Listening to digital health innovators report 2021

Published 20 August 2021


Foreword from Tara Donnelly

Welcome to the second listening to digital health innovators report. The first report, published in the autumn of 2019, outlined the five themes that digital health innovators identified at that time as the main issues they faced as barriers to adoption, and the subsequent work that NHSX was undertaking to address these.

This report, compiled in the spring of 2021, reflects the impact of the pandemic for companies who have been working closely with the NHS and social care. The past year has challenged health systems globally and seen rapid growth in digital health care in many countries across the world. We have sought to lead the way in the NHS in England and a number of digital health solutions have made an enormous contribution, such as connecting citizens with clinical teams, enabling care and consultations to continue at a distance, providing remote specialist advice or through linking up care homes to medical support. The pace has also been remarkable, with deployments taking place within days and weeks rather than months or years, with no corners cut but decision making happening at the speed of light and brilliant team work to ensure patients benefit as rapidly as possible.

The 15 months between the first Listening to innovators report and this one have seen unprecedented change in the way that healthcare is delivered by the NHS. Although the NHS Long Term Plan has guided accelerated strategic delivery of digital technology during the pandemic, many tactical decisions have needed to be taken to deliver more care, more quickly, in difficult environments. There have been opportunities for digital innovators, but also new challenges around standards and governance that NHSX has been addressing.

This report picks out five themes that innovators have highlighted over the course of the pandemic and how NHSX is addressing them:

  • Accelerated digital adoption was evident across the NHS, but supported by smarter procurement frameworks and enhanced information governance (IG) support in a new IG page on the website
  • Approach and delivery for digital solutions have been accelerated with remote first care implemented across the NHS. NHSX has sponsored remote care through the adoption of new digital pathways, virtual wards, and virtual primary care appointments across England. This was a huge change in delivery that the technology companies and the NHS collectively made last year.
  • Expanding services has been essential for both the NHS and innovators in order to pivot to meet the changing demand that COVID has brought. Supported innovators are with guide and providers with Digital Technology Assessment Criteria for Health and Social Care (DTAC), an entry level technology standards framework and a guide to good practice for digital and data-driven health and care technologies, a report to help innovators understand what the NHS looks for in digital and data driven technologies.
  • Responding to service provision outside the pandemic outlines the major initiatives beyond the COVID pandemic. This includes AI laboratory strategy, digital playbooks and accessing health and care records which are being rolled out across the health and social care.
  • Digital capabilities of the NHS is a concern to innovators. There are programmes supporting the digital skills of NHS boards, skills training for clinical teams, training for all staff under the digital ready workforce programme as well as the flagship Digital Academy.

I was heartened to read that digital health innovators consider that there has been greater recognition of them as partners as a result. There are increased levels of enthusiasm for digital products across the NHS and our mission is to make sure that NHS and social care staff are aware of the developments in devices and digital platforms that can truly transform care and that the momentum gained in the past year supports a continued move of digital innovations to be part of mainstream healthcare.

A great deal has changed over the last year but despite difficult times, digital health solutions have made an enormous contribution and our commitment to enabling better care through technology remains stronger than ever.

Tara Donnelly, Chief Digital Officer, NHSX

Introduction

NHSX has a clear ambition and strategy to digitise, connect and transform health and social care and an important part of this to encourage digital innovation to flourish; to solve problems and improve services delivered to citizens.

Since the global COVID-19 pandemic and national lockdown measures, both citizens and providers of health and social care have adopted digital technology as a conduit to care and the demand for more digital pathways has accelerated.

The NHS now needs to embed these changes in order to succeed. Digital innovators are key to this. The listening to digital health innovators report aims to outline and respond to the top five themes that digital innovators need to help accelerate and scale change, as well as highlighting the work that NHSX are undertaking in this area to further support this agenda. The report is the second in our series.

About NHSX

NHSX is a joint unit of NHS England and NHS Improvement and the Department of Health and Social Care, supporting local NHS and care organisations to:

  • digitise their services
  • connect the health and social care systems through technology
  • transform the way patients’ care is delivered at home, in the community and in hospital

You can read more about NHSX and what we do.

Why we listen to innovators

When NHSX launched in July 2019, we committed to creating an environment where digital innovation could flourish. Since then, we have worked closely with a wide range of stakeholders to put in place the mechanisms and environment to support adoption and address key barriers that were recognised by technology companies who work with the NHS.

It is important to acknowledge the changes to all our lives since the onset of the COVID-19 pandemic. Digital health has been central to our response. A number of technologies have been adopted very rapidly to support virtual consultations, remote monitoring, and to support the diagnosis and treatment of patients with COVID-19. Whilst there has been an acknowledgement of the contribution that technologies have made to support services within the pandemic - some digital programmes were paused as teams within the NHS were deployed to work on supporting patient care or vaccinations within the pandemic.

We published the first Listening to innovators report in October 2019 with five priority themes identified by technology companies that would improve the adoption of digital innovation within the NHS, and work that was underway to address these themes.

Since that report was published NHSX has implemented a number of recommendations. A procurement framework was commissioned which included a category for innovators within the Health Service Support Framework (HSSF). The Digital Technology Assessment Criteria was launched in beta in the autumn and in full in February 2021. This addresses much of the concern about standards raised in the initial report and is described in detail within this report.

Additionally, we have established a digital innovation function to provide support to innovators and lead work to scale digital tools across a priority area, supporting people at home through tech-enabled care. We have moved NHSX innovator events to virtual events, meaning we can open these sessions to a larger audience. We also held dozens of individual sessions with digital health innovators.

There is still much to do and we have undertaken three interactive polls and virtual workshops over the last four months to ask technology companies what the barriers and priorities are, following a turbulent 15 months. You can rewatch our events from December 2020 and March 2021.

As the ecosystem has changed throughout the COVID-19 pandemic, so have the priorities suppliers and innovators have highlighted to us that will become our focus for the next 12 months. The top five themes are listed below.

Five top themes

The responses quite understandably, focused on changes to their practise of the last year and how they had responded. The five highest themes are highlighted below:

  1. Accelerated digital adoption
  2. Approach and delivery
  3. Expanding services
  4. Non-COVID-19 work
  5. Digital capability

The priorities of technology standards and ease of procurement underpinned many of the themes above and we will describe our response to these within the document.

Some of the themes identified in this report resonate with the techUK Ten Point Plan for Healthtech, published in February. Digital capability within the NHS and a standards first approach to interoperability are picked up by both. However, whereas the techUK report makes recommendations for the NHS, the focus of listening to digital health innovators is aimed at understanding the needs of suppliers of digital technology and to make recommendations for how we as the NHS need to respond to these needs.

1. Accelerated digital adoption

The COVID-19 pandemic has led to an increase in the adoption of digital technologies in the NHS and changes to the way services are provided at an unprecedented pace. This was the most frequently raised topic, with innovators observing a marked increase in speed of decision making and deployment, a significant reduction in typical barriers, an increased interest from NHS staff and people towards digital transformation of care, and a recognition by the NHS that innovators were key delivery partners in response to the pandemic. Nonetheless, some innovators did note specific real and perceived barriers that still hinder adoption of their solutions, particularly in procurement and information governance.

Quotes

“...we have seen the usage nearly double throughout the pandemic. The pandemic has made us think more about how we can treat patients away from the hospital, through clinical innovation.” An NHS Advice and Guidance provider

“NHS partners have recognised our role in supporting digital delivery...” Anonymous

“At AWS we have supported over 150 [discrete] COVID-19 related projects, this has been an acceleration of digital adoption and a leap forward in digital confidence” Amazon Web Services

How are we responding

NHSX has supported adoption of technologies by giving simple and clearer guidance on information governance, which was raised as a key barrier to adoption from NHS teams and extending procurement frameworks to improve commissioning.

Procurement

NHSX has worked with NHS England and NHS Improvement and other NHS bodies to streamline what have been seen as onerous procurement processes.

This has seen the production of a new section on the Health Systems Support framework (HSSF) to respond to the requirements of new technologies.

The HSSF provides a quick and easy route to access support services from innovative third party suppliers at the leading edge of health and care system reform, including advanced analytics, population health management, digital and service transformation.

There have also been new strands of work on remote monitoring and ophthalmology (see section on Innovation Delivery, further on) where frameworks have allowed NHS teams to be introduced to the range of suppliers that meet the standards of the framework. Suppliers of innovations that deliver improvements to these digital pathways can include themselves on the following frameworks:

We acknowledge that more work needs to be done in this area and a full review of procurement by the NHSX commercial team is scheduled in 2021. NHSX, together with NHS England and NHS Improvement, is working on a commercial transformational project to establish framework governance models that span the digital category, with links to co-ordinated frameworks as well as non-framework procurements that cover all areas of digital and IT spend across the whole care system. This work seeks to deliver a framework strategy, rationalising frameworks and supporting vendors and buyers on their procurement journey.

The outcome will be to establish a central support model that steers vendors and buyers towards standard buying approaches and helps address the commercial challenges highlighted above. Among other things, it would lead to:

  • rationalisation of routes to market, focus buyers and suppliers to deliver value for money solutions
  • provide an agile mechanism to meet evolving data, technical and digital standards
  • leverage collective buying power to drive market investment and continuous improvement in the digital solutions being offered

Information governance

One of the biggest concerns from NHS staff is ensuring that they are acting in accordance with data protection law and the commitment's on confidentiality that their organisations have made. Expediting and publishing guidance to NHS staff and technology companies has streamlined the discussions on data governance.

In October 2020, NHSX launched an information governance (IG) portal to provide advice and guidance on using tools such as video conferencing, mobile messaging and using your own device.

Innovators are often unclear as to who they should speak to regarding IG. This question has repeatedly emerged over the last year with the rapid deployments taking place for COVID-19. Innovators should always contact the organisation’s data protection officer (DPO). Any organisation that determines the purpose and means of processing personal data is a data controller and as such they have the final call on IG issues. Your route to them should always be via your organisation’s DPO.

For specialist advice, health sector organisations entering into data partnerships can contact the Centre for Improving Data Collaboration (CIDC) to ensure they align with DHSC’s five guiding principles for data sharing. NHSX’s IG team works closely with the CIDC to provide support where any IG issues arise to ensure a consistent approach.

Looking to the future, NHSX is simplifying, raising awareness and increasing understanding of IG to bust the myth that IG is a blocker to innovation. We want to support you to ensure that IG is factored in at the design stage so that you can ensure that you arrange adequate protections at the start. Watch out for our step by step guide, IG for innovators, which is coming next year.

2. Approach and delivery

Another trend in the responses from innovators was how they changed their approach to delivering digital technologies to the NHS over the last year. The relationships between technology companies and the NHS has changed and is largely managed remotely.

Pressures to deliver both at pace and remotely were expressed, with a large number of innovators highlighting the many positive benefits this brought such as efficiencies in time and cost, and the opportunities to develop digital transformation training. There were also some questions raised around how the relationship with stakeholders could be strengthened when delivering remotely.

Quotes

“We now deliver completely remotely.” Anonymous

“It has required a reflection on what, when and how to present innovations to stakeholders in the health and care system” Anonymous

“COVID-19 has increased my skills for digital delivery. I plan my meetings and presentations in advance and email any materials in advance. I can reach larger audiences.” Anonymous

“Already being mature in remote working and coordination plus a good cloud platform, the impact on delivery has been minimal. However, customers' and suppliers' needs have changed massively because of the pandemic.” Anonymous

How are we responding

NHSX has also changed its way of working, innovation events are still run every quarter as virtual updates and the attendance has increased as a result of removing the barrier of location. Our events are now attended by over 300 attendees. The Innovation team also works with the AHSN Network, NHS England and NHS Improvement innovation service, DHSC Test and Trace service, the Department of Business, Energy and Industrial Strategy (BEIS), vaccination service and others to signpost relevant innovators when appropriate.

Innovation Intel Unit (IIU)

Working as part of the innovation team within NHSX, the Innovation Intel Unit has been set up to engage with innovators of digital technology as well as partner organisations such as Academic Health Science Networks (AHSNs), the Accelerated Access Collaborative (AAC) and other arm’s length bodies.

Using data from the innovations and experiences of innovators, the IIU will seek to build an evidence base of trends, both inside and outside UK healthcare and the barriers to adoption of positively disruptive technology. This, in turn, will provide a holistic approach to creating an environment that supports and encourages innovation. Through working closely with AHSNs and the AAC, we aim to streamline access to the right advice, guidance, resources and tools to support adoption and scale.

Innovation delivery

In addition to technology teams working remotely, there has been a shift to deliver NHS care remotely. During the first wave of the pandemic, NHSX launched a number of initiatives that delivered care remotely using digital technology provided by innovators. Virtual consultations in primary and secondary care were rolled out at pace with patients receiving care by video consultations. Virtual COVID-19 wards were established on a pilot in Hertfordshire and North West London. Patients’ vital signs were measured at home and monitored centrally by clinicians. The programme has subsequently been rolled out to over 90 organisations nationally.

With the impact of the COVID-19 virtual wards, NHSX extended the programme of pathway digitisation to other clinical areas. This included:

  • image sharing for ophthalmology
  • dermatology
  • hypertension
  • clinical communications tools across a number of clinical disciplines

Innovators who wish to be included in this work can join the procurement frameworks mentioned in section 1.

Closer working and engagement with regions - digital health

In addition to the impact of COVID-19 on the NHS and provision of care, innovators highlighted the way they were delivering digital technologies to the NHS. There were also some questions raised around how the relationship with stakeholders could be strengthened when delivering remotely.

NHSX worked with NHS regional teams, ICSs, CCGs and provider trusts to rapidly review and approve bids for funding for remote monitoring solutions that could be deployed at pace to benefit patients and local health services. Bids were approved from emergency COVID-19 funding totalling £18m covering all seven NHS regions and involving almost every ICS. These services were established very rapidly and, as of June 2021, are reaching 80,000 people across the country with plans for greater scale in the year ahead.

3. Expanding services

The impact of COVID-19 has been felt across the health and care sector and its related markets, with customer and supplier needs changing due to the pandemic.

Innovators said that they have had to diversify services and increase functionalities offered by their digital solutions. This has raised challenges around prioritisation of feature development, particularly to support clinical decision making and remote care, and the need to deliver at speed whilst meeting regulations and standards.

Quotes

“We have had to diversify our services in new ways to help services cope with the strain of pushing service users online. The change requested has been on a scale we have not seen before.” Anonymous

“[It has been] challenging responding to the speed required to get stuff operational while making sure that it is both fit for purpose and secure in terms of data protection and data flows.” Anonymous

75% of innovators said they have developed or added additional services due to COVID-19.

Pie chart showing 75% of innovators have developed or added additional services

How are we responding

NHSX is working to simplify disparate standards and processes for innovators to access what they need in order to comply with various technical and clinical requirements.

Digital Technology Assessment Criteria for Health and Social Care

Following wide consultation and issuing a beta edition in autumn 2020, the Innovation Development team launched the Digital Technology Assessment Criteria for Health and Social Care on 23 February 2021. DTAC gives staff, patients and citizens confidence that the digital health tools they use meet our clinical safety, data protection, technical security, interoperability and usability and accessibility standards. This replaces the Digital Assessment Questionnaire (DAQ). There have been a range of events about DTAC that provide a deeper insight.

The NHSX Innovation Development team listened to feedback from digital health technology developers that the DAQ had become overly complex, with little reward and not proportional to their technology. In addition, the DAQ was aimed only at app developers rather than digital technologies as a whole.

DTAC was designed to help health innovators and developers understand a baseline set of standards and best practices required in order to offer their solution to the wider NHS. It focuses on five areas:

  • Clinical safety
  • Data protection
  • Technical assurance
  • Interoperability
  • Usability and accessibility

All digital health products looking to achieve take up in the NHS or social care need to have completed the assessment as this will be the future expectation. NHSX is working with national and local policy teams, suppliers and a number of arm's length bodies to ensure that DTAC is adopted across the entire NHS ecosystem, ensuring that digital health technologies are safe and effective.

A guide to good practice for digital and data-driven health and care technologies

The NHS AI Lab team in October 2020 published a guide to good practice for digital and data-driven health and care technologies, designed to support innovators in understanding what the NHS is looking for when it buys digital and data-driven technology for use in health and care. The guide supports innovators so that these principles of good practice can be built into the strategy and product development "by design". This in turn will ensure that when products are presented for procurement or assessment, many of the criteria in the specification will have already been met. The intention is to ensure that the path between development and procurement is seamless so that the NHS may realise the benefits that digital technologies can bring.

DTAC and guide to good practice for digital and data-driven health and care technologies combined articulate a clear ambition for the generation of digital services designed around individuals needs and which adhere to key principles of privacy, security, interoperability, clinical safety, accessibility and inclusion.

Standards and interoperability

NHSX aims to ensure that digital technology is at the forefront of improving outcomes for citizens and transforming how care is delivered nationally. In the NHS there is currently not a clearly defined set of interoperability standards across the health and social care system. As different healthcare providers often adopt standards on an individual basis which leads to a varied landscape of standards and levels of quality this unfortunately proves difficult to identify the latest version of a particular standard or any further iterations to an existing standard.

The standards and interoperability team within NHSX is leading a piece of work which will ensure an authoritative single source of information for interoperability standards. This will be the standards catalogue, although a final name has yet to be determined. The catalogue will provide a comprehensive online listing of all approved information standards, technical standards and vocabularies to provide clarity and drive adoption.

It is still a work in practice that is currently being developed but there will be search, filtering and grouping capabilities to increase the accessibility of existing standards. Currently user research is being undertaken to understand the needs of different user groups and stakeholders to ensure that the catalogue will make standards easier to find, use, and assess compliance against. Relevant standards identified will be incorporated into the baseline DTAC standard where possible.

4. Responding to service provision outside of the pandemic

The focus of the NHS in responding to the COVID-19 pandemic has meant that many innovators have found it difficult to progress digital solutions for non-COVID-19 related services. Innovators also said that they faced challenges around progressing integrations with NHS systems for digital solutions that were deployed prior to the first wave of COVID-19 in March 2020.

Quotes

“COVID-19 has had a negative impact on projects not directly related to the pandemic” Anonymous

“Slowed down IT integrations. Slowed down cancer screening and uptake of our solutions.” Anonymous

How are we responding

One of the core NHSX aims is to transform the way that patients’ care is delivered at home, in the community and in hospital. During the pandemic, thousands of people with COVID-19 have had their condition monitored remotely with pulse oximeters in NHSX projects in over 90 sites in England. We will continue to transform care pathways that support people’s care at home through tech-enabled care that enable patients' conditions to be managed by monitoring them remotely by clinicians. Across the NHS, work has been prioritised on building the architecture for shared care records, improving electronic records systems within health and social care settings and expanding the adoption of digital products that support patients at home and address areas of pressure for the NHS. A key piece of work that brings together examples of good practice is the work on digital playbooks which is outlined below.

Digital playbooks

Between December 2020 and July 2021, NHSX published 8 digital playbooks on its website, as part of a programme of work supporting the commitment to reduce face-to-face outpatient appointments by up to a third over the next five years, as set out in The NHS Long Term Plan. The digital playbooks currently cover the 8 highest-volume specialities:

NHSX is developing the digital playbooks to help clinical teams to reimagine and redesign care pathways of the future by building digital technology into the modern patient journey. The aim is to help increase efficiency, choice and access such as supporting patients at home rather than in hospital, to support clinical teams to find new ways to meet patient needs and restore services in a safe and sustainable way. These playbooks are in response to feedback from clinicians that they wanted a resource outlining what digital tools were available to help to digitise the care they provide. The playbooks show clinical staff what options are available and how they are being used in the NHS across the country, using detailed case studies to show how these tools could be adopted. The playbooks link to the guidance from NHS England and NHS Improvement, Royal Colleges and associations to pull together digital tools and guidance on pathway development.

Following the launch of the first 8 playbooks, the next 4 will be co-authored by clinical experts for the following specialties:

  • Renal
  • Rheumatology
  • Perioperative care,
  • Ear, Nose and Throat (ENT)

Accessing health and care records safely where ever it is needed

An issue facing innovators who try to integrate with well-established electronic health records (EHRs) is the lack of interoperability support. Offering FHIR or HL7 compliance is of little use if there is not an effective open application programming interface (API) to use in order to read and write data securely with other EHRs.

NHSX is engaged in driving the adoption of NHSX open technical standards through linking funding to accredited frameworks such as Health Systems Support Framework (for more information see the section on procurement frameworks above) and clinical and digital information systems that promote those standards.

AI Lab

The NHS AI Lab has a clear mission: to enable the safe, ethical and effective development, adoption and use of AI-driven technologies in the UK health and care system. This includes the design, deployment and diffusion of AI-driven technologies.

To achieve this the team has key areas of focus that span the life cycle of AI-driven technologies and the surrounding NHS ecosystem.

This is an overview of the support the NHS AI Lab is offering to innovators (both private and public sector) and the wider health and care system:

The AI in Health and Care Award

The AI in Health and Care Award is accelerating the testing and evaluation of AI-driven technologies most likely to meet the aims set out in the NHS Long Term Plan. The lab is providing four levels of award to support AI-driven technologies from initial feasibility to evaluation within NHS and social care settings. The opportunity to bid for monies is listed on their website.

The AI Lab Skunkworks programme

The AI Lab Skunkworks programme is supporting the trial of AI ideas from scratch to proof of concept. The skunkworks programme aims to find new ways to use AI for driving forward the early adoption of technology to support health, in both clinical and business contexts. In order to do this, the team is engaging with the wider health and care community to find new ideas for problems to tackle.

The AI imaging programme

The AI imaging programme is facilitating medical imaging data collection on a national scale, and providing this data for the rapid development and validation of AI-driven technologies. This work is informed by NHSX’s development of the National COVID-19 Chest Imaging Database (NCCID) in response to the COVID-19 pandemic.

The AI regulation programme

The AI regulation programme is enabling a safe, ethically robust and world leading regulatory ecosystem for the development and deployment of AI-driven technologies. The NHS AI Lab is working with the Medicines and Healthcare products Regulatory Agency (MHRA), the Health Research Authority (HRA), the Care Quality Commission (CQC), and the National Institute for Health and Care Excellence (NICE) to review and streamline regulatory frameworks and associated processes to ensure they are fit for purpose for the introduction of AI-driven technologies.

The AI Ethics Initiative

The AI Ethics Initiative is improving ethical and regulatory assurance for the development and deployment of AI-driven technologies in health and social care through research and the trialling of practical interventions. The ethics initiatives first projects focus on a research call on optimising AI to improve the health and care outcomes of minority ethnic communities, in collaboration with the Health Foundation, facilitating early-stage exploration of algorithmic risks with the Ada Lovelace Institute and empowering healthcare professionals to make the most of AI in partnership with Health Education England.

The NHS AI Virtual Hub

The NHS AI Virtual Hub on the Future NHS platform is a collaborative space dedicated to bringing people together to facilitate the development and deployment of safe, ethical AI in health and care. The hub also enables the NHS AI Lab’s team to seek expertise from, listen to, and consult with members. As of June 2021, there were over 750 members divided between NHS, academia, policy-makers, regulators and commissioners.

5. Digital capability

Innovators referenced that the shift towards digitising the NHS has improved digital confidence. There has been clear momentum in the NHS’s digital capabilities driven by the pandemic, and innovators emphasised the need to further improve the digital readiness and maturity of trusts and other NHS providers, upskilling the NHS workforce in digital technology, and ensuring there is a strong steer from leadership to procure digital solutions that solve defined user problems were also mentioned.

Quotes

“[We have seen] increased interest in adopting digital health from clinicians and patients. Only created small efficiency gains at present as it has been adopted but for true change digital needs to change the flows” Anonymous

“COVID-19 has transformed interest by clinicians in telemedicine and telehealth in primary care, which has resulted in much-increased demands on my time for assessing applications and advising on delivery choices.” Anonymous

“We need an accelerated approach to break down barriers and ensure all Trusts are digital ready and mature. We also need to ensure digital inclusion for the population to adopt digital technologies.” Anonymous

78% of innovators think the NHS is becoming more digitally capable and confident.

Pie chart showing that innovators think the NHS is becoming more digitally capable and confident.

How are we responding

The national workstream on increasing digital capability is being led by Health Education England (HEE) via the Digital Readiness programme. This builds upon the earlier Digital Readiness Programme, established in 2016 to 2017 as part of the Digital Transformation Portfolio on the back of Personalised Health and Care 2020 and the Five Year Forward View. The subsequent Wachter Review (2016) led to the establishment of the NHS Digital Academy. It is delivering upon requirements made in the Topol Review (2019), which explored how to prepare the healthcare workforce, through education and training, to deliver the digital future. The programme delivers upon the NHS Long Term Plan and NHS People Plan (2020).

This programme’s vision is to ensure the health and care workforce have the right skills to support new ways of working. That means:

  • leaders with the knowledge and confidence to drive digital transformation
  • digital professionals that have the training, reward, progression and respect they deserve
  • clinicians and support staff whose training includes an understanding of how digital and data can help them deliver high quality services to support patients and citizens
  • staff across the board have a base level of digital capability and confidence

We will know we have succeeded when:

  • every leader in the NHS and social care is confident about driving digitally-led change
  • systems and organisations have the right executive digital leadership
  • there are established professions for both clinical and non-clinical digital professionals, and when every new doctor, nurse and support professional is confident and digitally-literate in their delivery of clinical, care and operational practice

Delivery is focused around four broad areas:

  • Supporting the right culture and environment, including senior leader development and awareness.
  • Professionalising our digital workforce, including defining roles, standards, career paths, member bodies.
  • Establishing learning and development, including NHS Digital Academy, digital literacy for wider workforce.
  • Building our future digital workforce, including workforce planning and models to recruit and reskill.

This involves a regional adoption and sustainability model where most projects are applied at a regional or local level, evaluated and then scaled where successful. The programme works closely with academic health science networks (AHSNs) through the AHSN network and commissions and NHS England and NHS Improvement and HEE regional teams.

Delivery highlights to date:

Digital Boards programme

The 'Digital Boards' programme with NHS Providers involves interventions for trust leaders, including delivery in 2020 to 2021 of 24 board development sessions, with extremely positive feedback to date. Delivery continues through 2021 to 2022 and beyond.

Member bodies for informaticians

The Faculty of Clinical Informatics (FCI) has been established, now with over 800 members, as has the Federation of Informatics Professionals (FEDIP), an umbrella standards body. Business plans are in place to grow membership, diversity, member services, and move to self-sustainability.

Adapt and adopt Digital, Data and Technology (DDaT) roles

Work is underway with NHSX and NHSEI colleagues to standardise digital role descriptions. This will help contextualise future needs, including learning and development.

Supporting collaborative communities (digital networks)

Recommendations have been set out to provide a model to enable networks to grow (for example the Shuri network) and we are supporting existing digital networks.

Informatics Skills Development Network (ISDN) expansion

A regional 'ISDN in a Box' model has been developed based on successful North West and Yorkshire and Humber networks. This is also just launching into three further regions.

Workforce analysis and modelling (shape, number)

This was benchmarked with the industry, to inform future workforce planning work. Demand forecast modelling was also undertaken.

Graduates into Digital model

With the Health Innovation Network, we are expanding the model into 2 to 3 regions after a successful London pilot (circa 80-85 digital trust posts were filled in a year).

Topol Digital Fellowships in Healthcare

Cohort 1 (17 Fellows) has been completed. This provides time, support and training to lead digital transformation and innovation. Cohort 2 (35 Fellows) has just launched.

NHS Digital Academy

Cohort 3 (100 people) of the Digital Health Leadership programme is now underway. Around 200 digital change leaders already graduated from the first 2 cohorts. Cohort 4 applications opened in April for a September start. This is supported through significant expansion plans in 2021 to 2022 for the NHS Digital Academy including re-use of learning for a wider audience and further learning programmes including an online digital certification offering.

Digital Futures Programme (Yale delivery)

Digital development aimed at ICS teams of 3. Cohort 1 was well received and Cohort 2 was scheduled to commence in early 2021.

Digital literacy self-assessment tool and signposting to learning

Underpinned by the HEE Digital Capabilities framework, the Digital Literacy Self-Assessment Diagnostic Tool is starting to rollout for wide use following pilot testing and initial evaluation. We addressed the need to identify digital skills learning needs and signpost to appropriate learning.

Global digital exemplar blueprinting

In terms of digital maturity NHSX has now worked with around 70 NHS trusts to produce blueprints, step-by-step good practice guides showcasing digital transformation, and other shared learning products to help health organisations deliver technology more quickly and cost effectively.

Around three quarters of all NHS Trusts are registered on the blueprinting platform , with over 1,000 users as of June 2021 from acute, mental health, ambulance or community trusts. The library of blueprints has also grown to more than 160 alongside around 2,400 useful artefacts including project plans, terms of reference, business cases, job descriptions, user guides, workflows and training materials.

The NHSX Blueprinting team achieved some further positive milestones for the week commencing 1 March 2021 with the 2,000th user registering for the blueprinting platform and also the 50th "blueprint on a page" published.

As a digital health innovator if you have previously worked with an NHS trust and would like to potentially showcase your digital transformation story or would like more information about GDE blueprinting please email gdeblueprints@nhsx.nhs.uk.

Building analytical and data science capability within the NHS

There are around 10,000 analysts in the NHS. During COVID-19, this analytical community mobilised to provide quick and robust analysis to inform decision-making including: tracking the virus, predicting outbreaks, and managing bed capacity.

The health professional analytical community is encouraged to embrace modern methods of analytics, including the use of programming languages, such as R and Python, and analytical tools. Working in innovative, open ways with a focus on capability building will help attract, recruit and retain a highly skilled workforce at all levels of the NHS. Our analytical community needs to be confident in the use of open-source software and in role-modelling coding in the open, where appropriate, sharing through GitHub (NHSX has its own GitHub repo) and others.

We are also expanding the learning and development offer for data professionals, analysts and data consumers to establish and progress priority activities to develop data and analysis as a profession in health and care.

Data literacy across the wider NHS workforce will be promoted through support from data and analytics teams throughout the system. The remit of data literacy readiness will be driven down from board level.

Digital inclusion and health inequalities

As health and care services are increasingly transformed by digital technology it is essential that everyone has the opportunity to experience the benefits. Not all citizens can access or use digital products and services and this often works to exacerbate health inequalities. There are important links between digital inclusion, health inequalities and social exclusion. People who live in areas of high deprivation and tend to have multiple and complex health and care needs are also more likely to be digitally excluded but often have the most to benefit from inclusion and digital products and services.

Reporting on pulse oximeters generally working much better on white skin than black skin is just one example of the interaction between technology and health inequality.

There is an increasing imperative to deliver positive change for communities that have experienced health inequalities and innovators should consider how digital can be a key enabler for health equity, rather than a barrier. Innovators should consider which parts of the population are currently not accessing services and are experiencing worse health outcomes as they design their solutions.

Guidance on inclusive service design can be found in the Digital Inclusion Guide for Health and Social care, published by NHS Digital, and the GDS Service Standard and Service Manual.

Next steps

NHSX will continue to work with innovators and will emphasise the themes of standards, interoperability and to support innovators to help increase their knowledge of the NHS ecosystem.

Innovator events

The Innovation Team at NHSX schedules a series of Innovator events that Matthew Gould regularly attends and speaks to that SMEs and tech developers can be updated on, discuss and input into the direction of travel of our work.

Future events will be published in due course on the NHSX Eventbrite page

Keep in touch

Web: www.nhsx.nhs.uk

Email: DNHSX@nhsx.nhs.uk

Twitter: @NHSX

LinkedIn: www.linkedin.com/company/NHSX

Acknowledgements

This report was written by Paul Hudson, Louis Edozie and Neesa Mangalaparathy on behalf of the Chief Digital Office at NHSX. We would like to thank the NHSX Comms team - especially Ellie Munari, innovators and companies for their responses and feedback, and everyone who contributed to the process.

Appendix

Appendix A

Responses to the poll that was circulated before the event on 8 December 2020 were collated into themes. The table below shows the number of topics that fell into each of the five identified themes. Additional topics that did not fall into these themes were placed in "other".

The number of topics that fell into five identified themes
Number Theme
1 Accelerated digital adoption
2 Approach and delivery
3 Expanding services
4 Non-Covid-19 work
5 Digital Capabilities
6 Other

Appendix B

The following is a list of potential procurement frameworks that can be used.

Dynamic Purchasing Solutions

Dynamic Purchasing System Marketplace

The Crown Commercial Service (CCS) offers multiple purchasing solutions. Suppliers wishing to register for this framework are required to meet specific requirements and the registration forms can take a few hours to complete.

Health Systems Support Framework

Health Systems Support Framework (HSSF)

Information for suppliers interested in providing services via the Framework

The HSSF procurement framework can be used by any NHS organisation and focuses particularly on services that can support the move to integrated models of care based on intelligence-led population health management.

The digital marketplace ('G-Cloud framework')

Digital Marketplace

Buying and selling on the Digital Marketplace

The Digital Marketplace G-Cloud framework is an online service for public sector organisations to find people and technology for digital projects. Any public sector organisation can buy using this marketplace.

The G Cloud framework is a closed framework with the current framework running until 27 September 2021. The next iteration of G Cloud will be open sometime in the late summer in preparation for the new iteration post September 2021.

Find a Tender: high value contracts

Find high value contracts in the public sector

The Find a Tender framework is a new framework replacing the previous EU's Tenders Electronic Daily that sits on the GOV.UK website and publishes all tenders from the public sector which are valued above a certain financial threshold - £118,000. Find a Tender is a personalised, sophisticated profiling service that guarantees regular, timely and relevant business opportunities within the public sector across the UK and Ireland. Find a tender is based on a searchable database that uses a unique keyword category system to filter tender notices according to product, service and industry.