doteveryone

The NHS isn’t a single organisation — it’s a vast patchwork of 8,988 providers and commissioners of services — from GPs to ambulance services, hospitals to mental health providers. Counted together it’s the fifth biggest employer in the world, filled with people who are brilliant at problem solving, providing critical services for people in need.

This complex, fragmented system won’t be digitally transformed by the launch of a single service or a set of apps, a group of designers, or the availability of care robots.

Doteveryone’s research into improving end of life care — where one-third of the healthcare budget is currently spent — shows that more joined up services, better patient engagement and future-proofed systems and infrastructure will flow from better digital leadership, on the ground, in the Trusts and CCGs that are delivering care and commissioning services.

If each commissioning body made just two better decisions each year there would be bigger, faster improvements in patient experience and efficiency than could flow from any central NHS digital programme. If ten CCGs didn’t commission a new app but invested in reusing technology made by another NHS body, or eight Trusts renegotiated the terms of a long-term contract to prioritise interoperability, NHS digital provision would become more joined up, more cost-effective and improve at scale more quickly.

And it’s striking, for instance, that even Google DeepMind hasn’t taken on the whole NHS. So far, the computing power and expertise of the world leader in artificial intelligence has been focussed on single conditions in single hospitals — causing some controversy along the way.

No single technology company in the world could oversee transformation of this scale.

Each trust is a large, complex organisation in its own right — for instance, the Royal Free in London has a turnover of almost £1bn, employs more than 10,000 staff and serves 1.6 million patients across 20 sites with specialist services in in liver and kidney transplantation, rare cancers, haemophilia, infectious diseases, plastic surgery, immunology and neurology.

Transforming one organisation like this would be a big ask for a Google or a Microsoft; taking the other 8,987 parts of the health service with it would be almost impossible.

But a better digital understanding at executive level would help the NHS to transform itself, and help the Trust and CCG leaders and clinicians who deliver care every day to identify and maintain the right digital solutions for themselves.

Good work on this is already happening. The role of the Chief Information Officer has been adopted throughout the NHS, as recommended by the Wachter Review and digital skills across the NHS workforce are improving.

But there needs to be a vital culture change where technology breaks out of its silo and is understood by all members of NHS executive teams. Like reading a balance sheet or calculating risk, understanding the impact of digital technologies is a fundamental part of making organisations which work — now and in the future.

The digital leadership work we’re doing at Doteveryone shows how we can help executive teams know which questions to ask and which acronyms to understand, so that it’s easier to prioritise, set strategies, and spot when things are about to go very wrong. Our shared values for commissioning show what this could mean for the NHS in practice.

And if NHS clinicians and leaders can start to combine their clinical expertise with digital know-how, they’ll be closer to taking advantage of innovative health tech that promises large-scale, future transformation and eventually make better judgements about technology we can’t yet imagine.