Innovation is not new to the NHS, Tara Donnelly, NHSX chief digital officer, emphasised at the recent Digital Healthcare Show in London. But despite the worlds of technology and healthcare continuing to intertwine, the UK’s health service is grappling with outdated systems unable to talk to each other, gadgets that have long been phased out in other sectors, and paper still shuffled around departments.

Prior to NHSX, Donnelly came to know first-hand the challenges digital health innovators face when trying to scale their solutions across the NHS through her role with the Health Innovation Network.

But innovation is not the exciting part, the NHSX CDO cautioned at the event; it’s scaling things that are “exceptional” for the benefit of patients, staff and the wider system.

“Seeing the great ideas systematically spread everywhere, part of routine care and available to millions of people is the bit that really excites me, not the innovation in the first place, in an ivory tower and not spread,” she explained.

Five missions for NHSX, new deputy CEO and acting CTO

NHSX, the new unit for digital, data and technology, was officially launched at the beginning of July. The venture is said to be bringing together a team of around 300 people from the Department of Health and Social Care, NHS England and NHS Improvement, however, it’s not another arms-length body.

“The idea is that rather than digital policy and strategy and delivery being in different places, they’ll be in one place. And importantly, NHS Digital, which is obviously a much larger organisation, will have a single commissioner rather than many different voices to respond to,” Donnelly told delegates.

Priorities will include setting standards “as clearly as possible, and in certain cases that will involve mandating them”, according to the CDO, as well as publishing APIs for key services and supporting innovators.

At the end of June, Matthew Gould, chief executive of NHSX, announced the so-called 'five missions' of the new unit:

• Reducing burden on staff
• Ensuring that clinical information can be safely accessed across the system
• Ensuring citizens have the tools they need to access information and services directly
• Supporting improvements to patient safety
• Increasing NHS productivity.

On Friday, he revealed that Simon Eccles, chief clinical information officer for health and care, and Hadley Beeman, technology advisor to the secretary of state for health and social care (Matt Hancock), would take on the roles of deputy chief executive and acting chief technology officer, respectively, of NHSX.

Delighted to announce two important appointments for @NHSX. @NHSCCIO will also be Deputy CEO. And @hadleybeeman will step in as Acting CTO. We are building a great team, and will be recruiting more soon

— Matthew Gould (@matthewsgould) July 5, 2019

Social care on the back foot no more

Prior to the formal launch of NHSX, the chief executive went to meet staff and patients from GP surgeries, hospitals, hospices, mental health clinics and care homes across England to understand the challenges they were facing regarding the use of technology.

“I’m really keen that social care shouldn’t be the afterthought that we get to at the end of each meeting when we’re done discussing the NHS and health,” Gould said at the Digital Healthcare Show. 

“The opportunities for digital technology, standards, interoperability and some of the things we’ve been talking about in the social care system are absolutely enormous, and, frankly, the levels of digitisation in the sector are at some of their most mixed out of all the places I’ve been [to]. I’ve been to care homes, I’ve sat down with care providers, social workers, care workers, I’ve seen the commitment they have to looking after the people they care for, and the opportunity that exists if we can get tech right for social care as well as the NHS.”

In his keynote, he praised the work done in some parts of the system described as digitally advanced, such as Chase Farm Hospital, which was recently validated at Stage 6 of the HIMSS Electronic Medical Record Adoption Model, an international benchmark. This, Gould said, was a “brilliant example of what can happen when a hospital really is determined to invest in technology”.

But he also saw parts of the system running “entirely” on paper, and emphasised that his team understood the skepticism of those familiar with the NHS IT landscape.

“I want to talk about why this time may be different, and ways it won’t be different, and what we’ve learned from what’s gone before,” he added. “And one thing I want to make absolutely clear is, I don’t believe we’re starting everything completely from scratch.” 

Their approach will see them focus on standards, avoiding “big-bang projects” and imposing solutions “on 240 different hospital trusts or every CCG [clinical commissioning group]”. 

“We know from what’s happened since the national programme [national programme for IT, dismantled in 2011] that the answer isn’t simply to let 1,000 flowers bloom and let everyone in the system work out the answer for themselves. There needs to be a sensible balance, and this is something, to be fair, that I think people in the system have understood for some while and have been moving towards,” Gould said.

“So it’s not so much, let 1,000 flowers bloom, as 1,000 standardised flowers. Actually, I should say, I’ve been told off for using that phrase by Hadley [Beeman], the secretary of state’s tech advisor, who says it’s not the flowers that are standardised, it’s their roots,” he laughed. “So it’s 1,000 flowers with standardised roots.”

Success will be defined against the five missions, the chief executive cautioned. But even though the focus is on “incremental improvement, not grand digital projects”, it's clear that all eyes will be on them now.