How to get the NHS out of the “foothills of digital transformation”: digital leaders on what is needed from the Autumn Budget Statement

As the NHS awaits the first budget statement of the new government, three digital healthcare leaders tell us what’s needed to ensure the digital healthcare agenda can move forward.  

The state of digital healthcare 

In his independent investigation of the NHS in England in September, Lord Darzi concluded that digital healthcare had received neither the capital funding nor infrastructure to succeed.  

“Over the past 15 years, many sectors of the economy have been radically reshaped by digital technologies. Yet the NHS is in the foothills of digital transformation. The last decade was a missed opportunity to prepare the NHS for the future and to embrace technologies that would enable a shift in the model from ‘diagnose and treat’ to ‘predict and prevent’.” 

The Autumn Budget Statement, due on 30 October 2024, could be an opportunity to do things differently.  

Speaking a week before the budget is unveiled, Health Secretary Wes Streeting is eager to act on Darzi’s findings: “Darzi has given us the diagnosis, now it falls to us to write the prescription through our ten-year plan”. 

That plan, Streeting says, will “require the biggest reimagining of the health service since its birth” to “transform the NHS into a “neighbourhood health service”, powered by cutting-edge technology, that helps us stay healthy and out of hospital.” 

We spoke to three digital healthcare leaders to get their views on how this reimagining of the NHS can be delivered to support a more effective digital transformation agenda.  

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Jim Ritchie, Chief Clinical Information Officer, NHS Manchester 

There are two things we need to make funding of digital transformation programmes in the NHS more effective. Firstly, a commitment to investing in ongoing training and people development – no increased funding or changes in how money is allocated will make a difference unless we invest in the people using the systems.  

Secondly, we need a rational dialogue about where investment should be prioritised. Investment must be tied to an outcome not the latest trends. I’d like to see a coherent perspective on why we are doing digital and what impact we are aiming for. For example, we could be using digital technology much more effectively to give people the tools to manage their own health. The NHS is overwhelmed by the demands of dealing with illness – if properly planned and prioritised, digital offers a chance to accelerate preventative actions and behaviours.  

Procurement processes also need to evolve. We certainly need oversight, but much of the time and money spent on justifying the need for and procuring a system (such as an acute EPR) could be better spent on implementing it well. Good procurement practice helps us to manage costs and support people to buy the right products and services, but we need to apply similar focus to assurance around the capability to deploy, train staff on and optimise our digital systems. 

Steve Black, healthcare data scientist  

The Darzi report was scathing about how the NHS does capital spending. The overall spend falls far short of peer health systems and the money is often spent badly. 

Is a shortage of capital spending the major reason for the slow pace of improvement in the digitisation of the NHS? 

It’s complicated.  

There is certainly a reasonable argument that the NHS has not devoted enough capital to the rollout of digital tools like new hospital EPR systems. And the all-too frequent short-term raids on capital and digital budgets to feed operational deficits in hospitals clearly makes planning effective digital progress harder. 

But allocating more capital to digital spend might not be the solution it seems.  

The NHS has a poor history when it comes to spending digital cash well. Even when shiny new EPRs are installed with the promise of major operational improvement and better data quality, the wheels often fall off at the implementation stage. To make the overall project appear better value for money, the plans often skimp on the training and implementation budgets. The result is that actual performance falls for months to years after the new systems become operational. A disturbing number of hospitals fail to even report spending on drugs, for example, for months after new systems go live. 

This problem is not caused by a capital shortage, though capital is short. It is caused by an even worse shortage of the operational management skill to use capital effectively.  

If the NHS is ever going to see the benefits of digital spending, it isn’t the shortage of capital it needs to fix: it is the shortage of management and digital skills to make use of it. 

Nicola Haywood-Cleverly, Senior Associate Consultant, Ethical Healthcare 

We are in an austere financial regime that continues to impact the whole of the public sector.  

In health and care across the country, every system needs to move towards a much more strategic framework of financial planning that will enable it to deliver its intended purpose: fully integrated, person-centric health and care based on the needs of its specific population.  

However, in many regions Integrated Care Boards (ICBs) are continuing to grapple with bringing down the deficit. Growing workforce shortages, and now firebreaks, are adding to the risk of being able to deliver improvements, whether these be cost improvement programmes (CIPs), critical infrastructure investments or innovation programmes that raise quality, reduce burden and increase safety.  

As a non-executive director, I see executive colleagues dealing with almost impossible conundrums. Various reviews and associated commentaries support observations regarding the misalignment of how the money flows between acute and outside-of-hospital services and the ongoing need for us to “left-shift”.  

And calls for funding, indeed for ring-fencing uplifts to community, mental health and social care (the latter often being treated as if it were not a key part of the equation), should be difficult for anyone to dispute. 

The mantra hasn’t changed. It’s just our financial planning and frameworks have never really managed to affect this. So, if it does, it will feel radical and those who are part of the system will need to be asked, possibly told, to adjust.  

My biggest concern continues to be that as a nation we don’t finally and firmly act on this. If we are not applying a fair share of resources to the most crucial areas of population health – children, complex lives (including mental health), and frailty – then the vulnerability of these populations will continue to increase. Alongside digital transformation funding, I feel it is important to draw out this wider context as it also impacts where and how we are investing in these. Digital investment is equally segmented and reflects this same imbalance.  

Most importantly, I believe digital finance frameworks could be determined and set up to fund the delivery of digital and data capabilities that explicitly achieve the “left shift” and enable an improved focus on the most vulnerable, returning us to the formative principles of the establishment of the NHS. 

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It is clear, then, that any prescription for the NHS needs to focus not simply on giving it an injection of money, but on allowing it to spend that money differently to support those most in need and supporting the workforce to develop the skills required to manage digital transformation effectively.