In the first keynote of the Public Policy Projects Annual Conference 2020, Baroness Nicola Blackwood spoke to Matthew Gould, Chief Executive of NHSX, about the unprecedented digital transformation in health and care.

As the pandemic continues to impact healthcare services across the country, services are changing their methods of delivery and, subsequently, the patient experience. Underpinning this change is digital technology, which many experts believe holds the key to addressing both long-term pressures and the immediate challenges caused by Covid-19.

One of those experts is Mathew Gould, a former UK Ambassador to Israel, who joined the newly established NHSX last year to help bring about digital transformation in health. His brief is even more important now than it was when he took up the post. While tragic, one of the positives to come out of the pandemic is the value placed upon innovative technology. Video consultations, triage tools and Artificial Intelligence (AI) solutions are the foundations to a long-overdue digital renaissance in the health sector. Mr Gould’s priority is ensuring that these changes are here to stay.

NHSX has made “steady progress” putting in place some of the building blocks for digital innovation, stressed Mr Gould. Perhaps the mortar for these digital “building blocks” is a level playing field of understanding about who is responsible and who is accountable for embedding technology. “One of the most important questions to have arisen from the pandemic is clarifying what good looks like, who pays for what and who does what”. This, he says, is the basic outline of digital guidance NHSX needs to provide to the frontline.

Digital integration

Calls to accelerate integration have grown louder over the course of the pandemic. The ways in which Covid has disproportionately impacted different services in different regions has highlighted major vulnerabilities in the national system of care. In response, NHSX is working hard to build capability and interoperability into the system to facilitate a shift towards greater integration. Mr Gould hopes that increased focus on shared patient records across the UK will help accelerate this digital drive, stimulating unprecedented collaboration between services in developing care pathways. However, he warned that “interoperability on this scale is not a sprint, but a long task of building standards to a point where you can have an open catalogue.” A further challenge lies in getting these standards to stick.

Simplifying governance

Mr Gould lamented the “complex and convoluted governance paired with inconsistent guidance” that has long created stumbling blocks to data spread across the health sector. He wants to use the “special status” of NHSX to transcend system borders and to convene with authorities in locality providing the coherent guidance they need to use technology in a more meaningful way, particularly when it comes to data sharing.

NHSX has created an information governance portal to provide more simplified guidance during the pandemic. Stating that: “If you are doing the right thing with data then it should be allowed,” Mr Gould acknowledged that public trust is essential if patient data is to be properly shared on a long term basis.

Starting to take shape

Mr Gould is eager to prevent NHSX from becoming another “leviathan” organisation. “I joined NHSX to help create platforms, mechanisms and regulatory frameworks from which other people can innovate from,” he clarified. An aspiration he still prioritises. Acknowledging the need for greater consistency and transparency around the financing of digital technology, he reiterated that providers need to know “who pays for what.”

While the centre has periodically come up with pots of cash for digital initiatives, cumulatively these have created a disincentive for innovators and providers to invest as they don’t know when the next pot is coming, Mr Gould explained. The NHS needs a simpler approach to investing-in and harnessing the benefits of digital technology.

Spreading the innovation

“The NHS does not have an innovation problem; it has a problem with capturing and scaling it”. This encapsulates many of the problems the NHS faces in allowing well-functioning digital products to permeate throughout the sector. Lengthy pilot processes are often needlessly repeated when, with greater cohesion, trusts could cross-pollinate innovation. Addressing this is a core function of NHSX but the path ahead is far from clear.

Taking no action has knock-on effects elsewhere in the sector. Barriers to scaling innovations are creating major challenges to the workforce strategy. Analysing the challenges in implementation reveals often reveals more about people than the technology itself.

While a minimum digital capability needs to be built into every trust, it would be unreasonable to expect all to have the same level of expertise in-house. Upskilling the workforce is crucial to establishing the common standards that drive NHSX. This is demonstrated by the recent investment into the NHS digital academy. “We must create confidence in the skills and progression of our CIOs, so that they get the status and rewards for a system that will value their expertise,” explained Mr Gould.

Learnings from the pandemic

It seems that Mr Gould is looking to lift the shackles on innovation. He is seeking to put aside the “cautious approach” in favour of the liberated determination which allowed “amazing things” things to happen at breakneck speed during the first peak of Covid-19. “I want to see us bottle this innovative, can-do spirit for the future,” he added.

As the second wave of coronavirus continues, managing the impacts while getting back to pre-Covid standards of care presents a mountainous challenge. This is especially true in light of the growing elective care backlogs being observed across the sector. Making innovation part of the solution will be key to streamlining treatments and prioritising patients.

NHSX played an intrinsic role in establishing the UK’s AI lab last year – aimed at igniting innovation and promote promising AI technologies. This is a “massively exciting part of NHSX’s agenda,” said the NHSX chief. On cancer screening, the transfer from legacy systems offers an opportunity to create much more effective, nimble and granular diagnosis and treatment pathways. “We need to be able to slice cohorts with more precision to develop a more personalised approach to care,” he explained. Doing so could turn a  “blunt tool” in screening identification into something more precise in identifying those needed for screening programs.

A patient-centric future

While the dial has shifted in favour of digital technology, and we should celebrate that, we cannot omit one simple fact – that the patient should be at the forefront of this progress.

“Ultimately this is all about the patient and creating services that work for them,” said Mr Gould, who was keen to not let this point get lost in the digital euphoria. Whatever happens next for the NHS, we can only progress beyond Covid if we keep the patient at the heart of all innovations.