Delivering digital services for NHS patients

So having sworn off the public sector (again) I found myself convinced by the Cabinet Office to have a look at a role within the NHS 18 months ago. I’d had a little exposure to health having worked as CTO for the Nursing Midwifery Council but frankly I had barely scratched the surface.

My role

I initially on-boarded to Skipton House with a team of about 20 who were leading the charge on transforming the NHS Choices service, initially in a pretty siloed way to the other 120 staff running the live NHS Choices service. An energetic and lively bunch of people, including some from GDS and other parts of government, who had achieved progress but also faced some challenges. To be fair to them, there had been a lack of clarity around the strategic direction.

It was key to me that I nailed down my mandate. Some of the existing team believed we were there to create a 'Health GDS', it was made very clear to me that wasn’t ‘the ask’ but regardless, the Patient Power Portfolio was a large and complex one.

The gig was the Digital Delivery Director role driving the Patient Facing and Prevention agenda as part of the ￡4.2bn Paperless 2020 programme managing a ￡300m budget - this would be a medium sized enterprise in the private sector.

My portfolio responsibilities included

• Running a live service (NHS Choices) that see’s 50m visits per month
• Transformation of NHS Choices into NHS.UK to create a multi-channel digital platform (driving a move to live transactional services)
• Rollout of free Wi-Fi across the NHS Estate (Primary and Secondary)
• Personal Health Records
• Citizen ID
• Digital Tools Library
• Widening Digital Participation
• 250 staff and a budget of ￡300m

Strategy and aims

The Patient Centric Strategy to achieve these objectives is set out in the NHS 5 Year Forward View and subsequently in the Patient Strategy developed for the Domain by the infamous Janet Hughes

In summary the aims were to:

Improve health outcomes for individuals and the population as a whole, by making it possible for people to take control of their own health and care and supporting shared care between patients and their clinicians

Increase efficiency / reduce cost by giving people access to the right care at the right time in the right venue, reducing unnecessary bureaucracy and process inefficiency, and improving the patient / citizen experience of using the NHS

Improve the patient experience by putting users at the heart of all digital services, making it easy for commissioners to buy / build high quality digital services, making it easy for people to get their needs met in the manner, time and place that best works for them, and removing causes of frustration, confusion and wasted effort and time

Cultural and business change

With any big transformation and change gig, emphasis and attention was needed on cultural and business change as well as driving delivery. 

An initial baseline of digital skills assessment across 150 permanent heads within NHS Choices led by digital partner Difrent and fronted by Rita Brockless identified a good baseline of our skills and a clear view of where we needed to upskill, cross train and support with vendors.

Culture, as ever was a challenge, there was refreshingly a fair bit of ‘start up’ mentality, more so than I have seen across Government before, and lots of delivery aspects being run outside the ‘corporate world’ , this was a challenge to manage and wasn’t constructive when trying to bring two teams together, but 18 months on I understand much better now why the team approached it this way initially!

We’ve spent a lot of time improving the culture over the last 18 months, getting a consistent strategy articulated, people on message about what we need to do and what our priorities are and we’ve used third parties to help us bring some of this to life, in a safe space where necessary. An extensive Leadership programme was delivered by Inspirati, and this paved the way for a number of ‘barrier breakers’ including our Firebreak and Unconference.

By no means have we got this nailed, cultural change is a huge challenge and my personal belief is the way people are rewarded and managed in the public sector really hinders delivery. The ability to move people on and actively using performance management would help immensely and team based bonuses for outcomes would drive better behaviour and delivery.

The Digital Lab - a multidisciplinary approach

One initiative driven by the domain was the adoption of a Digital Lab in Victoria, this has been key in bringing together not only multi disciplinary teams but also domains working across P2020. We housed 130 staff across two different domains, working alongside clinicians and vendor delivery squads from Mastek, Difrent, BJSS and Kainos. This will allow for a distributed agile model in the future but also addressed some cultural challenges head on.

The Fit for 2020 paper recently published by NHSD calls out some of the capability challenges NHS Digital, an open approach I applaud, I think this level of transparency is impressive. However these capability challenges meant we needed to change to the Operating Model within the Patient Facing delivery domain to drive early delivery. Our new operating model brings together perm headcount, individual interims and specialist vendors with a heavy front end digital delivery focus. Pre market engagement allowed us to see FTSE 100 clients utilising a blend of digital vendors working together delivering some huge transformations across HSBC and the Financial Times, big thanks to Cait O’Riordan and Jack Bennie for sparing us their time.

So what about actual Delivery?

NHS.UK – the transformation of NHS Choices to dynamic and contextualised content with live transactional services starting with Registering with a GP went live in Sep 2017. This service moved into a BETA in Sep 2017, more information can be found https://transformation.blog.nhs.uk

Providing free Wi-Fi across the NHS estate – We have rolled out WIFI to 1200 GP surgeries across the UK and will complete the Secondary Care estate by Dec 2017. https://transformation.blog.nhs.uk/how-were-providing-free-wifi-across-the-nhs

Digital Tools Library - We launched the digital tools library for public beta testing in March 2017 https://apps.beta.nhs.uk and added a further selection of apps by Sep 2017 (43 in total). The library is designed to help stimulate growth in the development of a vibrant ecosystem of safe and effective health and care apps, and to help people find high quality, safe and effective apps to meet their needs.

All the apps in the library have been technically assessed, for example to make sure that they comply with data protection requirements. Some apps have also had a more advanced level of vetting. These are labelled ‘NHS approved’ or ‘being tested in the NHS’. The library includes local digital products as well as national apps and services.

Citizen Identity - We are working to put in place consistent, safe and secure ways for people to prove their identity when accessing health and care services. This is a critical enabler for a lot of digital services, because without it we cannot safely allow access to people’s data and services online, and people will not be able to use online services safely, securely and quickly. Progress to-date includes

• Tested prototypes and run research and co-design sessions with users to learn about their needs and expectations when proving their identity online
• Worked with partners, including Cabinet Office, to test existing online identity assurance solutions in the context of health and care services
• Worked with service providers to understand their needs and requirements
• Worked with partners to developed draft identity assurance standards
• Researched and developed a technical identity hub for use with digital health services – this will allow services to ‘plug in’ and use nationally-approved digital identity solutions
• Created an Alpha using GDS Verify.

Personal Health Records - Our vision for personal health records is that they will provide (or enable provision of) easy access to a range of content and services tailored to people’s particular needs, including:

• content and tools for diagnosis, reference and self-care
• transactional services, e.g. appointments
• storing and analysing data produced by the patient and their chosen apps and devices
• managing correspondence
• viewing their historical records
• reminder and notification services
• paying for services like holiday vaccinations
• interacting digitally with clinical services, for example exchanging messages and having virtual consultations with clinicians
• controlling who has access to their data, for what purposes, including for example sharing data with carers and people with lasting power of attorney

In September 2017, we started a time-limited, private beta trial, limited to a few practices, of a service to allow people to access their GP records on NHS.UK utilising the white labelling Evergreen platform. Already we are seeing positive uptake and a willingness from patients to engage.

Widening Digital Participation - The purpose of the programme is to research and better understand the barriers to uptake of digital health and care services, and how we can make sure digital services meet the range of user needs.  Jeremy Hunt spoke at length about this during Expo and a recent blog from our third party Good Things Foundation covers progress to-date.

The portfolio has not been without the usual challenges but a robust delivery ethos has been instilled across the teams and a very strong can-do attitude and undoubtedly one of the best teams I have had the pleasure of leading!

Moving on

All ministerial commitments for March and Sep 2017 were delivered and plans are underway to workup a solution to Jeremy Hunt’s recent challenge - NHSOnline.

It has been a real privilege to lead the Patient Facing team for NHS Digital, at times challenging for the obvious reasons, but in equal measure I have loved the opportunity, met and worked with some truly inspirational people and genuinely feel I have made a difference, even a small one in how people access patient facing services in the UK.

As I hand over to Alan Morgans, my message to both my team and incredibly supportive SRO Juliet Bauer can be summed up brilliantly with the picture below.