What can national digital services do to support local health and care organisations? That is one of the big questions driving the NHS.UK alpha team.

We are Simon Dixon and Ninjeri Pandit, both part of the cross-system NHS.UK alpha team and part of the NHS England digital services team. We both started off working in local health and care services and have been exploring the relationship between national and local digital services for the alpha project.

It might seem obvious that local organisations have a better grasp of local issues and priorities, but historically national bodies have assumed that one size can fit all when it comes to proposing solutions. We need to strike the right balance nationally between highly centralised implementation of solutions and ‘letting a thousand flowers bloom’, a concept that was eloquently outlined in the NHS Five Year Forward View. There is more we can do to support and learn from local organisations and others.

The scale of digital services in health and care
There are over 3,000 nationally and locally branded websites and digital services on the .nhs.uk domain. In addition, local authorities have the duty to provide information and advice on their own websites to help people make well-informed choices about their care and support and how they fund it. Also, most GP practices also have their own websites.

This means that there are multiple access points, multiple brands and multiple services.

Understanding the challenges local organisations face
It is key for the success of NHS.UK that we work with local teams delivering health and care services to develop their digital capabilities to increase the take-up of patient focused digital services. To learn from local organisations and better understand the challenges they face, we have spent time travelling around the country talking to a wide variety of different organisations who commission and deliver health and care services.

In each area, we’ve been running workshops and having a discussion about what the NHS.UK proposition could be for local areas and how we can support them. We’ve talked through what we’re doing as part of the NHS.UK alpha and the national context and explored in detail the priorities and challenges of each area we visited, including an overview of the landscape and local provision of websites and other commissioned digital services. As we’ve spent a lot of time understanding user needs as as part of the NHS.UK alpha, we also took the opportunity to understand the local ‘touch and pain points’ based on user journeys – to learn about the potential hand-off points between national and local services and how national bodies can help to support local health and care economies. We’ve also been learning about the innovative and good practice approaches that local organisations are taking and understanding how we might be able to adopt them at a national level.

What we’ve learned
We have met with with 11 organisations, including Clinical Commissioning Groups, NHS trusts and local authorities, ranging from city centre to rural areas. We have heard about and seen that many of these organisations are working to develop innovative digital services for their populations, such as a messaging service for school nurses in Leicestershire, a mental health website for young people in Leeds, digital signage in the West Midlands and properly linked digital records bringing together health and social care, for example in mental health services in South London. Other organisations have told us that they want to improve upon their offer and embed digital services into the overall transformation of their local health and care economy.

So here are the 8 key things we’ve learned:

  1. Vision and strategy for digital health and care is not clear: This lack of clarity may discourage progress if organisations believe that the websites and services they are working on are already being developed by others.
  2. Whole system prioritisation for digital is non-existent: Although there are high-level commitments, such as those highlighted in the National Information Board’s Personalised Health and Care 2020, local organisations want a clear view of the deliverables (including products, platforms, standards, etc.) and timelines to be reassured that they will be delivered.
  3. Genuine concern about lack of digital capability and skills: There is a fear about technology and lack of basic digital skills both from professionals and patients/ the public. Local areas notice the difference geographically as there are challenges in delivering services to rural and remote communities. We will need to continue to work closely with activities such as NHS England’s Widening Digital Participation programme to ensure people are not left behind.
  4. Digital solutions must integrate with frontline workflows: Whatever we do nationally needs to seamlessly fit with clinical and practice workflows otherwise it will not be accepted.
  5. Silo working leads to duplication: If national agencies only focus on developing solutions to meet a “national need,” there will be significant duplication and waste across the system. As we also heard, social care is but one part of a local authority’s overall responsibility and developing solutions that work across only health and care may mean duplication for other council services.
  6. Lack of guidance and standards: The overwhelming feedback we had from teams building websites and digital services is that they wanted reassurance that they were doing the right thing in the right way. You can read more about our approach in our guidance and standards blog.
  7. Data quality about services is poor: Data about local services varies in quality. GP practices have got better things to do than update different directories of service. There is a need to have common data sources which different parties can access so they can tailor their local offering, but it needs to be easier to capture that service data. Additionally, national and local organisations will be each better placed to gather different types of data and information about services, so there should be clarity about these roles.
  8. Services don’t currently link up sufficiently: Making it easy for users to find what they need is key. We need to do the hard work to help them find the information that is relevant to them, in particular, local content or commissioned services.

What are our next steps?

Over the coming weeks we will:

  • Continue running workshops across the country
  • Continue to work with local health and care organisations to discover and sketch the local offer and proposition for NHS.UK and show how the link between local and national information and services could work

Our intent through our work with local organisations is to do what we can to help them make things better for their local population and drive up quality the quality of both national and local digital services across health and care to improve the public’s experience.

We’re planning to continue to run workshops across the country so if you’d like us to come and talk to you, then leave a comment or get in touch. You can follow us on Twitter at @ninpandit and @simondixon26 and the project on #nhsalpha

We have temporarily disabled the comment functionality whilst we make some technical updates. In the meantime, we’d love to hear what you think about our work so tweet us @NHSDigital using the hashtag #NHSTransformationBlog or get in touch at england.digitalhealth@nhs.net.