The announcement from Matt Hancock in Parliament of the formation of NHSX to lead the digital and technology transformation is one that we here at Difrent applaud.
Difrent loves the NHS.
70% of the work we do is in health, both on the front line and with central departments. We work with NHS Digital, Public Health England, The World Health Organisation and Leeds Teaching Hospital. We have had our people leading and delivering the work at NHS Digital over the past few years, in particular on the NHS.UK project and the Empower the Person Programme. We are immensely proud of the outcomes that have been achieved there and even more so of the people behind it. We want to share our learning, work in the open, code in the open, work for the public good and the organisations that serve it.
This new unit, a joint organisation for digital, data and technology for the NHS combining the best minds from the NHS, government and industry can bring together the pieces of the puzzle in ways that are challenging for the NHS. NHSX is the joint venture between the various organisations who previously defined digital strategy and commission digital services that have long been needed to bring cohesion — and to bring all the required capabilities — under one leadership team.
NHSX has been called a GDS for health in some circles. Many of us here have worked for, and with, GDS on numerous occasions. I think it is fair to say that not all departments have always had 100% positive views on GDS, with some critics describing it as great in theory but lacking in impact within departments. One area where it had great success though was in governing spend controls, with all central CTO’s reporting into Liam Maxwell at the time. This fostered great change, saved money, sped up the sharing of best practice and greatly improved procurement for tech and digital services. The representatives of GDS that would work with departments to assist in adhering to these controls were an incredible resource when it came to saving money from unnecessary duplications.
We hope that the lessons learned by GDS will be shared with NHSX, the move away from proprietary technology to open source is one we are a huge supporter of. We led the introduction of an open source CMS for NHS.UK, moving away from 27 separate contracts and a licence fee CMS, which is now an integral part of the running of the site. This was not an easy journey, but one that has paid dividends for NHSD, both literally and figuratively.
The NHS is an extraordinarily complex organisation. One of the many shocks that people who are new to it — and this includes many of us when we first joined it — is just how disjointed and siloed it can be. From the outside, the NHS is viewed as one big organisation, in reality, is more like a giant shoal of fish, all working independently but trying to stay together for the greater good. It is not easy to navigate through. The many large central bodies: DHSC, NHSE, NHSI, NHSD, NHSBSA and PHE (to mention a few) can be quite removed from the front line of NHS Trusts, hospitals and GPs. Spending can be chaotic, the centre is viewed from the frontline as wasting money, but in reality, many individual organisations are commissioning digital services and technology infrastructure on small scales at more expense. NHSX can align much of this and will hopefully bring the central bodies and the frontline closer together.
When our CEO Rachel Murphy took up her role as Digital Delivery Director at NHS Digital, she was greeted by an office with a wall of Gantt charts. She led the programme that introduced agile working to the project teams, a £300m digital transformation of all patient-facing services across the NHS. This included the move to a new Digital Lab in Victoria for collaboration within the London teams, the creation of NHS.UK, the rollout of free Wifi to all primary and secondary care locations in the UK, the creation of the NHS accredited apps library and the NHS app itself. Citizen ID for NHS was a theory; it is now a reality. This programme included working extensively with start-ups to foster an ecosystem of development, in a blended workforce of permanent staff, specialist contractors and vendor teams.
The involvement of industry in NHSX is an important factor. From the giants of “Big Pharma” to the myriad of health-tech startups, there is a wealth of knowledge, experience and expertise that can help the NHS in its evolution. The startup space is growing aggressively, positive disruptors in the field should be encouraged, the new technology and thinking they bring should be embraced rather than feared. Developer.nhs.uk is already a huge leap forward around API’s and enabling of syndication and the recent publication of the NHS Digital Standards is an important step in the right direction for better digital services. The NHS app library, accompanied by its assessment, accreditation and commissioning model is a credit to the forward thinking of the team and their work, it will enable so many more new products to be developed and reach their intended audiences.
Joining up the tech and digital strategies and leadership can be a massive catalyst to change. The crumbling and outdated tech infrastructure of the frontline can be assisted by great new digital services, but at the same time, they can’t necessarily be delivered upon it. One of the things GDS did was to handle Tech Leaders and Digital Leaders separately, this is something that may cause more problems than it could solve if it was mirrored in the NHS. The strategy has to be joined up to deliver real change, it also has to look at the skills needed to land it. We have done skills assessments in many public and health organisations (building on great work done by Tom Bryant on skills frameworks and David Best on operating models) to map onto SFIA and used this to undertake skills assessments at a one to one level across Dept for Education, The National Archives, The Nursing and Midwifery Council and then NHS Digital. We believe this is the most comprehensive approach applied to assess skills during our time in the public sector and recommend that it should be extended wider to assist this transformation.
Difrent were with the DHSC team behind the creation of NHSX when the announcement was made in the House of Commons, and the enthusiasm for the project was clear to see. It’s not often organisational changes within government departmental structures have the potential to improve people lives. The “Machinery of Government” (MoG) is something that often has served to get in the way of people’s needs, something that GOV.UK has always sought to remove. This, however, is not the normal MoG change. Normally they come about when priorities change for the Government when ministerial roles are changed, combined or moved. This is different, this one is driven by the challenges of improving the NHS for the people it serves.
Bringing together the leadership teams from DHSC, NHS Digital, NHS Improvement and NHS England will make the commissioning process so much better, this is something we worked hard to improve from within NHSD and successful relationships fostered great partnerships between the organisations. That these leadership functions will now sit under one CEO will remove so many perceived barriers, break down the silos within organisations that are trying to achieve the same objectives and as Matthew Swindell’s put it “improve the working lives of NHS staff and deliver better, safer care for patients”.
We, like all people in the UK, have personal experience of the amazing work that the NHS performs day in, day out. Amongst our family at Difrent we have a loved one who as a result of meningococcal septicaemia became a triple amputee, had skin grafts covering 70% their body and a kidney transplant, spending over 6 months in intensive care during a year in the hospital. These are debts we can never repay, but we will always work to help the NHS be better so that it can continue to be the pride of the nation, giving such outstanding, life-saving and life-changing care.
The key message for us at Difrent is that the new CEO of NHSX will have strategic responsibility for setting the direction on digital, data and technology across the NHS. This, combined with the commitment to work with the Government Digital Service and other government departments to learn from their experiences and ensure the NHS aligned with the rest of Digital, Data and Technology profession across government, is a truly transformative change for the NHS.
As we said at the beginning, we love the NHS, we are also excited about the potential of NHSX. Its remit and role will evolve over the next few months as internal assessments and evaluations are carried out, but we are positive that this new unit within government and the NHS will be a catalyst for the modern, open data driven, technology leading, digitally empowering NHS that this country deserves. We look forward to working with NHSX.