Spring Budget: Don’t give the NHS more money for digital

As we await the Chancellor’s Spring Budget next week, our CEO Thomas Webb isn’t hoping for more money for digital in the NHS.

Instead, he wants more strategic funding programmes and a greater focus on developing the digital workforce. That’s where the real value for money lies.

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Ahead of the Spring Budget on 6 March, I thought it might be useful to pen some notes on how to improve the investment in digital in the NHS, just in case Jeremy Hunt is reading this.

The first thing to say might be slightly heretical – but don’t give the NHS more money for digital. I know, shocking, right?

The issue isn’t how much money. It’s the type of money, what it’s allocated to, and how it’s spent.

Now, I know that the investment in NHS providers is typically around 2-3% of revenue, and we’ve all known about the magical 5% figure since the Wachter report six years ago, and therefore the NHS does need to spend more on digital.

But, more heresy I’m afraid, I think the Treasury has a point in resisting demands for ever more funding for digital. Because the story of investment in digital in the NHS has been an almost unmitigated disaster. I think that it is frankly quite sensible for someone outside of the digital health world to question whether they are throwing good money after bad.

Now, enough of the self-flagellation, because now to examine why investment in digital hasn’t delivered in the past and what we can do to improve it (and some of it is not our fault).

Coherent funding strategies

To be honest, I’m not familiar enough with Treasury and Whitehall processes to know why funding allocations are so haphazard and volatile, but, blimey, it would be great if that stopped. It would benefit providers no end if funding strategies were multi-year, announced at least 12 months in advance and coherent, with funding streams linked to each other and supporting each other to deliver the outcomes and national strategy of the NHS.

At the moment, funding is far too tactical, volatile and reactive. It would be great if funding was instead strategic, proactive and intentional, looking to address challenges before they happen, instead of reactive short-term funding pots like the Electronic Bed and Capacity Management Systems (eBCMS) fund used to try to help the NHS limp through the winter. To be clear, I’m not saying that the eBCMS fund isn’t useful, but it’s an example of reactive firefighting.

Type of funding

This is a well-trodden path, but it would be good to recognise that capital investment has a revenue tail. The Government can keep on handing out capital, but it’s a bit like handing someone a puppy every year. It’s great at the time, but after a few years you’ll be completely overwhelmed with the stress of looking after them, as well as the mounting costs of caring for them.

And these revenue costs are mandatory, you can’t choose whether to pay them or not. So, without increasing revenue funding streams alongside capital outlay, all you’re doing is asking NHS Finance Directors to make impossible choices about what to stop paying for to accommodate the ever-increasing digital costs across the NHS.

Investment in the quality of digital workforce

Again, this is nothing new, but I think it’s absolutely fundamental for the NHS to derive better value for money from digital, and therefore build itself the platform it needs to justify increased funding from Treasury.

The problem around tech in the NHS isn’t the tech itself. Technology largely exists and evolves completely separately from the NHS. The problem for the NHS is its ability to harness, implement and exploit technology in the right way.

Why can’t it do this? I mean there are thousands of reasons, but it’s all to do with people. There simply isn’t the right calibre or quantity of talent in the NHS to do digital well. This ranges from boards to frontline clinicians; at every level there is deficit.

There is a real issue that the capabilities of technology are rapidly outpacing the capabilities of the NHS to use technology. While the fourth industrial revolution is just beginning to convulse society as we know it, we have the NHS only just getting round to replacing systems that are over 40 years old.

We need a huge increase in digital upskilling for the NHS workforce, way, way beyond the NHS Digital Academy as it currently exists. And you know, it would be good if this was funded by a coherent multi-year funding package that included capital as well as revenue.

Only once we’ve grown the capability and capacity of the NHS to successfully implement and fully exploit digital technologies can we start to ask for sustained and improved funding for the technologies themselves. Otherwise, you really are throwing good money after bad. One quick win would be to invest in the quality and quantity of training, which I’ve written about before.

There is a lot more to write about in this space, such as properly leveraging the might of the NHS to negotiate with suppliers, or ensuring we have investment in the foundational things like infrastructure first. On that note, and as a final positive note, the What Good Looks Like framework, although now a with a lower profile than it used to have, is a great thing. Sonia Patel should be congratulated for it. Because it gives NHS England the intelligence and information it needs to be able to direct funding appropriately, to make sure that we do have a parity of foundational technology to build on. We just need the same thing but for workforce too.