It is no secret that delivering on digital across the NHS requires funding. In response to COVID-19, digital progress has been made with most NHS trusts quickly deploying virtual consultations and remote working, while others rolled out more advanced technologies such as robotic process automation. Over the coming months, financial investment in digital is needed to maintain this momentum as the NHS looks to live with the long-term impact of the virus, build resilience and transform services.
However, when trusts are faced with operational fires to put out, long-term digital investment can be overtaken by urgent immediate-need expenses. If the choice is between upgrading the WiFi or replacing a broken MRI scanner, it is difficult not to prioritise the latter. Overtime, underinvestment in digital means slower log in times for staff, aged IT systems and ultimately out of date processes that are no longer fit for purpose. Fixing these will not only allow the NHS to meet the 21st century needs of their patients and staff, but also present an opportunity to fundamentally transform the way services are delivered.
In recent years, the digital funding challenge has been complicated by uncertainty over what to prioritise, what money is available and how money can be spent. For example, technology is no longer treated (conceptually or logistically) as a one-off capital expense, but increasingly must also be factored as a day-to-day running cost (for example, software licensing). But revenue and capital budgets don't always reflect this rebalancing. In addition to this, national funding is often made available too late in the financial year for trusts to be able to make effective investment decisions.
The NHSX guidance provide a common aspirational vision of best practice in digital transformation.
Programme Lead (Digital ICS)
In an attempt to clarify some of these strategic challenges, NHSX recently released the What good looks like framework alongside funding structure guidance Who pays for what. Who pays for what attempts to address barriers to digital investment in the sector by setting out plans for improved benchmarking, benefits realisations tracking and the revisiting of national policies to better support digital investment. It also gives long awaited clarity over areas in which central versus local funding can be expected. The funding roles and responsibilities described by NHSX include consolidation of national funding streams in 2021/22 under a unified technology fund and the shifting of greater funding allocation control to integrated care systems from 2022/23 onwards. Combined, the NHSX guidance provide a common aspirational vision of best practice in digital transformation.
While there remain a number of unanswered questions from these proposals, the new guidance represents an ambitious and pragmatic roadmap for NHS digital transformation. However, delivery now relies on the amount of funding made available to the NHS. Otherwise, there is risk of putting 'the cart before the horse'.
The groundwork has been laid for a more digitally advanced health service, and now is the time to capitalise on this to drive digital transformation. To accomplish this, a multi-year settlement is now needed to allow trusts to adequately plan and carry out their digital strategies. The government's upcoming comprehensive spending review provides an opportunity to unlock the true potential of NHS transformation. A positive first step is demonstrated by the NHSX guidance, but bold moves must be made to realise this vision of digitally enabled care, which, when done right, will provide a multitude of benefits for patients, service users and staff.
This blog was first published by Public Finance and repurposed for Public Sector Focus in December.
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