In November 2023, HTN asked its followers which health tech area they would prioritise this year. Improving digital culture and skills came out on top, with 38% of the vote, closely followed by improving systems in place (29%) and availability of data/use of data (28%).  

Just a week after HTN published its research, NHS England wrote to trusts to inform them that planned investment for frontline digitisation may be pulled from all but the least digitised trusts to help offset the impact of strike action.  

So how do trusts balance the demands for digital culture and skills with a lack of funding to support them? 

Kate Dawes, our Principal Consultant, reflects on how the NHS can embrace digital – and all its benefits – more effectively.  


Following a slow start (we are the last industry in the UK to digitise), we are seeing health and care invest in digital technology and processes. Whether this is due to enlightenment or central pressure, I will let you decide. I think we can agree, however, that digitisation is the right thing to do, given the precipice that we face. 

Yet the variation in implementation success is vast and, given the small technology market, product capability doesn’t appear to be the cause. Recent research by KLAS, Ethical Healthcare and NHS England seems to support this, with 66% of variability in usability down to the individual health and care provider. Specifically, causation relates to digital literacy and overarching clinical engagement. In fact, we are seeing this currently with the recent British Medical Association (BMA) vote of no confidence in the Federated Data Platform. Can this ever succeed without support of its users? 

The health and care sector seems to understand the need to drive a new approach to digital transformation, with the HTN research showing a clear prioritisation of digital culture and skills for this year’s investment focus. However, are we setting providers up to fail? With the removal of core digital skills and roles within the long-awaited NHS Long Term Workforce Plan, I would suggest so. 

Digital cannot continue to work in siloes and deliver the digital maturation the centre demands and patients need. Delivering successful transformation requires understanding of psychology and behavioural change to bring people on the journey; it’s one of the reasons Ethical have invested in a behavioural practice 

The new NHS England Chief Digital Information Officer (CDIO) role, therefore, provides a key step forward. It offers a duality of skills in system thinking and transformation, and digital transformation at executive level, translating technology with clinical, financial and operational peers and integrating digital into the care industry. Certainly, in their book, Building Digital Culture: A Practical Guide to Successful Digital Transformation, Rowles and Brown reflect that with the markers of “falling commercial performance” and the need to signal intent to stakeholders, the role of CDIO has the opportunity to be very effective. 

However, a mere change in organisational structure won’t reveal the Holy Grail. As Andy Kinnear reflected recently, many incumbent Chief Information Officers (CIOs) have become disillusioned with the uphill struggle to identify the need and importance of digital to their boards. We know from the KLAS research that approximately one-third of investment in electronic patient record (EPR) systems is devoted to implementation, reflecting the cultural journey still to walk. 

Historically executives and non-executives have been required to be financially literate and conversant in quality, operations and assurance. Indeed, Health MBAs have been developed to support this need. Yet boards remain unable to comprehend digital. CDIOs undoubtedly aid this and with time and credibility, decision constraints may relax, but I ask you, has the NHS got time to imbed these new roles and can they alone turn the tide? 

To deliver such wholesale change, board culture will need to shift to viewing digital and data as an equal amongst its executive peers, seeking to understand and value the qualitative and quantitative benefits to care that digital can enable. CDIOs can certainly bring digital to the table and translate but given the pressure that the health and care sector is now under, boards will have to meet digital halfway and be open to driving digital as a core component to strategic change and delivery. Boards will have to “do” digital. 


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