Nationally driven, locally led?
- Ross Fullerton
- Oct 1
- 4 min read
The government is rapidly announcing how technology and data are going to improve the quality and efficiency of NHS services in England. There is broad agreement that the NHS must change the way it works in order to meet the needs of an aging population who have more complex healthcare needs, whilst also finding ways to make better use of the resources at its disposal.
Is the NHS ready for this change? Is it finally time for the NHS to truly become a digital health service?
At Starlight we believe there are three essential components of long-term NHS reform:
stable and clear national vision and policy
long-term funding commitments
locally led delivery with the public, patients and the NHS workforce.
In recent months we've seen the public announcement of the Health Data Research Service, the 10 Year Health Plan for England, nationally available online GP bookings, the development of the Single Patient Record, rollout of the Federated Data Platform and most recently the new NHS Online service. All that without even mentioning artificial intelligence...
Layering these changes onto a service that is undergoing huge upheaval requires careful planning and management. At the top of the tree there is an increasingly directive Department of Health and Social Care (DHSC) and a soon-to-be abolished NHS England. These organisations set direction and often make bold commitments on delivery. Commitments then filter down through NHS England's national teams, into NHS England regions, across Integrated Care Boards and on to NHS providers and GPs who need to work out how to make it all work.
This is rarely a slick and well-oiled process. The time taken nationally to polish plans and satisfy the evolving ministerial and treasury requirements eats into scarce hands-on change implementation. Local teams eventually receive requirements in the form of a series of complex templates to populate overnight with detailed delivery plans, procurement approaches and funding specificity. At some point somewhere in the future the funding eventually appears - usually as capital allocation with an interest charge - and has to be spent within a few short weeks before the financial year ends. The result is all too often a poorly implemented technology without the essential business change required to help people adapt to new ways of working.
A better way?
The public sector in the UK knows how to deliver large-scale digital transformation. From local authority services such as managing waste collections through to complex national services such as delivering justice, there are many examples of well designed and executed digital services - both public-facing and behind the scenes. The UK has historically been celebrated internationally for the achievements in digitising our services.
We believe the NHS must learn from these successes and address three critical enablers.
Stable and clear national policy
The raft of announcements above highlight the continually evolving demands placed upon NHS organisations and their partners to change direction, implement new services and rethink their business plans.
The 10 Year Plan provides some excellent policy objectives for the NHS in England, from wearable technology adoption to scaling genomic medicines. However, the plan doesn't reference NHS Online which is yet another service for local organisations, and patients, to interact with.
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The Secretary of State, through DHSC and local NHS leadership needs to focus on delivery of the commitments that are already established, providing clarity to providers and stakeholders on expectations and unblocking legislative reform to expedite adoption of digital and data transformation in care.
Long term funding commitments
Digital transformation rarely aligns to financial years; even less so in an NHS where budgets aren't confirmed until mid-summer, national funding released in January and a new set of expectations emerge shortly thereafter.
The 10 Year Plan sets out an objective for multi-year funding settlements and the ring-fencing 3% of revenue for one-off investments in service transformation. For a typical district general hospital this could equate to about £13.5m/year, and in excess of £30m/year at a large teaching hospital. Boards must resist the pressure from finance chiefs may look to re-badge existing money to meet this expectation and deliver true benefit.
The ambitions here are laudable. To enact delivery on the ground, DHSC and Treasury must move swiftly to establish multi-year funding agreements tied to clear transformative outcomes.
Locally led delivery
Public sector reform rarely occurs as a result of ministerial musings; complex organisations such as the NHS are much more likely to unlock lasting change when it is delivered locally, led by those who understand the local population, the strengths and weaknesses of local organisations and who can work all the way down at neighbourhood level to connect people and make change happen.
The national roll-out of virtual wards provides excellent learning. National objectives were set (albeit with some metrics that over time turned out to be imperfect) and local organisations were asked to work out which services they could best deliver and would suit their population needs. After 24 months of learning, the requirements were tightened up and local teams were asked to prioritise areas that had developed the greatest benefit and were transferrable to other organisations. The challenge is knowing when to let the thousand flowers bloom, and when to set out that everyone must grow daffodils in the spring.
In this context the voice of the patient is key; they can cut through competing organisational preferences, bring reality to decision making and galvanise those involved in the change to deliver the best possible outcome with the resources available. With the pending abolition of Healthwatch organisations it will be crucial to find representative members of the public and support them to be the real-world voices in the room.
We have seen in recent years that the NHS can overcome the most difficult situations to deliver change faster than was ever imagined. With the right conditions, the NHS can become a much more digitally-led, patient-oriented organisation that improves the health of the nation.
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