NHSX moves on

After three years leading the digital transformation of health and social care as NHSX, we are integrating with the Transformation Directorate at NHS England.

Our mission will remain – to drive the digital transformation of the NHS and social care. And our status as a joint unit of NHS England and DHSC continues as well.

We have made huge progress over the past three years, emphatically through partnership with NHS Digital, NHS BSA and frontline NHS and social care organisations. There is now a long list of achievements to NHSX’s name. Let me highlight just a few.

First, we have put digital at the heart of the future plans of both the NHS and social care, and taken it out of its silo. The first line of the job advert for Simon Stevens’ successor mentioned digital transformation. The NHS Operational Planning Guidance has digital running all the way through it. So does the guidance for ICSs. And the Social Care White Paper could not have been clearer a bout the place of digital in the future of social care.

The creation of the Transformation Directorate, incorporating NHSX and NHSD, is a reflection of this shift in attitudes. When I started, there were Trust CEOs who told me they were proud of how little they knew about digital transformation. I don’t think they would be so proud of their ignorance now.

Second, we have put in place the guidance that frontline leaders need to make this a reality. In 2019 when NHSX was created there wasn’t a national vision for what a good digital NHS or social care organisation should look like, there was confusion over how technology funding was made available to the system and we didn’t have clarity over our future capital allocation.

Two and a half years later and all of those building blocks are in place. We published What Good Looks Like and Who Pays for What. The Unified Tech Fund changed how tech funding was applied for this year, and this year we will publish ‘Who Does What’ guidance as the final piece of the jigsaw.

And we’ve had a three year capital spending settlement of £2.1bn to help drive the digital transformation of health and care.

Third, we have helped numerous trusts raise their digital maturity. We moved away from a policy of helping the best get better and switched our funding efforts to support those who needed extra help to level up across the country. We are already supporting almost 60 NHS Trusts on our Digital Aspirant programme, and we recently announced seven Trusts we are partnering with to further shape the electronic patient record market.

Fourth, we’ve changed how data flows across the system. At the start of pandemic my team led the creation of the NHS Datastore, together with NHS England analytics chief Ming Tang. This provided a near-real-time data-driven foundation for handling the pandemic, and then for the vaccine rollout. It was transformational.

Since then we’ve got basic Shared Care Records into every ICS except one – enabling health and care staff to view and edit the same version of a person’s medical history across health and care settings so that they can collectively deliver safer, more joined up and seamless care.

And we’re supporting ICSs to start using population health analytics, including Cheshire and Mersey ICS where we helped them set up CIPHA – a powerful platform already covering 17m people.

Fifth, we’ve driven a shift in attitude and practice to digitally-enabled care at home. In the first months of the pandemic we supported West Hertfordshire Hospitals NHS Trust to set up their first virtual ward. Now there are 44 virtual wards live across the country caring for over 2,500 patients. And the recent NHS England planning guidance made virtual wards a key part of the future.

This is part of a wider shift to care at home. Working with the regions, my team has got over 200,000 people with long-term conditions into programmes that let their clinicians monitor how they’re doing remotely.

Sixth, we stood up the NHS AI Lab and worked with other healthcare agencies and bodies to start to design the world’s first comprehensive regulatory framework for AI in health. During the pandemic we established the COVID-19 chest imaging database, that hosts over 40,000 images from more than 20 trusts, to help researchers and developers train new AI tools that could help against covid. Our AI Awards are supporting 80 winners to develop their innovations in areas such as urgent stroke care, home testing for disease and cancer screening.

And finally, last year I brought together a team to deliver the NHS Covid Pass in the NHS App, a complex tech project that hit every deadline to the day, and has helped enable millions of people to travel and go to events more safely. Adding the NHS Covid Pass to the NHS App led it to become the most downloaded free iPhone app last year – we have gone from 2m users to over 24m.

Looking to the future we now have an opportunity to transform how the 24m people now registered with the NHS App interact with the NHS.

There is still a huge job to do. My team aren’t going anywhere – we will be pressing on with our work, as part of NHS England’s Transformation Directorate, and as part of DHSC. And actually, my team is my proudest achievement of all. Diverse, committed, skilled, they have together built NHSX into an open, unhierarchical, creative and supportive environment. We will be proudly taking that culture, and our mission, into our new home.

Here are some of the things NHSX has done. Almost all of them have been delivered in partnership with NHS Digital and our other partners:

• We helped secure £2.1bn for digital technology in health and care in the Spending Review.

Digitising

• We have moved digital transformation up to the top of the national agenda; with digital being referenced in the first line of the job advert for the NHSEI chief executive in 2021.
• Over 50 NHS trusts are being supported as Digital Aspirants to level up technology across secondary care.
• We are helping share best practice so other NHS organisations digitise more quickly and cost effectively, with 188 blueprints (step by step guides to digital transformation), 146 Blueprints on a Page and nearly 3,000 supporting artefacts created.
• We developed a digital blueprint for the New Hospital Programme, setting out how digital technologies are designed into new hospital build initiatives.

Connecting

• We ensured basic shared care records were in operation in every ICS except one, enabling health and care staff to view and edit the same version of a person’s medical history across health and care settings so that they can collectively deliver safer, more joined up and seamless care.
• With Cheshire and Mersey ICS, we initiated and funded Cipha – a uniquely scaled population health analytics platform drawing on the shared records of 17m citizens, allowing care to be targeted at those who need it.
• We've also supported cloud-based analytics projects in London (8.6m citizens) and across the Yorkshire & Humber region (5.6m citizens)
• We distributed 11,000 iPads to 9,000 care homes in England so that residents could stay connected to loved ones, and worked with care system suppliers to allow social care staff to access vital information directly from the GP record.

Transforming

• From 2m to now over 24m people (around half the adult population in England) have now registered for the NHS App. This led to the NHS App being the most downloaded free iPhone app of last year.
• 2/3 of all adults in England now have an NHS login, driven through close integration with NHS Test and Trace.
• In December 2021 the NHS App was used to register 38,000 organ donation preferences, order 1.5m repeat prescriptions, and view over 11m GP records.
• The NHS COVID Pass was developed successfully in six weeks, with more than 140m COVID passes generated so far.
• We have scaled remote monitoring of patients at home, with over 200,000 patients benefiting so far, including 2,500 patients currently being cared for in virtual wards.
• The NHS website (NHS.UK) received over a billion visits to the site in 2021.
• 99% of GP practices are now able to conduct video consultations, from under 10% in February 2020, so more patients can see their doctor online than ever before.
• Through our NHS AI lab we are supporting 80 winners of the AI Awards to develop their innovations which will support areas such as urgent stroke care, home testing for disease and cancer screening.
• We have supported clinical teams to transform patient care through the publication of eight digital playbooks from cancer and musculoskeletal to dermatology and eyecare. These playbooks showcase proven technologies and have had over 130,000 views.
• We published the Digital Technology Assessment Criteria for health apps, giving staff and patients confidence that digital health tools meet our national clinical safety, data protection and cyber security standards.
• We published in draft a data strategy for health and care, the first of its kind, setting out a clear vision and action plan to make better use of data to save lives.
• We have increased access to the Electronic Prescription Service, with the first hospital now accessing the system to support remote outpatients consultations. Every provider of hospital outpatient prescribing systems can now work to add in this functionality.
• We supported publication of a new standard to ensure medicines and prescriptions information is shared in a standard way across Health and Social Care to improve patient safety.

Supporting the NHS and social care frontline

• We and NHS Digital saved the NHS at least £300m thanks to our deal with Microsoft to provide Microsoft 365.
• We’ve supported NHS Providers to deliver 50 training sessions on digital transformation to NHS trust board members.
• We launched the information governance portal to provide a one stop shop for simple, national IG guidance. It has received more than 120,000 visitors.
• We've published our What Good Looks Like guidance, setting out for the first time our common vision for good digital practice.
• We have given clarity to frontline leaders on funding tech, with the Unified Tech Fund and the Who Pays For What guidance.
• We supported the publication of the People at the Heart of Care White Paper for Adult Social Care, with a commitment to invest at least £150m in digitisation as a key enabler for reform.
• We launched the assured supplier list for Digital Social Care Records, supporting a diverse marketplace of electronic systems that are interoperable with the NHS.

Responding to Covid

• We set up the NHS datastore at the start of the pandemic, which underpinned the NHS response and the vaccine rollout.
• We published simple, empowering guidance on sharing patient records safely, endorsed by the ICO and the NDG, that gave clinicians confidence they could share data when they needed to do so.
• We used the Control of Patient Information (COPI) (2002) Regulations to allow public sector organisations to share patient information to support the COVID-19 response.
• We extended the number of patients having an ‘enhanced Summary Care Record’, allowing important details about their health to be shared with their clinicians, from 3m at the outset of the pandemic to just under 57m today, delivering better, safer care across all care settings.
• We initiated the COVID-19 chest imaging database, which now contains over 40,000 images from more than 20 trusts, making it one of the largest data collection exercises for medical imaging in the UK.
• We responded to a frontline shortage of laptops by finding and deploying 40,000 laptops in weeks.

Cyber security

• We have alerted over 400 health and care providers to 23 critical cyber vulnerabilities and supported them with fixes.
• In collaboration with NHS Digital's Cyber Security Operations Centre, we have provided 24/7/365 cyber incident and response capability across 1.6m endpoints and thousands of servers across the health and care system, enabling the prevention of 5 'WannaCry-style' cyber attacks.
• For the first time ever, we provided system CEOs with key metrics so they can understand the cyber risk to their clinical services and take appropriate action to address them.
• Our Better Security, Better Care programme has delivered direct support to care providers to comply with health and care cyber standards, resulting in care provider compliance with cyber standards going from under 10% at the establishment of NHSX to over 40% today.