The Personalised Health and Care 2020 portfolio itself is a key enabler to support the strategic objectives set out in the Five Year Forward View, to help the NHS become financially sustainable by bridging the three gaps relating to health and wellbeing, care and quality, and funding and efficiency.
This is a major shift in the scale and complexity of the requirements that fall on NHS Digital. At the same time, we have new arrangements for governance and assurance as the Department of Health slims down to its new role and hands over funding and controls to its Arms-Length Bodies, including NHS Digital and NHS England.
The step change for delivery responsibility and financial accountability for our organisation is substantial. We need to have the capacity, capability and corporate governance arrangements in place that are recognised as being robust enough to deliver these new requirements, to accept this new autonomy, and have the confidence of our key external partners and stakeholders, including HM Treasury.
Between October 2016 and March 2017, NHS Digital conducted a review (known as the 'Capability Review') whose purpose was to baseline our capabilities and identify what steps would be needed to further transform NHS Digital into a modern, agile organisation capable of meeting the delivery commitments made in Personalised Health and Care 2020 and the discharging of our statutory functions. A short description of the scope of the Review is included in Appendix 2. (add link here)
We wanted to ensure that our decisions about how we change are responsive to our partners and stakeholders. We employed independent advisers to help us with the Review, to ensure objectivity. We asked the advisers to gather views from our partners and stakeholders. We are grateful to all who contributed, as the feedback gave us some important insights into the way we work and our role in the system:
- Few people are aware of our role and functions in their entirety - especially our statutory role. People base their perceptions of our organisation on the services or functions they know - they are rarely reflecting a complete view of our organisation. Comments about our services are extremely varied across the scale of excellent, good, bad, or improving. We are recognised for our expertise in delivering large scale infrastructure and technology live services, but there is frustration about our handling of data services.
- Our national partners recognise the criticality of our role but are also concerned about our ability to step up to the delivery of the strategic requirements of Personalised Health and Care 2020.
- Our local stakeholders say we are distant from the front-line, and this is exacerbated by the way we communicate with other organisations, which is experienced as 'transmitting' information rather than 'engaging' with organisations.
- Many commented about a lack of clarity about the roles of national organisations involved in data and technology, including the system-level leadership and governance, approvals, assurance and governance processes as well as roles and functions.
Our national partners recognise the criticality of our role but are also concerned about our ability to step up to the delivery of the strategic requirements of Personalised Health and Care 2020.
The advisers told us that there is much evidence of progress and development across our organisation in our first three years - we have a sound foundation to build on. But they also gave us invaluable advice and direction to help us improve our effectiveness. They have set out the headlines from the Review for us in a separate document, and these are included in the next section below.
The commitments we are making in this document go beyond the scope of the recommendations from the advisers. They are intended to address the changes we need to make, and also the changes to the way we and our national partners - notably the Department of Health and NHS England - manage the system-level leadership and governance.
We are proud of the expertise that our staff have and the work they do for the benefit of the health and care system. We also recognise the importance of changing the way we work, of building and sustaining trust and confidence in all that we do, and of working in partnership to ensure that the total value of our collective effort to transform the way health and care services benefit from using data and technology exceeds the sum of the separate parts.
This document describes our ambition and our plans for transforming NHS Digital. It aims to assure the general reader that we are 'fit for purpose' to deliver the commitments set out in Personalised Health and Care 2020 as well as the longer term strategic challenges that health and care organisations are facing. Taken together, the commitments will consolidate our role as the key delivery partner for health and care data and technology services, and restore our voice and influence on behalf of the health and care service.