivity means working smarter, not harder. Our Digital Productivity programme aims to accelerate the adoption of evidence-based digital tools to improve productivity across the NHS and deliver care and treatments to more patients, improve the quality of care, reduce the burden on the workforce, save time, lower costs, reduce waste, and increase patient and staff satisfaction. The programme aims to support HMT’s target to achieve commitments on digitally enabled care in the NHS Long Term Plan and realise the Secretary of State for Health’s Tech Vision. Key projects within the programme include Robotic Process Automation (RPA) , Real Time Locating Systems/Radio Frequency Identification (RTLS/RFID) and Extended Reality technologies (XR) .

We are enabling scale and spread of productivity-improving technology across the health and care system by providing organisations with:

• evidence-led good practice and buyers guidance
• financial support via the Unified Tech Fund and Digital Productivity Fund
• access to communities of practice
• a comprehensive library of evidence and case studies

Why we need digital productivity technology

Digital productivity technology enables our health and care system to address the current challenges faced due to increasing demand by:

• delivering care and treatments to more patients, more efficiently
• saving time
• lowering costs
• reducing waste
• improving data quality and analytics
• increasing patient satisfaction
• increasing staff wellbeing

Explore our digital productivity programmes

We work to accelerate the adoption of proven technologies across the NHS, including robotic process automation (RPA), radio frequency identification (RFID) and extended reality (XR). Case studies worldwide have evidenced their potential to augment and support, not replace, health care professionals by enabling them to provide the best level of care.

Discover more about our work - including the potential benefit across the NHS and resources available.

Join our RPA community or practice here or read more about our achievements, plans and aspirations for robotic process automation here.

Reducing inefficiencies using RPA

Robotic Process Automation (RPA) is a form of business process automation using software robots (also known as digital workers ) that quickly and accurately interact with the “back end” and the “front end” of a system, meaning it’s able to mimic everything a human can do, such as opening documents, clicking, and typing, etc. RPA can run 24 hours a day, any day of the week, and allows data to be transacted between systems, databases, digital forms or even many Microsoft Office products. Think of automations like additional team members, here to support your existing team.

By automating stable, rule-based, repetitive processes that require standard input, you can repurpose the time otherwise spent, and fully focus on high-value or high priority activities, such as complex strategising, or face-to-face interactions. RPA can support many functions, and our team can help you understand which processes are likely to benefit from RPA.

The benefits of RPA

Robotic process automation has proven it can release health care professionals from administrative tasks and reduce operational costs. It can also improve quality and compliance using proactive record management. For example, used in HR and recruitment, it can increase efficiency by:

• Increasing the productivity of recruitment staff
• Reducing vacancies by filling positions faster and more efficiently, finding candidates quicker, and improving staff retention due to increased staff satisfaction and wellbeing
• Speeding up the onboarding process
• Reducing costs by lowering the need for temporary bank and agency staff

Identifying automation opportunities

Select processes that:.

• Require improvement / could be better ( like regular Master data file updates)
• Are time consuming or time critical (like repetitive monthly reports and procedures)
• Are high volume and frequent ( like extracting, capturing, and filing data)
• Are logical and rules based ( like matching up or alignment of data sets)

Identify where your team is:

• Gathering data from multiple sources / systems ( like capturing new starter informationfrom their application)
• Transferring data from one system to another (like setting up a new starter across multiple systems)
• Checking data consistency (like checking you’ve entered the correct data)
• Updating identical data across multiple systems (like setting up new starters in various NHS systems)

RPA case studies

Selected to become an NHS Centre of Excellence (CoE), Northampton General Hospital’s Automation Accelerator programme has identified over 500 viable automation opportunities across multiple NHS organisations. The potential automation ideas are projected to repurpose around 115,000 hours per year - that’s over half a million hours over the next 5 years. This is expected to greatly increase as more Trusts work with the CoE.

Blackpool Teaching Hospitals streamlined and automated their new Single Point of Discharge (SPoD) service for hospital patients. The integrated solution allowed hospital nursing staff to make a single, simple referral to the SPoD where the patient is reviewed, triaged and signposted into the most appropriate downstream out-of-hospital service. As a result, they:

• Reduced rekeying of data between systems
• Improved referral quality and accuracy
• Reduced discharge delays
• Reductions in length of stay in hospital

West Suffolk NHS Foundation Trust used robotic process automation (RPA) to streamline outpatient updates and e-prescribing by integrating kiosks with patient administrative systems (PAS) through a proof of concept. Processing around 500 appointments per day, the automation automatically updates the PAS with patient check-ins and any changes made. This released receptionists from manually transferring data between two systems, and saved clinicians time by automatically notifying them of patient arrivals.

RPA resources

If you work in the NHS, you can access resources about RPA on the Future NHS RPA Community of Practice . Examples of resources include:

• an introduction to RPA
• case studies and good practice guidance, providing you with tried and tested approaches
• guidance on how the technology should be used
• forums to connect and collaborate with peers

If you would like to get involved, you can join our XR community of practice here or read more about our achievements, plans and aspirations for XR here.

XR discovery: opportunities within the NHS

XR is an umbrella term for immersive technologies that blend the digital world with the real world. This can be on a small scale - like visual overlays that interact with your current, real environment - to entire simulated worlds. Examples of XR technologies include assisted reality, virtual reality (VR), augmented reality (AR), and mixed reality (MR).

The digital productivity team has carried out discovery work to understand how the NHS and social care can safely use extended reality technologies such as virtual reality and augmented reality, and maximise its benefits. This has helped us understand the current use of XR in health, identify current and future opportunity areas and inform guidance on the infrastructure needed to support this.

Our work involves generating real-world evidence for the NHS and managing a community that supports sharing of knowledge and best practice between health and care providers, technology suppliers and innovators, arms length bodies and research organisations. We have been collating evidence and insights to highlight the benefits of using virtual or extended reality to improve patient experience and reduce pressure on care , whilst building recommendations for good practice.

The benefits of XR

Our team has been working to understand the capabilities of XR, and its current use in the NHS and healthcare internationally. We found that XR was being used in a multitude of ways across the NHS and social care. The top four areas using XR were:

• Education and training for patients and staff
• Mental health and wellbeing
• Physiotherapy and rehabilitation
• Pain management

Other areas such as 3D visualisation of images or scans for pre-surgical planning, image guided surgeries and remote connections (for example for community nurses) were also mentioned.

The benefits associated with XR across these areas included:

• saving staff time
• improving staff experience
• increasing accessibility
• improving efficiency of services
• increased positive patient outcomes

These benefits align with key commitments outlined in the NHS 2022-23 business plan around delivery of more elective care, improving mental health services for everyone, and improving productivity across the health system.

XR case studies

There are multiple use cases and case studies that evidence the benefits and potential of XR across health and care, including some within the NHS. In 2019 Northumberland, Tyne and Wear NHS Foundation Trust completed a study involving immersive VR treatment of children with autism related phobias, with results showing that nearly 45% of patients remained phobia free six months after treatment.

At East Suffolk and North Essex NHS Foundation Trust trainee doctors are using virtual reality training equipment to practise endoscopy skills in an immersive and realistic way. Teachers are able to accurately assess students’ progress with the aim of maximising patient safety in real operations .

NHS North Lincolnshire CCG has leveraged XR to improve the retention rates of patients with Chronic Obstructive Pulmonary Disorder (COPD) . This has boosted patients’ independence and enabled patients to be treated more quickly. The CCG also hopes that this technology will reduce hospital visits. You can find out more here about how NHS Lincolnshire CCG used virtual reality.

Torbay and South Devon NHS Foundation Trust’s Digital Futures programme allows staff to be exposed to digital technology and empowers them to develop their own digital solutions within patient pathways, to improve patient experience and support health outcomes. So far, this includes the use of mixed reality headsets for remote consultation for breast wound care, and virtual reality to distract from pain or anxiety in toenail removal surgery. This has saved the trust £40,000 a year compared to traditional delivery of care . The program is also developing digital solutions in adolescent mental health and intensive care rehabilitation pathways and remote multiple sclerosis consultations.

Join our RFID / RTLS community of practice (FutureNHS) here , or read more about our achievements, plans and aspirations for RFID / RTLS here.

Improving standards of care and managing inventory using radio frequency identification (RFID)

RFID and RTLS can support health and care organisations with:

• medical device tracking
• stock and inventory management
• patient flow management

Key benefits identified by successful sites include lower costs - associated with reductions in waste, over ordering and lost items - improved patient and staff experience, and time saved.

RFID case studies

Passive radio frequency identification (RFID) tagging at East Kent Hospitals NHS Foundation Trust has led to less time spent looking for medical devices, reduced delays to patient care, and improved employee and patient experience. You can read more here about how East Kent Hospitals used radio frequency identification.

Cambridge University Hospitals NHS Foundation Trust (CUH) has implemented medical equipment tracking using RFID. This enables automated reporting for clinical engineers and delivers significant time savings. The target for “average time taken to supply a device to a ward” was 30 minutes: the use of RFID has reduced this average to just 12 minutes, and audit times reduced from 90 minutes to just 8 minutes per ward. This efficiency has led to improved device utilisation and a better patient experience.

Our digital productivity journey: achievements, plans and aspirations

Our Digital Productivity programme aims to accelerate the adoption of evidence-based digital tools to improve productivity across the NHS and deliver care and treatments to more patients, improve the quality of care, reduce the burden on the workforce, save time, lower costs, reduce waste, and increase patient and staff satisfaction. Find out more below about the achievements, plans and future aspirations for our key projects within the programme, including Robotic Process Automation (RPA), Real Time Locating Systems/Radio Frequency Identification (RTLS/RFID) and Extended Reality Technologies (XR).

Robotic Process Automation (RPA)

Aim: to improve robotic process automation capability across as many NHS services as possible by 2024.

Our achievements

• Distributed £7.5 million to RPA projects across 32 sites through the Unified Tech Fund (UTF) 
• Published the first National RPA Guidance on designing, sustaining and delivering automation within healthcare, and developed user-experience videos
• Developed National RPA Community of Practice for the public sector, sharing knowledge and best practice. Join here .
• Commissioned two Centre of Excellence pilot sites (The Royal Free London and Northampton General Hospital) to spread their knowledge and expertise by automating 42 processes in 21 organisations within 12 weeks
• Published a Global Digital Exemplar Blueprint built by Northampton General Hospital, to demonstrate the improved workflow via automation across multiple NHS trusts, along with their learnings and recommendations
• Conducted the discovery work for Primary Care and Intelligent Automation (IA), to gain insight on IA capability with the NHS and investigate how quality of care can be improved through the application of IA
• Distributed £6.2million to RPA projects through The Elective Recovery Transformation Investment Fund with £4.5m dedicated to Midlands region RPA accelerator
• Established a new board. Executive Sponsor Tim Ferris, chaired by Caroline Clarke CEO Royal Free Hospitals
• Develop the first e-learning programme - the first of its kind - for NHS staff in association with Health Education England (HEE)

Our delivery plans (2022/23)

• Developing first RPA e-learning programme for the NHS staff in association with HEE and ELFH
• Generating evidence of impact from applications of RPA from the UTF sites over the next 2 years, to track the benefits of implementation
• Publishing RPA Blueprints in collaboration with UTF sites to demonstrate how optimisation of processes is achieved through RPA, along with learnings and recommendations
• Developing an open source RPA repository on GitHub, where public sector organisations can freely share and obtain codes for various processes across multiple vendors
• Developing a robust plan for Diagnostics. Prioritising Imaging, Pathology and Community Diagnostics Centres capability for automated scheduling and booking, mapping and baselining potential by October 22
• Smashing our target deliverable of 40% coverage in 2022, every ICS has automation capability covering MH, community, ambulance, primary care and acute sectors
• Established the whole region RPA Accelerator programme. 11 ICSs, 1000 organisations reach of opportunity. 65 processes developed across elective recovery, clinical admin and back office functions. First regional approach led by the Midlands Region.
• Develop the New Hospital Programme where Blueprints automation capability is a core architecture solution in the footprint for enabling transformation

Our future aspirations (2023 onwards)

• Enabling major digital transformation programmes through RPA, including People Digital Strategy and Diagnostics Programme delivery
• Accelerating the spread of RPA technologies across the system, aiming for at least 40% of Integrated Care Boards to have RPA capabilities by 2023/24
• Using Kirkpatrick’s methodology to evaluate the first national RPA training programme
• Continue the growth of the RPA Community of Practice as a key tool for knowledge sharing and networking
• Intelligent automation discovery, unlocking the potential for intelligent automation capabilities as the evolution of RPA, including natural language processing, optical character recognition, speech recognition, ambient and sentient capabilities and machine learning.
• Support the Elective recovery programme. Unlocking the potential of automation within clinical admin and elective services, collaborating across the system of experts to achieve the national objectives
• Accelerate automation update in HR. Collaborating with the People Directorate to showcase the opportunities for automation with HR functions, supporting the HR and OD Plan
• Continue with extensive communications and engagement plans. Ensuring the enablement of automation capabilities to be maximised across healthcare,. Partake in external events to showcase the tech and raise awareness of its value.
• Develop the 2023-25 plans for Intelligent Automation. As set out in our 5 year roadmap, evolving to IA unlocks greater potential for automation enablement. Developing and publishing our plans is crucial to achieving the vision in 2025.
• Joining up the wealth of expertise and talent to achieve the national potential

Radio Frequency Identification (RFID) / Real Time Location Systems (RTLS)

Aim: To support successful adoption of Radio Frequency Identification (RFID) / Real Time Location Systems (RTLS) across as many NHS organisations as possible by 2024.

• Designed the National community of practice for clinical engineers, IT and other NHS staff linked to RTLS projects.
• We completed the discovery phase, where we interviewed and surveyed stakeholders to explore the uses of RTLS, to identify the potential for adoption. This was summarised in a blog published on the NHS England website.
• Distributed £1.6 million to 10 sites looking to deploy RTLS and generate evidence of impact
• Generating evidence of impact from applications of RTLS from our Unified Tech Fund sites over the course of the next 2 years
• Continue to grow the community of practice (FutureNHS) both in membership and useful content including case studies and example business cases
• A Blueprint is currently being created by Hull University Teaching Hospitals NHS Trust, which will act as an exemplar for other organisations looking to do a similar project, and provide learnings and recommendations
• To review current legislation, policy, regulations and standards and provide recommendations for improvement
• Share evidence of impact generated by the 10 funded sites across the wider NHS to build confidence in the workforce to use RTLS to increase productivity
• Increase adoption of RFID / RTLS across the NHS

Extended reality (XR) including virtual, augmented and mixed reality

Aim: to build a world-class ecosystem for XR technologies in healthcare, improving productivity and patient outcomes

• Analysed over 250 case studies and academic papers, and engaged with over 100 stakeholders to identify potential application areas of XR
• Built the XR in Healthcare community platform for knowledge and best practice sharing
• Awarded 14 sites with £2 million from the Unified Tech Fund to pilot XR and generate evidence and learnings
• Commissioned a discovery on XR to gain a better understanding of its capabilities in healthcare
• Establish a clear route to market for XR in education and training to be taken forward by Health Education England
• Publish findings from the discovery work to develop an ambition statement for XR
• Generate evidence of impact including from our funded 14 sites over the next 1-2 years
• Develop and publish case studies and blueprints to share knowledge and good practice
• Build a public dynamic tool to help find relevant XR evidence based on unique user needs
• Build a benefits, risks and costs framework to standardise evaluation of XR projects
• Collaborate on the development of a national strategy to enable effective and safe use of XR in the NHS and social care
• Continue to generate and build evidence of impact
• Publish resource to support those developing, buying and selling XR in healthcare

Digital productivity opportunity pipeline

Aim: to identify and evaluate digital productivity opportunities which could benefit health and care services at scale.

• Reviewed the evidence for multiple new and innovative technologies that have the potential to generate benefit, including blockchain, drones and 3D printing in health and social care
• Joined up our ways of working with the Academic Health Science Networks (AHSNs) to support research and scale of proven innovations in healthcare
• Developed a pipeline process for all technologies under our review based on their maturity and readiness for scale
• Continue to carry out research to identify technologies with the potential to improve productivity
• Prioritise the review of technologies with the strongest alignment to NHS initiatives such as the MedTech Funding Mandate and the Artificial Intelligence Award
• Evaluate the cost-effectiveness of technologies with the strongest potential to improve productivity and partner with other teams working on these technologies to reduce duplication and silos
• Provide subject matter expertise and direction to other teams within NHS England such as the Accelerated Access Collaborative (AAC) to support the use of proven technologies with productivity benefits within the NHS and social care in England

Benefits, research and reporting

Aim: to ensure the Digital Productivity programme is benefits focused, and continuously evaluating evidence and research to achieve maximum gain/impact for the NHS.

• We have used artificial intelligence to analyse over 500 pieces of research - ensuring that our programme is evidence based, supports horizon scanning for our pipeline, and informs our technology workstreams
• Supported over 100 NHS Providers to understand reporting productivity related benefits
• Developed digital productivity benefits reporting guidance and documentation for over 60 Unified Tech Fund sites
• Developed benefits and evaluation frameworks for RPA and RTLS to support NHS providers and suppliers to evaluate their impact
• Tracking 400+ measures of impact for 67 Unified Technology Fund sites - supporting some sites to publish a blueprint for implementation at local level
• Develop unified productivity metrics across the NHS
• Supporting the pipeline of proven productivity improving technologies through appropriate support and change management with the system
• Help steer robust evaluation of the programmes work
• Collect and analyse evidence for the benefits of implementing productivity improving tools for NHS staff, patients, the public and the wider NHS
• Develop a benefits and evaluation framework for XR technology that incorporates cost and risk
• Deliver a set of unified metrics for productivity informed by the 60 Unified Tech Fund benefits and developing a unified metrics dashboard which visualises the impact of our work
• Publish digital productivity playbooks to increase confidence in adopting digital technologies and realising positive productivity outcomes
• Publish our two year impact report (end of 22/23 FY)

Get in touch

Discover how we can help you to adopt digital technologies to improve productivity, or share your experiences with us, by joining us on the Future NHS collaboration platform, or emailing: [email protected] .

Related Pages

Digital productivity fund.