PRSB advisor Bernard Crump blogs in response to the Secretary of State for Health and Social Care’s announcements for health and care at the Health Service Journal’s Digital Transformation Summit on the 24^th February 2022.

No one who is interested in improving health and care and the development of patient centred, safe and reliable services could fail to agree with the proposition that digital transformation is vital. It is also unarguable that the pandemic brought a major shift in momentum to this agenda with frontline clinical staff and, crucially, people using services, adopting news ways of working. This change, borne of necessity and inventiveness, creates a new springboard to a greater role for digital tools to enable and support healthcare delivery.

There is every reason to be confident that, if implemented well, digital tools will both substantially enhance the experience of receiving, and delivering, care for individuals. Further, as a beneficial by-product the data captured through delivery of care in this way will enable previously unimaginable opportunities for healthcare forecasting and planning, and for entirely new insights from data analysis and machine learning, leading to health improvement for the population.

So, the ambition demonstrated in the Secretary of State’s recent announcements is very welcome as are the plans being implemented to coordinate the digital delivery agenda in a single organisational structure and for the leadership of the agenda to be brought alongside the closely related tasks of quality and service improvement, in the role of Chief Transformation Officer for NHS England.

For this ambition to be realised, a number of additional steps need to be taken as the Secretary of State references in his speech. The exciting future he describes can only be achieved if the clear information standards he alludes to are extended to all of the relevant aspects of health and care delivery and move from being an afterthought to a key priority for achieving  interoperability in a world of plural system delivery and ownership. They are the essential “rules of the road” for the digital agenda and an end-to-end process for their development, ratification and full scale adoption is long overdue.

Secondly, the Secretary of State rightly identifies that digital transformation must be led “from the front”. We would argue that this means being led through full blown engagement of the frontline. On a daily basis, we hear of digital delivery being undermined by very poor basic provision of the essential elements of a system that works for staff delivering care. Of slow systems which waste, rather than save, clinical time. Of multiple credentials to different systems to piece together a seamless record. To a shift to digital delivery of an historic way of working, rather than a transformed service, enabled by digital opportunity.

Thirdly, engagement needs to extend to the co-design of new services hand in glove with the ultimate beneficiaries; the patients and service users whose care is to be transformed. The pace of change during the pandemic might have justified the emergence of new solutions without a great deal of user participation, but that should not be seen as acceptable for the next phase of transformation. To paraphrase Don Berwick “transformation progresses at the speed of trust” and it is essential that service users gain confidence in new tools that support their care. This requires that they see that people they recognise as sharing their experiences, their interests and their values have played a full role in the way these tools and associated safeguards have been designed and implemented.

Sadly, the digital transformation of health and care services has seen, on too many occasions over the last twenty years, in the UK and in other settings, as ambition couched in terms of deadlines, which in time prove to be less a stimulus to action, and more a timetable for failed hopes. Expectations are re-defined, deadlines slipped or worst of all, met, but with inadequate solutions that “hit the target, but miss the point.” This arises, not because the ambition was misplaced, nor that effort was inadequate, but because of the inherent complexity of our system.

Acceleration of the development and adoption of standards, a real commitment to engagement with frontline professional communities, a relentless focus on ensuring the delivery of workable basic infrastructure and a partnership with people who will benefit from this revolution, will deliver a direction and pace to the transformation agenda that will lead to lasting and real change in which all involved can take pride.