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After having been an NHS IT staple for more than a decade, NHS Digital has now officially ceased to exist. Yesterday (1 February 2023), NHS England assumed all responsibility for the technology function as staff and assets were transferred to the organisation.
The decision to merge the organisations was announced in November 2021 as part of a review carried out by NHS Digital chair Laura Wade-Gery, which recommended the move as a way to improve care, centralise the NHS workforce and accelerate service digitisation.
So what does this mean for the future of the NHS technology function? The Department of Health and Social Care (DHSC) hopes the move will lead to more streamlined data-sharing processes across the NHS, and that by improving data sharing, patients will get better care and be able to make more informed choices about their care, as well as gaining easier access to electronic patient records (EPRs) through “accelerated digital transformation services for patients”.
Exactly what this will look like is still unclear, as the NHS technology function will shortly go through the wider Creating a New NHS England change programme, which aims to ensure the government retains the “necessary talent and expertise of NHS Digital”.
Based in Leeds, NHS Digital employed around 6,000 people, including contractors. Staff have been transferred to NHS England for now, but job losses are to be expected, as NHS England plans to reduce its headcount by 30-40% in an effort to streamline the organisation.
NHS Digital’s most recent CEO, Simon Bolton, who himself has now left the organisation, said the merger “creates the opportunity to put digital at the heart of the NHS and build on what we’ve already achieved at NHS Digital”.
“Technology and data are helping to improve people’s lives every day, whether ordering a repeat prescription through the NHS App, getting the latest health advice from the NHS website, or arranging a Covid vaccine using our national online booking service,” he said.
“We’re proud to be making a real difference both to colleagues in the NHS and the people it serves. The merger will help us continue that journey as one central organisation, using digital to transform the NHS and provide the best care possible for patients.”
However, the creation of a single statutory body for data, digital and technology has been a controversial decision. In March 2022, former NHS Digital chair Kingsley Manning penned a letter to the British Medical Journal, saying the plans would endanger the rights of citizens in regard to how their data is collected and used by the NHS, and calling the move a “grave error”.
Manning, who quit after a disagreement over the publication of statutory statistics, argued that the Health and Social Care Act of 2012 had already given NHS England too much oversight of NHS Digital, and that since 2016, its influence over the body had grown.
“In effect, NHS England will be able to decide that its legitimate interest[s] override those of the citizen and the patient, with little or no external constraint or scrutiny,” he wrote. “With no requirement for transparency and with additional barriers to citizens asking for information about the use of their data, individuals may never know what NHS England chooses to do with their data.”
The story of NHS Digital
The role of NHS Digital in the NHS IT landscape has, although pivotal, been an ongoing source of confusion for those within the organisation and outside it. Its responsibilities have sometimes overlapped with other NHS organisations, including NHSX, which has now also merged into NHS England.
Former NHS Digital CEO Sarah Wilkinson told Computer Weekly in her exit interview in July 2021 that one thing remaining a constant is “the structural confusion, the organisational complexity, the weakening of responsibility and the lack of strategic consistency at the centre over the past few years, which has been exacerbated by the existence of too many organisations with unclear and sometimes overlapping responsibilities and occasionally even different agendas”.
One reason for the confusion around NHS Digital’s exact role is the way the world of healthcare IT and the NHS have changed drastically since the service’s inception. First set up in 2013 as the Health and Social Care Information Centre (HSCIC) in response to former health secretary Andrew Lansley’s reform of the NHS, separating policy, delivery and commissioning, the organisation’s original remit was responsibility for infrastructure and contracts around data collection and analysis.
Read more about NHS Digital
- In her exit interview with Computer Weekly, NHS Digital’s former CEO Sarah Wilkinson talks about the organisation’s transformation over the past few years, the Covid-19 pandemic, bureaucracy challenges and big wins.
- NHS Digital interim CEO Simon Bolton calls for a stronger mandate from the centre around the systems in use in the NHS, with no more than four to six electronic patient record systems used across the country.
- NHS Digital and NHS England will now merge in early January 2023, aiming to create a single statutory body for NHS data and technology.
As the organisation evolved, in April 2016, the government changed its name to NHS Digital to better reflect its increasing role as a technology partner to the NHS.
At the time, the focus in the NHS was on becoming “paperless” by 2020 – an arbitrary target that had been changed many times, with the shadow of the NHS National Programme for IT (NPfIT) still hovering.
Since then, NHS Digital has delivered several huge and critical services and programmes to the NHS, including NHS Spine, the NHS App, the NHS 111 non-emergency helpline and online service, summary care records and the electronic prescription service.
While NHS Digital has often been there, quietly in the background, holding up NHS IT, the Covid-19 coronavirus pandemic put the organisation at the absolute forefront of the NHS. It suddenly had to deal with huge demand for its technology products, rapidly having to scale up services and infrastructure to help the NHS cope with the increased pressures.
The organisation delivered a phenomenal amount of work, and following the pandemic, Wilkinson was hopeful of a “different NHS”.
The future of NHS IT
The NHS is indeed different today. Short staffed and at breaking point, technology could be the difference between a complete collapse and helping the NHS rise up again. Perhaps not the holy grail it has been dubbed by some, but the right technology in place both on the front line and behind the scenes could alleviate some of the pressures facing today’s health service.
The question is whether moving every part of the NHS technology function into NHS England will help lessen the confusion around responsibility and make it easier and quicker to deploy good, trusted technology in the NHS – or whether Manning is right, and this is all a “grave error”.
NHS England itself believes the merger will create a “closer link between the collection and analysis of data to help drive improvement to patient outcomes”.
Commenting on the merger, health and social care secretary Steve Barclay said: “New technology and better data about how our health and care system is working at the front line is key to improving care for patients.
“Bringing the latest digital tech into the heart of the NHS will help join up services and streamline decision-making, boosting our recovery from the Covid pandemic and reducing waiting times.”