ELENABSL-ADOBE
Can a future digital NHS survive another change?
Computer Weekly looks at the prime minister’s decision to abolish NHS England and the potential impact on the progress of digitising the NHS
Prime minister Keir Starmer’s decision to scrap NHS England is the latest in a series of changes the national health service has faced in the past 10 to 15 years.
In a speech on 14 March, the prime minister announced he would abolish what he sees as the “world’s biggest quango” to take back democratic control of the NHS.
“We are duplicating things that could be done once,” he said. “If we strip that out, which is what we are doing today, that then allows us to free up that money to put it where it needs to be, which is the front line.”
The move to streamline leadership is, in theory, a sound one. The NHS, particularly those services responsible for technology delivery, has been fraught with confusion over responsibilities, leadership and a lack of structural consistency for years. However, whether the NHS can handle yet another change in a landscape already suffering with staff shortages and morales and cuts to technology budgets remains to be seen.
Hugh Alderwick, director of policy at the Health Foundation, called Starmer’s move a “watershed moment in how the English NHS is governed and managed – and ends a 12-year experiment with trying to manage the NHS more independently from ministers”.
He added that while there is some logic in the move, in reality “it is impossible to take politics out of the NHS”, stating: “History tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect.
“Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients. It will also eat up the time of ministers, with new legislation likely needed.
“Expected cuts to local NHS management budgets will add to the disruption, and may undermine the NHS’s ability to implement the government’s plans for improving the NHS. Reforming NHS bureaucracy is not the same as reforming patient care – and government must be careful that these changes don’t get in the way.”
All change – again
While NHS England as an organisation was not directly responsible for digital and technology until 2023, it has held the power of overseeing and mandating technology deployments.
First set up as an arms-length body in 2013 alongside the creation of 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, NHS England was meant to be responsible for delivering high-quality care, supporting staff and ensuring value for money on projects such as technology change programmes.
From its inception, there were serious points of contention between NHS England and HSCIC, which would later become NHS Digital. The latter was created in 2016 as the NHS technology partner, however, it was often confusing even for those in charge about whether NHS England or NHS Digital really held responsibility.
At the time, the focus in the NHS was on becoming “paperless” by 2020 – an arbitrary target that has been changed many times, with the shadow of the NHS National Programme for IT (NPfIT) still hovering.
In 2019, yet another change emerged as the then health and social care secretary, Matt Hancock, launched a new central unit to lead on digital strategy, NHSX. In February 2021, it was decided that NHSX would become part of the NHS Transformation Directorate, which also sat under NHS England.
Two years later, NHS Digital was gobbled up by NHS England, following 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. Billed as a merger, NHS England assumed all responsibility for the technology function as staff and assets were transferred to the organisation.
While these changes have gone on in the background, numerous programmes have been created to get to grips with technology in the NHS, yet many NHS organisations today still operate with disjointed and siloed IT systems.
This latest change, following the decision by the previous government, throws yet another spanner in the works for NHS organisatons already grappling with a health service under pressure.
Chief executive of the NHS Confederation Matthew Taylor, and incoming chief executive of NHS Providers Daniel Elkeles, said in a joint statement that the end of NHS England comes at an “extremely challenging time, with rising demand for care, constrained funding and the need to transform services. History tells us this will cause disruption while the transition is taking place.
“Much of trust and integrated care system [ICS] leaders’ focus will need to go on stabilising the NHS in the short term as they prioritise patient care, but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming 10-year plan,” they said.
Labour’s 10-year plan for the NHS, launched in October 2024, aims to create a more modern NHS by bringing together a single patient record, summarising patient health information, test results and letters in one place, through the NHS App, aiming to put in control of their own medical history, and NHS staff will have the full picture of patients’ health.
However, historically, digital and technology initiatives – although seen by many as the holy grail that will fix a broken NHS – have not been given the funding or national leadership needed to drive this forward.
Former civil servant Alex Case, now government principal at Pegasystems, said that streamlining the bureaucratic structures and bringing in more democratic control of the health system is welcome “so long as it doesn’t distract from the urgent task of shifting from an analogue to a digital NHS and consequently improving the experience and outcome for patients”.
Job losses
However, disruption is inevitable. The merger of NHS Digital and NHS England in 2023 saw a reduction in headcount by 30-40%, meaning the loss of many digitally focused staff.
There is also a question of staff morale. Prior to the prime minister’s announcement, NHS England staff had already been told the headcount would be reduced by half, and are now faced with the abolishment of their organisation, likely to lead to a higher number of redundancies.
Earlier this month, NHS England CEO Amanda Pritchard announced she was leaving the role, which is being filled by James Mackey. He said that while he understands the transition will be unsettling for staff, it brings “welcome clarity as we focus on tackling the significant challenges ahead and delivering on the government’s priorities for patients”.
“We now need to bring NHS England and the Department for Health and Social Care [DHSC] together so we can deliver the biggest bang for our buck for patients, as we look to implement the three big shifts – analogue to digital, sickness to prevention, and hospital to community – and build an NHS fit for the future,” said Mackey.
The government anticipates that it will take two years to fully bring NHS England into DHSC.
Read more about the NHS and technology:
- In his plans to reform the state, the prime minister is pushing for artificial intelligence to take on tasks for civil servants and calling time on NHS England.
- The Chief Data and Analytical Officers Network has raised concerns over the way the NHS Federated Data Platform is being implemented and NHS England’s approach to its adoption.
- The Data Use and Access Bill will pave the way for sharing medical records across the NHS and give police the ability to access databases without having to manually log the reasons for their use.
