Successive Governments have recognised the importance of moving the NHS onto a digital footing. “Digital transformation” encompasses “digitising” services and processes that have traditionally been delivered physically, and greater use of innovative approaches to care that are enabled by advances in technology. Digital transformation is vital for the long-term sustainability of the health service: the Department of Health and Social Care (the Department) and NHS England believe that a shift to digital channels (such as the NHS App) is necessary to delivering priorities such as reducing care backlogs and improving access to primary care. Digital can also deliver improvements in care to patients, ranging from increased convenience to access to cutting-edge treatments and diagnostics.
Past attempts at digital transformation have been frustrated by a number of factors. These include the preponderance of old, out-of-date “legacy” IT systems and hardware that cannot handle the demands of a modern digital health service. Parts of the health service still lack even the most basic, functioning IT equipment. The Government recognises that “levelling up” NHS organisations’ digital capacity to a minimum standard is necessary if digital transformation is to proceed across the board. There is reason to be optimistic about the Government’s approach, but it will need to address the mistakes of past attempts if it is going to succeed.
Digital transformation is not just about new technology. Equally important is the role of the workforce, from leaders to clinicians and frontline staff. Attracting enough skilled digital specialists to the healthcare workforce has long been a challenge, as it is across the civil service: digital specialists can often command better remuneration in the private sector. We recommend that the Government allow NHS England to move away from Agenda for Change pay scales when recruiting Data, Digital and Technology (DDaT) specialists to ensure it can recruit and retain the people that it needs.
Without wider staff engagement, digital transformation risks being perceived as an unwelcome, time-consuming imposition on an already over-stretched workforce. Coproducing digital initiatives with staff—including, but not limited to clinicians—is essential to ensure that these offer improvements to existing working practices and problems. The Government must ensure that those working in the NHS have the time and headspace to engage with digital transformation. The Government must also address the long-recognised digital skills gaps in the NHS and social care workforces. We recommend that the Department of Health and Social Care work with NHS England and Skills for Care to design training in which digital skills are embedded throughout.
Digital healthcare accelerated during Covid-19. For many patients this worked well, but not for everyone. The Government has a role in addressing the reasons why people might find themselves excluded from, or chose to opt out of digital services: these include problems around access to technology, digital skills and confidence, and motivation to use a digital service. People who are “digitally excluded” from health services are also likely to experience digitally exclusion more widely, making this a much broader problem than the Department can address alone. A cross-government approach will be crucial to success.
Other challenges around exclusion or opting out require a more specific response. The Department will need to clearly set out the benefits of using technology, as well as addressing risks and patient concerns. This is important in encouraging people to use services such as the NHS App, which the Department and NHS England intend to develop as “front door” to NHS services that can alleviate pressure in the wider system. Its success in achieving this will depend on whether it can present a compelling case for using the App, such as when it was used to host the Covid pass in 2021.
More widely, health apps offer an accessible entry point into digital services—but it can be almost impossible for patients to identify quality apps from ones that present risks in terms of efficacy or security. The Department and NHS England should introduce an NHS accreditation scheme for apps, which should be used in their wider communications addressing the risks, and benefits, associated with digital healthcare.
As the Government seeks to tackle digital exclusion, it should not forget that there will always be people who need or prefer non-digital channels. The NHS is a universal service. The Government must ensure that it maintains twin-track digital and non-digital services to prevent people from missing out on healthcare that they are entitled to.