NHSX has identified three areas for the focus of much of its work in the next few months, according its chief executive Matthew Gould.
Taking part in an onstage interview at the Digital Health Rewired conference – a few days after the publication of the Digital Health Technology Standard – the head of the policy unit for digital issues in the Department for Health and Social Care outlined the next steps from last year’s focus on standards and platforms.
Asked about where NHSX plans to direct its efforts in the short to medium term, Gould said: “Number one, and it’s not obviously an area for a quick win but one in which we can do something, is for information governance. Getting this right is incredibly important and protecting patient confidentiality is sacrosanct.”
He said there are currently problems with the overlapping rules and laws on how patient information can be used, such as the Caldicott Principles, the common law duty of confidentiality, the Data Protection Act and General Data Protection Regulation. Several organisations are providing guidance and, combined with the knowledge that getting it wrong can create big problems, it has creted a situation in which even sharing for direct care – which is obliged under the Caldicott Principles – is not always happening when it should.
Gould said he has been talking with the relevant parties to develop more coherent and straightforward guidance, adding that it won’t necessarily work for the “edge cases” but will work for standard cases.
Need for productivity
A second area is to encourage the adoption of productivity applications in the health service. Gould pointed to an element of the recently published operational guidance that said providers are expected to make use of applications that boost productivity, while also acknowledging that the organisations with the most need are often those that have the least bandwidth for deployment.
In response, NHSX is aiming to provide ways of supporting deployment, although it is still working out the best way to do it.
The third area is to focus on the Digital Aspirant Programme, which is aimed at helping organisations follow the lead of successful exemplars in making more of digital solutions.
“It’s not just about the best of what we do, but about how we do it,” Gould said. “I’m really keen that in the Digital Aspirant Programme we have light touch governance, working on the basis of presumed trust, presumed competence. We don’t require massive lengthy form filling every month, but work on the basis that everyone in the system has tried their best.
“There is limited bandwidth so we need it to be used on the actual thing rather than the governance, but nonetheless, if people don’t fulfil the much shorter list of commitments we set out, then there will be consequences.”
He added that the programme is still under design but is likely to be carried out in waves.
Despite the close attention to technology, Gould emphasised that the effort is as much about people and systems, and said there will be a significant investment in the Digital Ready Workforce Programme for the NHS.
This will involve three main elements, the first being the building of communities for technology people in the health service to ensure they are able to learn from each other and adopt best practice.
“We also want to make sure that these staff – and there are tens of thousands of them across the system – have all the benefits of being part of professions, “Gould said. “That’s all the accreditation, training, kudos and rewards that go with being part of an acknowledged profession.”
Second is a focus on leadership to give organisations’ boards the confidence to focus on transformations; and third is ensuring that people coming into the workforce know about the digital tools and are confident in using them.
While NHSX does not want to be too prescriptive over what organisations should be spending on their digital technology, Gould said it will be looking at whether there are minimal and optimal levels. He acknowledged there is probably an “irreducible amount” needed to keep everything working, but that it is also possible to waste money and it is important to spend it well.
In response, it is aiming to appoint a commercial lead in the near future.
“We want to think about what we should be negotiating and purchasing nationally, and what we should be negotiating nationally but purchasing locally,” Gould said. “And where we leave it to the system to purchase tech locally, what support can we give in terms of advice, terms of conditions and market information.
“It’s all part of trying to improve the help we give the frontline.”
The subject of supporting the integration of health and social care also emerged, prompting Gould to say NHSX has created a team focused on the issue, and that the core of its effort will be focused on standards.
“It’s partly because it’s a different sort of sector from health, with a huge number of providers, many of which are private or not-for-profit. We’ve set up a forum with the sector and the message has come through loud and clear that it needs standards, for technology, for how we describe things, and they need to read across to the standards in health so that data can flow effectively between the two.
“Our intention for health and care is to publish a catalogue of open standards, so it’s really clear when people are doing things for transformation what needs to be complied with, and if it is compliant in social care or health we can have some confidence that systems will be able to talk to each other.”
Gould was also questioned about the response to the spread of coronavirus, the threat of which was rising on the day of the conference. Again, he outlined a threefold response: improving the capabilities of the NHS 111 online service to reduce the pressure of the contact centre; meeting an increased need for remote consultations with doctors; and establishing how the NHS can use data more effectively to deal with the outbreak.
The emergency demonstrates that the demands on NHSX are varied and likely to change over time, but Gould emphasised that it needs to strike a balance between responding to these while providing a coherent, long term approach that reflects the underlying pressures on the health service.
“Some of this is emphatically for the long haul,” he said. “We need to show we are doing stuff and keep a steady nerve for the next few years, not just chopping and changing.”
Image from GOV.UK, Open Government Licence v3.0