Laura Wade-Gery's letter to the Secretary of State for Health and Social Care about putting digital and data at the heart of transforming the NHS
Published 23 November 2021
Applies to England
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Dear Secretary of State,
I was commissioned to lead this independent review last summer in my capacity as Non-Executive Director of NHS England and Improvement and subsequently the interim Chair of NHS Digital. The review’s goal is to build on the progress made during the pandemic and ensure the centre of the NHS (defined as NHSEI, X and D) can lead the digitally enabled transformation of the wider healthcare system, supporting integrated care systems to deliver better citizen health. This is about enabling the centre to have the mindset, operating model, skills, capabilities and processes to provide the right leadership and support to integrated care systems, so that together the NHS delivers improved citizen and patient outcomes. The pandemic has delayed final completion of the review but has also given time to begin implementation of some of its recommendations. It has also profoundly changed the context and the NHS’s experience of digital and data.
The future tech-enabled citizen centred healthcare service is not hard to imagine. It means getting your questions answered by a trusted source at any time using your phone. And you being able to choose if the source is a customised webpage or a live person. You see your options for scheduling an appointment or a diagnostic test and you choose what works for you, avoiding the need to take a day off. Your mother’s diabetes is monitored remotely and she only needs to see the diabetic nurse specialist when the data suggests her blood sugar levels are not adequately managed, removing that bus ride to the GP for the previously every 3 month scheduled check-up. You can renew your prescriptions online and you always have access to your complete healthcare records. And even more is possible – your data, securely stored and properly curated, will be used to alert you and your doctor to changes in lifestyle or medications. And you will be able to enrol in research studies that give you access to innovative therapies. The tech-enabled NHS is also about making the work lives of our clinical staff more sustainable, enabling our clinicians to spend more time with their patients and less time on administrative tasks. They will have personalised decision support – using data to make specific suggestions on ways to improve the delivery of care, and voice recordings will generate the records so our busy clinicians don’t have to.
The need is compelling. The NHS faces unprecedented demand and severe operational pressure as we emerge from the pandemic, and it simply won’t work to revert to old models. The review sets out 9 recommendations that address this by putting data, digital and technology at the heart of how we transform health services. The recommendations are grouped under the headings of mindset, operating model (and organisational consequences) and critical enablers. The extent of the changes envisaged should not be under-estimated; they get to the heart of how the centre of the NHS operates, and critically the culture, skills and capabilities, incentives and operating processes in place. It will be tempting to focus on the organisational consequences. However, implementation will fail unless the accompanying enablers for change are not followed through. As such, the change management effort is significant and will require full-time resource and the determined sponsorship and commitment of the new CEO of NHS England and NHS Improvement (NHSEI) and the CEO of NHS Digital (NHSD) and their wider Executive Team and Boards. Engagement to date with the Boards of both NHSEI and NHSD has revealed strong support for the proposed changes.
I would like to express my profound gratitude to the many people from across the NHS and outside who made time to speak to me about their experiences and share their knowledge. I would particularly like to thank the team who worked on this in the autumn last year, Verena Stocker who has led the day to day work for a year, and David Roberts who supported me in the latter stages; as well as all those who have advised and helped me over the last year.
Laura Wade-Gery