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NHSX sets out digital guidelines for NHS organisations

The What Good Looks Like framework provides instructions on how NHS leaders should improve the use of digital in their organisations

NHSX has set out new guidance for NHS organisations on how to get digital right, with clear instructions for NHS leaders on ways to improve tech offerings in their trusts.

The What good looks like framework aims to build on established good practice in the NHS, and make it easier for NHS managers to know what they should be doing to increase and improve digital offerings such as remote monitoring, secure digital infrastructure and digital systems that meet the needs of patients and staff.

“This will improve the outcomes, experience and safety of our citizens,” the framework said.

It added that the framework “is directed at all NHS leaders, as they work with their system partners, and sets out what good looks like at both a system and organisation level”.

“It describes how arrangements across a whole integrated care system (ICS), including all its constituent organisations can support success,” it said.

The guidelines, which aim to be “easy to use”, focus on seven different areas of measuring success for both the ICS and the individual NHS organisation.

The first is to be well-led, which is classed as where leaders across the system “own and drive the digital transformation journey”, where there is an ICS-wide digital and data strategy in place focusing on “levelling up” with a sustainable financial plan underpinning it. For individual organisations, it is key that boards are on board with digital and equipped to take the lead on digital transformation.

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The framework also calls on ensuring smart foundations are in place, with well-resourced, multidisciplinary  teams able to deliver the organisation’s digital and data ambitions, as well as maintaining standards for safe care, as set out by the Digital Technology Assessment Criteria for health and social care (DTAC).

Other guidelines include supporting the workforce to be digitally literate and encouraging a digital first approach, and empower citizens to have access to their own healthcare information and take an active role in their health and well-being.

The guidelines also call for ways to improve care through embedding digital and data in care pathways. This includes having an “ICS-wide approach to the use of data and digital solutions to redesign care pathways across organisational boundaries to give patients the right care in the most appropriate setting”.

Commenting on the framework, health and social care secretary Sajid Javid said that during the course of the Covid-19 pandemic, “we have all appreciated the immense value of technology”.

“This is particularly true for the NHS with digital technologies freeing up hospital beds and allowing clinicians to continue seeing patients remotely – and it will be invaluable in meeting other health challenges in the long-term,” he said. 

“This new guidance from NHSX provides a clear direction to all NHS trusts on how to drive digital transformation forward and transform organisations, which will improve patient care and save lives.”

NHS organisations and the ICSs will be assessed against these guidelines on a regular basis through a process which will be outlines by NHS later this year (2021). “This will help you to identify gaps and prioritise areas for local improvement. Assessments will be repeatable so you can track progress year-on-year,” the framework said.

New funding models

Alongside the framework, NHSX has also published proposals for new ways of funding technology and digital projects.

The Who pays for what proposals bring together several existing funding pots into one national application process, aiming to make it easier to bid for funding. There is currently often uncertainty around what is funded nationally, where the funding comes from and how and where local NHS budgets should focus their digital efforts.

This includes the “wrong mix of capital and revenue to support optimal tech spending including a lack of recognition of the revenue consequences of capital investment,”, the proposals said. “This is an increasing problem as tech shifts to being consumed and managed as a utility.”

The government aims to consolidate national funds for transformational tech projects into a single fund and aims to publish a prospectus of projects for which ICS’s can bid for funding through an online portal.

“We will provide guidance to bidders on what to include in their business cases and keep them fully informed on the progress of their bids throughout our approvals process,” it said.

Meeting guidelines

The government will also create a calculator to help care systems understand their digital debt and what they need to meet the success guidelines set out in the framework. Existing digital products and services will be made available to share best practice across organisations and track benefits from tech investments.

From 2022, ICSs will be expected to fund their tech plans from their own budgets and the government will move away from central funding of frontline tech.

ICS funding will cover hospital systems such as electronic patient record systems, cloud services and datacentres, hardware, cyber security measures and shared care records, while national funding will only cover national infrastructure, national products such as the NH app and pilots linked to the NHS Long Term Plan.

“To enable this over the next four years we plan to shift to funding arrangements under which the centre’s role will be one of supporting investment, setting standards, delivering national products and assuring and approving local spend,” the proposals said.

“In 2022 to 2023, we will begin to allocate funding directly to ICSs before the start of the financial year rather than asking them to bid for it. Initially this will prioritise the need for levelling-up tech capabilities and will then move to a fair shares basis once sufficient progress has been made. We will move as rapidly as possible to give systems control over a significant majority of the funding available.

“We will work with colleagues in government and NHS England and NHS Improvement to explore whether the capital and revenue mix of funding can be made more flexible and ICSs given more certainty about the amount of funding for tech that will be available to them in future years.”

Digital maturity

In a blog post about the framework and proposals, NHSX CIO Sonia Patel said the digital maturity of organisations across the country remains varied.

“At NHSX we want to support every local health and care organisation to digitally transform so that no patient or member of healthcare staff is left behind, and digital progress continues,” she said.

“I think it’s really important to learn within systems and across systems, and embrace the opportunities that exist with some of our exemplar, more digitally mature organisations,” said Patel.

“The ethos of shared learning underpins all of our support to frontline digitisation, and will be a key component of the support offered through What good looks like going forward.”

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