Board leadership
Trust boards are increasingly engaged with the digital agenda and are working collectively to drive progress further and faster, but experience across the sector is varied.
Trust leader responses reveal a notable rise in the profile and priority of digital initiatives in recent years. Additionally, board members' understanding of their roles in driving digital progress has expanded.
Three quarters (75%) of all respondents agree that their board is engaged and driving the digital agenda. While it is a positive sign that overall, there is an increasing recognition across the whole board of the importance of digital as an enabler for improving productivity, patient safety and the experience of NHS staff and service users, the picture is mixed across trust types. Board engagement was reported as highest from acute specialist and community trusts (91% and 87% agreement, respectively) and lowest in mental health/ learning disability trusts with only 50% of respondents agreeing, 30% disagreeing and 21% neither agreeing nor disagreeing.
There has been a significant shift in the awareness of the role digital plays in delivering the strategy. Recently we appointed a non-executive director lead for digital with significant experience of digital transformation. The board recognises the benefit of convergence, working on a single electronic patient record instance across the system.
There has been a significant increase in digital leadership on trust boards.
Digital leaders (36%) were most likely to be reported as having responsibility for digital at board level (29% chief digital information officers (CDIOs) or digital directors, and 7% chief information officers or IT directors), closely followed by finance directors (27%). This marks a shift in board leadership for digital since 2019 when a similar NHS Providers survey was conducted, finding that 56% of trusts had their finance director as the board digital lead.
The sector has seen, and is likely to continue to see, an increased focus on the digital portfolio on the board. Some trusts are now moving towards a combined board role with responsibilities across transformation, improvement and digital. This shift may provide trusts with an opportunity to better leverage these aligned skill sets and capabilities. While an increased spotlight on the digital portfolio on the board is a positive shift, it is important that driving the digital agenda forward is seen as the collective responsibility of the board.
Progress and priorities
Despite the challenging internal and external environments, trusts remain committed to the digital transformation agenda and are making steady progress across key areas.
Categorised below are the most common priorities, themes and reported areas of progress in recent years:
Frontline digitisation and electronic patient record (EPR) implementation
Aligned to the national focus on frontline digitisation set out in the Department of Health and Social Care's 2022 Plan for digital health and social care, the majority of respondents report making the most progress in the last few years on frontline digitisation. This is mainly seen with implementations of new EPR systems or optimising existing systems. EPR implementation is a large-scale transformation process for trusts and is often the highest-profile transformation programme a trust undertakes. EPR programmes are a process of continuous improvement that take a large amount of leader headspace and organisational capacity. This focus is reflected in NHS England's (NHSE) Frontline Digitisation Support Offer, which aims to help trusts meet a minimum digital standard and has boosted substantial progress over the last few years. Trusts are increasingly collaborating with system partners to share resources and learnings to more efficiently and successfully roll out EPRs and in some cases undergoing joint EPR implementations across trusts.
This remains a key priority for board members over the coming years with many leaders focused on EPR optimisation and convergence of EPRs across multiple providers.
Our EPR implementation is the biggest digital transformation project that has been undertaken by the trust and anticipation is quite high.
We are prioritising: EPR implementation, which resolves significant infrastructure risk, improving digital literacy across all staffing groups and designing a digital department for future technologies and a more data driven organisation.
Investing in IT infrastructure and cyber security
Several respondents highlighted their focus on addressing 'technical debt' which had accumulated due to previous lack of sufficient digital prioritisation and funding at local and national levels. Progress has been made in strengthening core infrastructure, cloud migration, working towards greater interoperability of trust systems and strengthening cyber security processes. Trust leaders, notably in community and ambulance providers, reflected that investment in core IT infrastructure, combined with innovative digital tools, is supporting clinical care through virtual wards and enabling staff to work remotely, particularly in areas where care is provided in community settings.
Looking forward, trust leaders are focused on investing in cyber security assurance and preparedness, with many board members reflecting on the need to invest in tools and infrastructure to prevent cyber attacks.
Substantial progress has been made in getting decades of under investment in digital addressed, but that only largely gets the basic infrastructure to a good position, e.g. Wi-Fi, data centre, networks, etc. There is still a massive amount of work to be performed on getting modern applications in place.
A real focus on getting the basics right, so a focus on IT infrastructure and cyber security. In addition, the continued optimisation of our EPR has been at the forefront of our work programme.
Using data to make informed and joined up decisions
Trusts are further developing their data and analytics capabilities to improve outcomes and enable data driven decision making. Trusts are integrating data through shared care records as well as through engagement with the national Federated Data Platform (FDP) products. A large number of providers and integrated care systems (ICSs) have signed up to the FDP programme, indicating a strong interest in building digital, data and analytics capabilities and willingness to pull together in the same direction and dedicate resource and time in service of joined up data that benefits the whole system. Among trusts who are not yet involved in the FDP programme, there is still demonstrable appetite for capability and capacity building in this area.
As trusts work towards closer collaboration with system partners, we heard that trust leaders are focused on using data across system partners to provide a joined-up view and enable the delivery of care across organisations.
The trust has made progress embedding the use of data, increasing board awareness on digital importance, including transformation and cyber risk and increasingly through a joined up system approach.
Our data is of a much better quality and we are now able to use it to drive change. Still early in the process, but improving.
Developing a digital strategy and vision for the trust
Many trusts are prioritising a refresh of their digital strategies, often aligning specifically with the national What good looks like framework or Healthcare Information and Management Systems Society (HIMSS) accreditation. To support the delivery of the digital strategy, respondents mentioned improved governance structures and establishing dedicated digital committees, as well as appointments of senior digital roles, like CDIOs and clinical-digital roles such as chief clinical/nurse information officers (CCIO/CNIOs).
There is no one size fits all approach to digital strategy. Some trusts have a standalone digital strategy whilst others include digital as an enabler of the overarching trust strategy. Trust leaders are focusing on aligning their strategies with the national direction of travel and ICS priorities.
Enhancing efficiency and productivity
Nationally there is heighted focus on the role of digital transformation and new technologies in driving productivity and cost savings. Trust leaders are looking to digital as an enabler for improving efficiency, productivity and patient care, and reflected that the link between productivity and digital is the key to tackling some of the biggest challenges facing the NHS.
For example, trusts are improving ways of working to reduce duplication and using automation tools to streamline processes, with several trusts reflecting on the potential of artificial intelligence to reduce the administrative burden and contribute to an improved staff experience. We also heard how one trust is using digital to meet their NetZero commitments.
Our priority is to use digital as an enabler to free up clinicians' time to be able to focus on patients. To use digital as an enabler to improve efficiency and productivity.
Upskilling staff and raising awareness of digital
Many trusts are working to increase the confidence and capabilities of staff across the organisation. Trusts have reported upskilling staff through digital literacy training and further building their board's awareness of digital as current priorities.
We are focussing on strengthening digital foundations, increasing digital roles within the whole workforce and improving digital literacy.