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NHS dangles £6.7m for "digital maturity assessor"

"Recent initiatives have seen a reduction in the supplier base in some markets."

NHS England has up to £6.7m available for a provider to conduct its annual digital maturity assessments.

Getting the various component parts of the NHS up to speed with electronic systems has been an uphill struggle, with many NHS trusts still not using electronic patient records (EPR) systems.

A Health and Social Care committee found in January 2022 that many trusts were still using predominantly paper-based record systems. The government aims to have 100% of trusts on digital EPR systems by December 2025 as part of a “plan for digital health and social care” strategy and “What Good Looks Like” (WGLL) programme.

Better access to medical data, and improved interoperability, is an important part of being able to make better use of NHS patient data, as outlined in the recent NHS data strategy, Data Saves Lives. While the use of patient data remains controversial, its potential for improving outcomes is significant – but first it has to be usable.

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The new NHS Digital Maturity Assessments (DMAs) are aimed at systematising health service bodies’ approaches to IT, and ensuring compliance with the WGLL framework. According to the tender, the new DMA provider will score NHS organisations on compliance with the framework – a move away from the previously self-assessed DMA programme.

“Annual digital maturity assessments will allow health and care organisations to measure their progress towards the core capabilities set out in What good looks like and identify the areas they need to prioritise,” said the government’s policy paper on improving the use of technology in health and social care.

According to the paper, the WGLL programme will be expanded to cover the social care sector by September 2022. The up-to-£6.7 million DMA contract will cover NHS trusts, community integrated care organisations, and integrated care services.

The NHS digital maturity assessments tender also highlighted the need for discretion when it comes to sub-par performers: “Due to the nature of the work, there may be information on under-performing NHS organisations. The supplier will liaise with the WGLL DMA team on such matters, especially where any perceived reputation risk is concerned. This means the supplier must have in place control mechanisms on reports along with the audience they are presenting to.”

NHS digital maturity: Supply-side problems

One issue with digitising healthcare services is a shortage of suitable systems, with academics from the University of Edinburgh suggesting the market for Electronic Health Record (EHR) system providers had shrunk – partly as a result of efforts to improve standards. Kathrin Cresswell and Professor Robin Williams submitted evidence to the Health and Social Care select committee’s inquiry into digital transformation in the NHS, saying the body’s digitisation efforts needed more careful attention.

“Multiple recent policy initiatives have attempted to address these issues [of supplier diversity] by seeking to promote a more vibrant marketplace. However, these market management efforts have often not had the desired effect. Indeed recent initiatives have seen a reduction in the supplier base and supplier/data lock-in in some markets,” wrote Cresswell and Williams.

They also noted the problem will take time to solve: “The diversity of core Electronic Health Record (EHR) systems adopted by acute providers across the NHS, in part due to the piecemeal adoption post-[National Programme for IT in the NHS], presents a complex legacy. It increases the costs of establishing and maintaining data exchange for delivering integrated care across primary and secondary health and social care and for clinical research.

“Newly established Integrated Care Systems (ICSs) now need to confront this diversity. However EHR switching costs are high and harmonisation of systems will need to be gradual given the necessarily long contracts with existing suppliers.”

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For its part, the government is aiming to improve suppliers’ adherence to standards, according to its recent policy paper: “Service providers’ ability to meet mandatory standards is partly a function of their IT suppliers’ conformity to the standards. We are therefore working with the DCMS to include in the forthcoming Data Reform Bill further changes to Section 250 of the Health and Social Care Act 2012.

“These will include a power to apply technical standards to suppliers of IT systems and services equivalent to those applied to health and social care providers. They will provide a power to enforce these standards through compliance notices and financial penalties, along with a power to establish and operate an accreditation scheme.”

While sticking to standards is vital, this could seem to be exactly the type of intervention which, if handled less than optimally, could see suppliers leave the market rather than deal with additional bureaucracy. As Cresswell and Williams note, the road to NHS digital maturity requires "nuanced long-term policies".

As the NHS grapples with its digital growing pains, it also faces a far more acute malady, in the form of crippling staff shortages across the organisation. A Health and Social Care committee report released today says NHS England’s recruitment issues are jeopardising patient safety.

Given the critical issues seen at NHS trusts across the country, there is a distinct possibility the NHS as we know it may have ceased to exist long before its component parts manage to reach digital maturity.