At techUK we’ve been working with NHSX since its inception. We held a joint event with CEO Matthew Gould, CDO Tara Donnelly and (now officially in-post) CTO Hadley Beeman on 10 June, bringing the views of 100 tech companies to their prioritisation process. NHSX’s Indra Joshi joined us Google Deepmind later that week to talk about how we can ensure AI is benefitting the NHS and the population. Rhod Joyce, NHSX’s Head of Partnerships kindly hosted a Q&A with our elected Council on 18th June, and I hosted a webchat featuring the smartest dressed man in healthtech - NHSX’s Sam Shah the following day.
But NHSX only officially came into being a week ago. I joined techUK members including System C’s Beverley Bryant, UK Cloud’s Cleveland Henry and Digi.Me’s Daniel Bayley at the launch event GOSH Drive last Wednesday, where Secretary of State Matt Hancock and CEO Matthew Gould spoke about their plans for X.
And on Thursday we techUK hosted the ‘Digital Innovators Launch’ of NHSX, bringing together a range of SMEs across health and care to shape NHSX’s policies to drive innovation in the health and social care sector.
So no one can accuse NHSX of not engaging with the tech sector. I think you’d struggle to find a Government body that has done more in such a short space of time.
What have we learned from this engagement so far? I won’t repeat the 5 missions and priority programmes of NHSX – all of which are detailed in Matthew Gould’s blog here. Rather, I’ll write a bit about what we might be able to conclude from NHSX’s pre-launch period and first week of official operation:
1. NHSX is genuinely listening
X didn’t start out from a position of expertise. Matthew Gould’s background is in international relations, cyber security and govtech, so he will be on a steep healthcare learning curve, no doubt armed with King’s Fund animations and concentric circles. He has a lot of NHS experience in his team, particularly in CDO Tara Donnelly and deputy CEO Dr Simon Eccles, but the whole team have approached their prioritisation process with a refreshing sense of humility and alacrity. Matthew Gould has been tweeting frank and honest videos from his twitter account about his month touring the NHS. He has been clear that X will not sit at the centre claiming to know best and has urged his staff to engage with the frontline of health as much as possible.
2. NHSX is culturally different
You can’t establish a workplace culture in a month, but you can certainly set the tone. Government bodies are often accused of being somewhat impenetrable bureaucracies. NHSX has set out to be the opposite of this. Judging from how much I’ve seen them, many of NHSX’s staff will have seen very little of their own office in the past month. Announcements are being made through blogs and Twitter. NHSX is also looking at novel ways to engage with start-ups and no doubt some of that culture has been infectious.
3. Swift decisions are possible
Gould’s first act as CEO was to scale back plans for the NHS App, a welcome move amongst many techUK members. This is something we have been raising since the App was announced by Jeremy Hunt – and a point we made clearly in our Manifesto for Matt published last year. There are lots of innovative companies making healthtech apps with overlapping functionality, so the notion of a NHS App and the potential for scope creep worried many of our members. A ‘thin’ NHS App which forces functionality like the opening up of GP appointments and secure login could open the door to a raft of innovation from the market and ultimately deliver better outcomes for the public. NHSX’s ability to make this big (and right) call so early on bodes well for the future.
4. NHSX needs to grow
NHSX is an amalgamation of people from different parts of the system. Putting them together under one metaphorical roof undoubtedly results in a messy org chart that is hard to rationalise. But whilst there will be some duplication and reorganisation to be done, it is clear that the task at hand is too great for the 300ish people currently employed by NHSX. Perhaps we will see some industry figures joining NHSX to counter the flow in the opposite direction.
5. There will be a focus on distinct, achievable goals
In the history of the world, no-one has ever successfully boiled an ocean (though it may seem like a good idea if you ever try surfing in Tynemouth). There are great expectations for NHSX, no doubt fuelled by a Secretary of State known for his enthusiasm. But it is important that everyone involved in this ecosystem is realistic about what can be achieved. If it was quick and easy we’d have done it already. Mr Gould has openly stated that he wants us to judge NHSX in two years’ time and that there will be tangible progress towards its goals. This means a two-pronged approach. Firstly, a focus on fixing the foundations - things like standards, frameworks and spend controls – thus allowing others to get the tech right. And secondly, enabling tech projects that are best considered the low hanging fruit of the H+SC world.
6. Social Care is a high priority
At the launch of NHSX Matt Hancock stated that the ‘S’ of NHSX stands for Social Care. Both the Health Secretary and Matthew Gould have been clear that social care should not be an afterthought in NHSX. In a recent article, Mr Gould said that he had ‘visited care homes and sat down with care providers’ and understands ‘how tech can make a difference to both quality of care, and to the quality of life for staff’. I think it’s fair to say that the digitisation of social care has not been a priority - at least not with any serious funding behind it. Given the myriad of social care providers across public, private and third sector organisations and a baseline of digitisation that makes the NHS look futuristic, this will be no easy task.
7. Some of the barriers to digitisation can’t be fixed by NHSX
There’s a raft of tech out there that could reduce your need to go to hospital. There are apps that can check for signs of skin cancer, do home-based urinalysis and replace the need for physio visits. But traditional healthcare models mean the hospital gets paid when you show up - so there is no incentive to invest in technology that means that you don’t. Too often, the financial benefits of health tech accrue in a different pot to that which is supposed to pay for it, meaning it never gets serious consideration. The public suffers because of mere accounting arrangements. Joining up health and care and the budgets to pay for it has been a common policy theme for decades, but the commitment that all of England will be organised into Integrated Care Systems (ICSs) by April 2021 should help to make it a reality. This move will be supported by a health and social care bill that may not see the light of day until parliamentary arithmetic makes passing such a bill easier. These are fundamental policy questions that sit squarely with the Secretary of State and NHS CEO Simon Stevens rather than NHSX.
And perhaps the most pressing problem the NHS faces is one of staff shortages. The NHS needs more clinicians, more people with digital skills and more people with both of those attributes. Whilst NHSX can play a role in developing digital skills, factors such as NHS contracts, pay and immigration are beyond its remit.
Thankfully, in appointing Matthew Gould, NHSX has a seasoned diplomat and political operator who is used to working across Government Departments and can give NHSX the best chance of its priorities being heard elsewhere in the NHS and Government.
What have I missed? I’m sure this list could have been longer so feel free to comment with your own conclusions.
And happy 1 week birthday to NHSX and happy 71st birthday to the NHS!