Future of the three NHS bodies managing health tech in doubt after £2.1bn cash injection

Health secretary signals shack-up could be on the cards

UK health secretary Sajid Javid has strongly indicated that the individual health bodies responsible for IT spending in the NHS will be reorganised.

IT strategy across England's unwieldy public-sector health system rests on the shoulders of three organisations: NHS England & NHS Improvement, NHS Digital, and NHSX. While individual trusts and GP surgeries manage their own technology spending, these central management bodies are together driving an £8.1bn digital transformation strategy up to 2023-24. Around £1.6bn is being spent keeping systems up and running over the same period.

Speaking yesterday at a conference for NHS care providers, Javid said: "Although we've seen phenomenal work on digital transformation during this pandemic from so many people, it does strike me as odd that digital leadership is currently split across NHSE, NHSX and NHS Digital."

For non-native speakers, "strikes me as odd" could be read as a Briticism for describing something fundamentally flawed and doomed to failure.

Laura Wade-Gery, the former chief executive of Tesco.com, is currently conducting a review of NHS IT strategy and Javid promised she would be looking at the structure of the bodies leading the health service's digital strategy.

The health secretary's decision to cast doubt on the future of the three bodies follows a £2.1bn cash injection from the Treasury, which over the next three years promises to "support innovative use of digital technology so hospitals and other care organisations are as connected and efficient as possible," according to the Autumn Statement.

What happened to the previous digital transformation push?

Javid is not alone in questioning the structure of NHS IT management. Last year, the National Audit Office, an independent watchdog for public spending, identified problems with the model.

NHS England & NHS Improvement is responsible for IT strategy and approves projects where capital cost exceeds £15m. NHS Digital is the main national body responsible for delivering this strategy.

Then in 2019, the Department of Health launched NHSX to "lead digital transformation in the NHS."

"National governance arrangements for digital transformation remain confused, despite attempts to clarify them," the NAO report said in May.

It also warned that the current digitisation strategy was failing to learn lessons from previous NHS IT disasters, including the £9.8bn National Programme for IT (NPfIT) fiasco, which kicked off around 20 years ago and cost the UK £9.8bn.

The Public Accounts Committee, the Parliamentary spending watchdog, later said the digitisation strategy didn't really amount to a strategy because it did not set out how ambitions would be met in practice.

The organisations have not exactly been keeping low profiles.

NHS Digital has been mired in the battle over access to GP data in a project which gave scant time for patients to understand their data rights and makes decisions on how their medical information is handled. Plans to extract data under the General Practice Data for Planning and Research (GPDPR) project are currently suspended following a backlash from GPs.

NHS England & NHS Improvement contracted US spy-tech firm Palantir to build a COVID-19 data store. In February, campaigners filed for a judicial review of the extension of that contract after they threatened legal action to force the publication of the original documents.

NHS England staff have complained they are being denied access to datasets on the Palantir platform.

NHS England has a broader remit than just NHS digital strategy. It also manages the flow of money to the service from the government. The £300m plan to replace the Oracle ERP system that does this is already running behind and has yet to produce a business plan. ®