Written evidence submitted by the Department of Health and Social Care (DHS0042)
Commitment 2: “By increasing digital connection and providing more personalised care, we can support people to monitor and better manage their long-term health conditions in their own homes, enabling them to live well and independently for longer.”
Commitment 3: “Roll out integrated health and care records to all people, providing a functionally single health and care record that people, their carers and care teams can all safely access, enabled by a combination of nationally held summary data and links to locally held records, including shared care records.”
Commitment 1: “Through the Data for Research and Development programme we will invest up to £200 million to transform access to and linkage of NHS health and genomic data sets for data-driven innovation and inclusive clinical trials, whose results will be critical to ensuring public confidence in data access for research and innovation purposes.”
Commitments 1 and 2: We will streamline contracting methods both to leverage NHS buying power and simplify the process of selling technology to NHS buyers (ongoing). / We will consolidate routes to market and strengthen our commercial levers for adopting standards through a new target operating model for procurement. This will include embedding standards as part of procurement frameworks, supporting NHS procurement teams to prioritise adherence to standards. Consolidation of the number of frameworks will encourage market entry and more choice in some markets, incentivising vendors to follow NHS standards.
Commitment 1: We will co-create a national digital workforce strategy with the health and care system setting out a framework for bridging the skills gap and making the NHS an attractive place to work.
Commitment 2: We will enable recruitment retention and growth of the digital, data, technology workforce to meet challenging projected health and care demand by 2030 through graduates, apprentices and experienced hires creating posts for an additional 10,500 full-time staff.
We welcome the Expert Panel’s evaluation into this important topic. Digital transformation of health and care services is essential to offering patients safer and more effective levels of care while reducing the burdens faced by NHS staff.
We have made significant progress in the digital transformation of the health and care system, but there is still much to do to ensure its long-term sustainability. During the pandemic, digital capabilities were pivotal to the delivery of care. The opportunity now is for the health and care sector to build on this and use the potential of digital to help the NHS address both its long-term challenges and the immediate task of recovering from the pandemic. We also recognise the Expert Panel’s broader interest in this topic, as demonstrated by the Panel’s recent assessments on the health and social care workforce, and cancer, mental health and maternity services. We also understand the Expert Panel’s findings will be used to support the Health and Social Care Select Committee in its standard inquiry on NHS digitisation.
In August 2022, we provided the Panel with a list of commitments from the recently published ‘A Digital Plan for Health and Social Care’ and ‘Data Saves Lives: Reshaping Health and Social Care with Data’. Our written evidence below focuses on the nine commitments selected by the Panel.
As the committee will be aware, inflation and other in-year pressures not accounted for in the current settlement mean DHSC & NHSE need to keep spending and delivery plans under review to ensure best value for money and prioritise where needed. This applies to digital transformation, including the nine commitments selected by the Expert Panel where we continue to look at our investment and implementation plans to ensure we are prioritising correctly to best achieve our goals. Where we need to prioritise, we look to maintain as many of the benefits for patients and the health and social care workforce as possible, albeit sometimes through different means or to amended timelines.
We look forward to further supporting the Panel with this evaluation as it progresses.
The Expert Panel requested the following evidence (further details are outlined below).
o *Book GP appointments
o *Access GP medical records (where made available locally)
o Access prescriptions from a GP and the ability to order a repeat prescription
o Access to NHS e-Referral Service, which allows patients to choose their first hospital or clinic appointment with a specialist
o Access national data opt out
o Access organ donation preferences
o Access NHS 111 Online
o Health A-Z advice and guidance
o Check Covid vaccination record
o *Have integrations to local patient engagement portal providers (e.g., Zesty, Patient Knows Best) and GP online consultation providers (e.g., eConsult, Accurx etc.) where made available locally
The Expert Panel requested the following data (further details are outlined below).
We are on track to meet the commitment. The trajectory for the App of 68% of the population using it by end March ‘23 and 75% by the end of March ‘24 is on track with the initial target of 68% having been met in October ‘22.
We monitor this metric carefully, and are currently forecasting:
Planned investment will enable us to expand and improve services made available through the App, and marketing will position the App at the centre of NHS England and DHSC communications to drive public awareness and uptake. This will ensure we successfully meet the target, as well as continue to deliver for patients and the system. In addition to growing our user base we also need to retain users by ensuring that the App truly serves as their ‘front door’ to the NHS. This will require us to address variation across the country in transaction availability and continue to develop and deliver the functionality that users want and need.
Fig 1: NHS App sign-ups actuals and current forecast:
* Sign-ups are the recorded number of users with P5 verification (users with P5 verification can undertake a range of transactions including ordering repeat prescriptions, view their health record, manage their hospital or clinic appointments, register as an organ donor, and view their COVID Pass). This total figure covers sign-ups across England and the Isle of Man, which includes those aged 13-15. Sign-ups do not necessarily map to individual users, as one person may use multiple email addresses to register for the NHS App. Work is underway to de-duplicate to a person level, however we use ‘sign-ups’ as a proxy for equivalent % of the English adult population.
What impact has the pandemic had on achieving the commitment?
The pandemic, and in particular the decision to host the COVID Pass on the NHS App, has been transformational. There were 260,000 sign-ups for the NHS App in January ‘20, growing to 2.3 million in January ‘21, with another spike in May ‘21 after the introduction of the NHS COVID Pass. Growth can be observed in the chart included above (figures in the table below).
Growth up to May 2021
A National Institute for Health and Care Research (NIHR) funded evaluation of the rollout of the NHS App in England is being conducted by Imperial College London and the University of Oxford. The initial phase of the evaluation used descriptive statistics and an interrupted time series analysis to look at monthly NHS App metrics at a GP practice level from January ‘19-May ‘21 in England, enabling an in-depth understanding of the impact of the pandemic on App uptake and usage.
Mass adoption of the NHS App was driven by the pandemic. Between January ‘19 and May ‘21, there were 8.5 million NHS App downloads and 4.5 million sign-ups. In April 2021 there were 650k downloads of the NHS App and in May 2021, when the COVID Pass feature was introduced, there were 2.7m downloads, representing a 4-fold increase.
Growth beyond May 2021
After the introduction of COVID Pass, there was continued growth in users, with another spike in November / December ‘21, when COVID Pass was mandated. Additionally, use of transactions within the NHS App continued to rise:
The commitment is funded as part of a package to develop the National Digital Channels to achieve transformation and maintain objectives as set out in the business case, delivered by NHS Digital. Marketing spend was not funded through the Programme Business Case and was a known cost pressure.
The ambition of our citizen-facing digital offer, which also includes NHS.uk and NHS Login, is to enable all adults in England to access digital health and care services in order to stay well, get well, and manage their health and care. The NHS App is central to our offer.
On a monthly basis circa 25% of user logins to the NHS App (c.25% of user base logged in during September ‘22), and c.75% of users have logged in during the last 6 months, demonstrating a core userbase that remains engaged. Usage indicates that people are opting to self-serve when given the opportunity to do so. In September 2022 alone there were:
NHS App user experience feedback
NHSE and NHS Digital user research teams conduct regular research to understand experiences of using the NHS App (and transactions), supporting the continual improvement of services.
The NIHR evaluation of the NHS App includes qualitative research to understand patient experiences of technology-enabled access to primary care. Emerging findings indicate that patients value the speed and ease of accessing services via the NHS App. Ordering repeat prescriptions was noted to be quick and convenient, and patients valued access to their personal health record which was perceived to contain useful and important information. Many users feel that the App offers an easier way to access services compared to ‘traditional’ routes. However, key issues that users reported include:
Yes - the NHS App is central to the digital offer to citizens. It was a crucial tool in the fight against COVID-19, and it has changed the way millions of adults in England now access health services. As one of the principal channels for accessing digital health and care services, it supports a wide range of health and care activities, both built natively and through integrations. Emerging evidence from the NHS App will also allow us to better understand health inequalities.
Emerging evidence on the NHS App and health inequalities
The NIHR evaluation analysed App usage against a range of variables at GP practice level (including age, gender, ethnicity, Index of Multiple Deprivation). Emerging findings highlight lower App uptake correlating with greater deprivation, and higher App uptake correlating with practices with the highest proportion of white patients, demonstrating that there is more to do to support the widest range of citizens possible to participate.
A number of workstreams are working to better understand the relationship between the NHS App, health inequalities and digital inclusion, and what can be done to mitigate these systemic issues. As many people are unable or unwilling to access digital services, the NHS App must serve as one aspect of an inclusive NHS offer that reflects the needs and preferences of individuals and includes non-digital options to ensure equitable access. Better understanding users and non-users will inform a wider digital and health policy areas and improve digital engagement.
Considerations for understanding the impact of the NHS App on patients
The Expert Panel asked for the following additional evidence (further details outlined below):
‘A plan for digital health and care’ 29 June 2022 sets out NHSE and DHSC’s commitments to scaling digitally enabled healthcare, delivering more care to people in their homes (as per extract below), and 2022/23 priorities and operational planning guidance published 24 December 2021 sets out specific deliverables for systems.
“Connected, supported and personalised care at home”
By increasing digital connection and providing more personalised care, we can support people to monitor and better manage their long-term health conditions in their own homes, enabling them to live well and independently for longer.
These commitments to scale digitally enabled care to more people in their homes are largely delivered by two programme areas: virtual wards, and supporting people at home. Both programmes are currently on track to deliver or ahead of plan.
The programmes commenced after the outbreak of COVID-19 and rapid uptake was facilitated by the shift to digital care seen during the pandemic. Although the national programme of work for virtual wards and associated funding commenced in 2022/23, additional funding was made available to systems before then who were ready to implement virtual wards as part of the COVID-19 response.
'Virtual wards’ are nationally defined as a safe and efficient alternative to NHS bedded care that is enabled by technology. Virtual wards support patients who would otherwise be in hospital to receive the acute care, monitoring and treatment they need in their own home. Technology enablement means the management of patients via a digital platform managed remotely by a clinical team.
Virtual wards should be developed across systems and can be based on partnership between acute hospital, a community service team, social care, mental health services and in many cases partnerships with the independent sector.
NHS England asked all ICSs to extend or introduce for the first time the virtual ward model. At a minimum, ICSs were asked to establish virtual ward models for two pathways - acute respiratory infection and frailty – although depending on the maturity of services, other pathways can and should be developed in addition.
ICSs are making progress on this ask and as of October 2022, there are 110 tech enabled virtual wards across 31 ICSs.
By December 2023, NHS England has asked systems to deliver virtual ward capacity equivalent to 40–50 virtual beds per 100,000 population.
Current system trajectories indicate at least 36 virtual beds per 100,000 adult population by December 2023, with further work underway to meet the ambition.
Supporting People at Home
The Supporting People at Home programme has provided funding for project teams to scale digitally enabled healthcare. Digital home care services include vital sign monitoring, tech-enabled annual physical health checks for people with severe mental illness and home blood pressure monitoring.
The Supporting People at Home programme saw reductions of up to 60% of emergency admissions for those with chronic obstructive pulmonary disease (COPD) and heart failure when digitally supported. In one care home example, the local team demonstrated a 33% reduction in ambulance call outs to care homes that introduced digital vital sign monitoring in comparison to those that didn’t.
Delivery against these commitments are as follows:
A tech-enabled annual physical check for people with severe mental illness has been developed, with roll-out taking place in a selection of ICSs ahead of the March 2023 target date. Many are now live and this commitment has been met with 6,810 people having received their annual physical check in year by October 2022.
3. 687 GP practices volunteered to be Trailblazer sites for home blood pressure monitoring. Examples of impact are as follows: and results were as follows -
The virtual wards programme is a dedicated programme of work to support implementation of virtual wards across all 42 ICSs in England. The requirements to rapidly increase NHS bed capacity as part of the post pandemic recovery of the NHS played a major role in these funding arrangements. The aim of the investment and mandate was to drive up implementation of virtual wards and use of technology to enhance care across England.
The funding model took into account insights from established virtual wards and hospital at home services. As a major contribution towards the set up and development of virtual wards, NHSE published planning guidance in December 2021 which made up to £200 million available in 2022/23 and up to £250 million in 2023/24 to ICSs.
Funds have been made available to ICSs through Service Delivery Funding via fair share allocation and ICSs have had to develop and submit comprehensive systems plans covering implementation, workforce and finance. This includes local selection and commissioning of technology platforms. Funding is confirmed for 22/23 and 23/24 and £198m has flowed to systems in 2022/23.
Supporting People at Home
In the autumn of 2020, Emergency COVID-19 funds supported the extension of home or remote monitoring during the pandemic. This enabled NHS organisations to implement remote monitoring for people living with long term conditions, as part of their Covid@Home response. This was in recognition to the momentum for digital health that the response to the pandemic had generated, as well as to provide more home care, freeing hospital beds to reduce the backlog.
The Supporting People at Home programme has helped to accelerate the adoption of home monitoring technologies, helping people to stay well, and independent, in their own homes. Funding had been planned for a three-year period, however, as shown in the table above, this has ceased early, this reflects:
Funds have been coordinated by the seven NHS Regions and passed onto CCGs and latterly ICSs. This includes local selection and commissioning of technology platforms.
People with Covid, acute respiratory infection (ARI) or frailty have been the main groups that have benefited from virtual wards to date although there are also examples of virtual wards supporting other patient groups such as children and people with heart failure. The model is anticipated to cover a broader range of conditions in the future, once all ICSs have ARI and frailty provision in place.
For the national virtual wards programme, evaluation is just beginning. There is limited evidence yet on equity of access and outcomes. The national programme team are scoping the long-term evaluation approach for virtual wards and exploring how to assess the impact on health inequalities with all system plans outlining the local approach to addressing any identified risks to widening health inequalities through implementation. As part of the national virtual wards programme there is a focus alongside the evaluation strategy to improve the data flow to support evidence and insight into improved and measurable outcomes.
Supporting People at Home
The Supporting People at Home programme has reached different groups of the population as outlined below:
The evidence presented below is early, locally collected and from relatively small-scale user bases. A major independent evaluation is planned, led by NIHR who are currently selecting the lead research group.
Local evaluations (between November 2020-September 2022) have focused on the impact for different groups, and in particular whether older people are able to take part in digital home care. The Croydon digital home care evaluation shows high levels of satisfaction with the technology used (94% said they found it easy to use) with an average participant age of 80.
Hypertension is closely linked with deprivation, with many more deaths and adverse cardiac events in the poorest populations. Hypertension is the most common long-term condition in England, affecting more than a quarter of adults in England and contributing to around 75,000 deaths each year.
Local evaluations demonstrate a range of early benefits such as improved blood pressure control from a digitally supported home monitoring service. Emergency admissions for heart failure and COPD reduced by 60% and ambulance conveyances from care homes reduced by up to 33%. Some of these are being prepared for publication.
Early though it is, evidence suggests that the commitments are achieving improvement for service users, healthcare staff, and the healthcare system as a whole.
The wider ambition is right, that people are able to experience care at home. In the future, it is right that this sits almost largely with ICSs to integrate into care pathways. Our view is that the scope of the commitment is both wide and specific enough. The specific mandate and funding for Virtual Wards has accelerated progress.
The Expert Panel requested the following evidence (where applicable, further details are outlined below).
Please include The Expert Panel requested the following data (further details are outlined below).
The COVID-19 “Phase 3” letter from the NHS England, 31st July 2020 set out a requirement for all Integrated Care Systems (ICS) to create plans for “developing and implementing a full shared care record, allowing the safe flow of patient data between care settings, and the aggregation of data for population health.”
With £50m in capital funding, our Shared Care Record Programme was successful in supporting ICSs to help 100% of ICS to have a basic shared care record by the end of FY 2021/2022. Basic Shared Care Records are important for patients that interact with multiple parts of the healthcare system as they allow professionals to be aware of what matters to patients without patients having to frequently repeat their story.
A specific requirement of the programme was to ensure that professionals did not have to log-on to separate systems or portals to view the information held in a Shared Care Record but could access it through the primary clinical system they used for their day-to-day activities.
In parallel with the development of local shared care records, the long-standing Summary Care Record continues to be available for those who do not currently have access to their local shared care record – e.g. community pharmacists, some paramedic services.
At a minimum, the Summary Care Record holds important information about;
Additional information can be included within the Summary Care Record. Pre-pandemic this was a facility to which patients had to “opt-in” and as a result only c.3.5 million patients had a Summary Care Record with Additional Information.
As a result of the pandemic, the opt-in was amended to an “opt-out” arrangement, which led to an increase in the number of patients with a Summary Care Record with Additional Information to 57 million. A consequence of this richer additional information being more readily available was an increased use of the Summary Care Record as users found an increased likelihood of there being valuable information available.
The Summary Care Record is accessed through an application called the National Care Records Service which surfaces the information detailed above and enables viewing of some locally held information such as mental health crisis plans and end of life plans using the National Record Locator service. It provides a valuable solution while the national network of interconnected shared care records develops.
Beyond a Basic Shared Care Record and Summary Care Record, there is current work to extend the benefits in Phase 2 for FY 2024/2025.
Original aims of Phase 2 are outlined below in detail below to March 2025, but as integrated care becomes the norm and systems are increasingly focused on digital maturity and safe data sharing, we have reviewed our approach and by March 2023 through this programme, we will:
Furthermore, rather than funding a stand alone programme on Shared Care Records, we will deliver the same ambition through embedding a collaborative approach into our biggest programme – Digitising the Frontline. This collaboration will be more efficient with a broad focus on digitising, driving adoption of electronic health records and interoperability.
As set our in our Plan for Digital Health and Social Care, next steps are to ensure that constituent organisations of an ICS are connected to an integrated life-long health and care record by 2024, enabled by core national capabilities, local health records and shared care records, giving individuals, their approved caregivers and their care team the ability to view and contribute to the record.
Targets in place for this commitment as follows:
The initial target was for all 5 ICSs in Phase 1 to have shared care records by September 2021 with all ICSs expected to have a basic shared care record by April 2022. As noted above, our Shared Care Record Programme was successful in supporting ICSs to help 100% of ICS to have a basic shared care record by the end of FY 2021/2022.
Full plans to deliver our expectation that, by March 2025, all clinical teams in an ICS will have appropriate access to a complete view of a person’s health record, including their medications and key aspects of their history are set out in Annex 2 of A Plan for Digital Health and Social Care.
The agreed priorities from now to 31 March 2023 are:
Impact at Trust/patient level
Meeting the commitment has enabled professionals working in trusts and general practice to be able to access additional information about the patients they care for. In ICSs where access has already been extended to other services and care providers so there are increasing examples of better care co-ordination, reduced time spent chasing information, results and records, and better experiences for patients.
Does data show achievement against the target?
Specific funding arrangements
Phase 1 was delivered using targeted national funding, which was local matched. National funding was aimed at supporting the acquisition and deployment of shared care record solutions, while the operational costs – and realisation of benefits - were to be born and accrued by local systems.
All ICSs were asked to submit proposals for national funding support to enable them to meet the MVS specification. As proposals were received, they were assessed against a set of criteria and – if satisfactory, an allocation made against the £50m capital.
Who was responsible for funding arrangements?
ICSs were invited to apply for funding. These applications were considered by the national programme team to ensure that they were being appropriately applied and in line with conditions, such as compliance with the MVS specification, the requirement to use solutions from the national procurement framework, and a commitment to local matched resourcing.
Recommendations of the programme team were then presented to the Programme Board and the Programme SRO for sign off on the allocation to local ICSs.
To deliver the Phase 1 objectives, yes. No reasonable application for funding from ICSs was turned down and the total funds allocated were within the £50m allocation limit.
An indicative figure has been allocated to the national programme for the SR period. The current working assumption is that local teams will be expected to progress their initiatives irrespective of the national funding position and that we are intending to include guidance to this effect to local systems.
As part of NHS England Transformation Directorate’s rationalisation programme, the existing Shared Care Records programme team is being divided:
Implementation at local level
National funding was made available for the development and implementation stage. Local ICSs are expected to fund the ongoing operation of their shared care record solutions, and will retain realised benefits locally.
Factors considered when determining funding
That matched resourcing would be provided by local systems alongside national funding support National resourcing support should be targeted at those ICSs which were least mature.
Outcomes for different groups
Further work is required to understand impact on specific groups. There are some groups for whom the basic shared record implementations may not be providing full benefit such as those with conditions who travel to receive care from specialist centres outside of the area in which they live, including patients of some clinical networks and those with rare diseases. Other groups who may not yet fully benefit from existing solutions would be transient populations such as students, members of the military, prisoners, and travellers. Though these groups will still be covered by Summary Care Records. The plans we have set out in A Plan for Digital Health and Social Care aim to address this.
Improvement in measurable outcomes
Qualitative evidence suggests that access to richer information improves the quality of decisions made about patient care and created opportunities for efficiency through removal of duplication etc, however it is too soon to evaluate this deliverable as basic shared records have only been in place everywhere since April this year.
Benefits for patients and service users
In several areas implementing care plans across a range of professionals from different services, patients and their carers are involved in enriching shared care records with information that the patients want their professionals to be aware of such as the “What matters to me” datasets. This information can then be made available to professionals without the patient – or their carer – having to repeat themselves.
Though not specifically studied for this programme, previous evaluations of record sharing initiatives have indicated efficiencies through better care coordination and reduction of duplication in things such as diagnostic testing.
Local systems had been seeking to establish record sharing within their local communities but in an ad-hoc, uncoordinated way, including inconsistent approaches to information governance.
The need for a national programme to better coordinate and standardise activity and ensure national interoperability was identified.
There clear benefits for the use of resources in the wider system – for example where repeat diagnostic tests do not need to be carried out, where ambulance crews can avoid unnecessary transfer and subsequent admissions, where discharge planning can be undertaken more quickly and with greater confidence etc.
Breadth of commitment
The overall vision is a broad one, looking to bring together all records and plans for an individual into a birth to death longitudinal record. The programme has sought to address challenges in the interoperability between NHS Trust and general practice and now will seek to extend that to address national interoperability challenges.
The programme has stimulated thinking about the value of managing information around the person receiving care, and less on the provider of care or the place of residence or treatment.
Specificity of commitment
Phase 1 commitment was specific and measurable.
Phase 2 commitments – these are also designed to be measurable but the specific targets – e.g., the pace of connecting local authority social services - may need further revision, subject to funding and other delivery factors.
It has highlighted the importance of a clear national strategy for record and plan sharing to avoid duplication of effort and there is now a commitment to publish a national architecture.
Level of ambition
Patients are shown to largely expect that information about them and their care is available to all professionals caring for them. The large-scale public deliberative engagement programme carried out in London was described as “the world’s largest public deliberation on the use of health and care data”.
Is the target an effective measure of success?
It supports the policy aim of providing integrated health and care services, by focusing the sharing of information around the person receiving care rather than the provider of that care.
Was the commitment addressing an identified need and relevant to the problem?
The presence of and feedback from over 60, organically developed, record sharing initiatives across the country indicated unmet need. The aim of the programme was to better coordinate those and ensure increased implementation of common national standards.
Impact on other aspects of care
Deployments of the infrastructure underpinning shared care records is a major enabler for the adoption of new care models, where care may be delivered by other professionals in a range of care settings and using innovative technologies, such as remote monitoring and the creation of virtual wards.
The Expert Panel asked for the following additional evidence (further details outlined below):
The Data for R&D Programme funding runs up to March 2025, with our vision to have a world-leading NHS-wide health data research infrastructure that enhances patient care, sustains the NHS and supports innovation.
The programme has made excellent progress moving the NHS Digital Secure Data Environment and NHS DigiTrials out of ‘minimal viable product’, and launching a funding call for Sub National Secure Data Environments. However, there have been delays to some elements of the programme due wider financial and operational factors. Whilst these factors have had an impact on the programme, every effort has been made to mitigate against loss of benefits for example utilising NHS Commissioning Support Unit support for capacity, and leveraging delivery partner activity where possible.
It is acknowledged that Patient and Public Engagement and Involvement are critical to the success of the Data for R&D Programme. Therefore, the programme has allocated significant resources to support a wider public conversation about use of NHS data as part of Data Saves Lives implementation. Additionally, consultation work is ongoing with the NHS DigiTrials Patient Involvement Panel, UseMYData, and at regional level as part of the development of Sub-National Secure Data Environments, a key advantage of which is connectivity to local communities. Some activity has also been moved from 22/23 into 24/25, particularly relating to data driven clinical trials.
Extensive industry and medical research charity engagement has taken place across over 80 organisations through the Programme’s ‘Data User Group’, including ministerial briefings leading up to announcing Programme funding, and a recent in-person meeting for 150 delegates, garnering strong buy-in and support for the programme. This has included public positive endorsement from Health Data Research UK, the Association of Biopharmaceutical Industry, and the Association of Medical Research Charities.
ICS and regional engagement has been strong, following seed funding for four localities to perform discovery work on ‘Sub National Secure Data Environments’ in 21/22, leading to promotion of an EOI process that will lead to funding commitments being made on 11 November 2022.
Patient and Public Engagement and Involvement work has taken place, including a public deliberation by OneLondon, and presentations to the NHS Digital DigiTrials Patient and Public panel. The direction of travel has been reinforced through recommendations in the Goldacre Review. The Data Saves Lives strategy committed to implementing Secure Data Environments across the NHS, with further detail provided through the publication of 12 Secure Data Environment Guidelines, supported by an easy to understand public explainer developed with patient panels and representatives.
There is also data to show achievement against the target:
This commitment is jointly funded by NHS England (£160m), BEIS (£30m) and DHSC SRE (£10m). Funding was announced on 3 March 2022. These financial commitments are a new resource stream and subject to appropriate approvals.
Funding was based on significant discovery work in the lead up to SR21 and through seed-funding provided by DHSC and BEIS in 21/22, which enabled us to calculate costs and potential benefits of up to £1.7bn if the programme and interdependencies are fully delivered.
Funding has been agreed with NHS Digital for the NHS Digital Secure Data Environment and the NHS DigiTrials service, with a positive response to the funding strategy for Sub National Secure Data Environments from localities seeking to bid. Of courses, more could be achieved with further funding, but focus is on delivery and benefits maximisation of current programme.
This programme is designed to ensure that access to data results in research outputs that are representative of our diverse population. This includes accessing data through National and Sub National Secure Data Environments covering all of England, recruiting citizens to clinical trials through the NHS DigiTrials service, and empowering citizens to participate in trials through the NIHR Be Part of Research Platform.
If fully implemented and fully supported by complementary initiatives and funding, the programme predicted to generate up to £1.7bn in benefits over 10 years, including patient benefits of over £380m (£139m in improved cancer treatments, £188m in AI-enabled cancer diagnosis, and £53m in risk stratification and improving CVD outcomes), £545m in NHS benefits (reduced treatment costs, reduced readmissions and reduced imaging spend), nearly £650m in clinical trial benefits and over £139m in industrial growth.
This programme is designed to deliver on public confidence in access to health data for research and empower citizens to be involved in clinical trials. More patients being represented in faster and more effective data driven research will drive patient benefits and generate a fair return that supports a sustainable NHS.
This programme focusses on delivering against our biggest health challenges, as outlines in the Life Sciences Vision’s Healthcare Missions. However, the data infrastructure investments are disease agnostic, and enable data to be collected and curated once, at scale, and used multiple times, enabling benefit across the full spectrum of patients and service users.
A Public Sector Equality Duty assessment has been conducted, and the programme will improve the representation of those with protected characteristics and underserved communities in research. Patient and Public Involvement and Engagement, as well as involvement of medical research charities and their representative body the Association of Medical Research Charities, plus Behavioural Science approaches are being deployed to ensure maximum reach of opportunities to understand, feedback on, and participate in data driven research.
Yes. The Programme launches in April 2022 and will generate benefits for:
This scope of the programme is designed to invest in health data research infrastructure at scale across England, and covering four key data modalities (EHR, imaging, pathology and genomics). It is complemented by other programmes including frontline digitisation and the Federated Data Platform. This commitment also focusses on 6 key research use cases, and builds upon previous research infrastructure investments, patient flows and research collaborations.
In terms of level of ambition, whilst the programme runs until April 2025, that benefits realisation for research infrastructure investments are longer terms, with Programme Business Case benefits calculated over a ten-year time horizon.
This programme is supported, and supports in turn, the development of Secure Data Environment Policy and Accreditation, with 12 SDE policy guidelines published in September 2022, and is a delivery vehicle for commitments made in Data Saves Lives. This policy is designed to deliver on data commitments made in the Life Sciences Vision, NHS Long Term Plan, DHSC Vision for the future of UK Clinical Research Delivery, Genome UK Strategy and Data Saves Lives. These strategy commitments are in response to a well understood problem of unrealised potential of NHS longitudinal care record for research due to the fragmentation of the health data ecosystem.
The Sub National SDE funding strategy has taken into account the readiness of localities in the context of other initiatives including Electronic Health Record transformation and levelling up.
To support the wider system with this commitment, funding is now being provided to support implementation of Sub National Secure Data Environments, and research use of health data is key to unlocking more efficient and effective means of care delivery. However, it is acknowledged that frontline teams are under significant pressure to delivery care and frontline digitisation, which is a documented programme risk.
Primary care data is vitally important to improving services and patient outcomes. As recognised in Data Saves Lives, we will continue to work with our partners to evaluate the impact of the solutions currently in place for access to primary care data. A Digital Plan for Health and Care also outlines future plans to support primary care to use technology to streamline routine tasks and processes by better exploiting current functionality, and we have already invested significantly in supporting the adoption of primary care records (GPIT).
NHS Digital is already able to extract de-identified data from GP practices through General Practice Extraction Service (GPES), which is able to interrogate data within the GP system and produce aggregate results. This system, however, is ten years old, operating over capacity and lacks modern capabilities for data processing.
The specific commitment noted above was linked to the GP Data for Planning and Research (GPDPR) programme, to support and enable the movement of de-identified patient data from GP practices to NHS Digital, where it could be safely stored, processed and used transparently and in line with the Health and Social Care Act 2012.
Privitar, the technology to enable pseudonymised data to be extracted, was successfully implemented within GP systems in May 2021, but has never been activated into live use and data is not being extracted using this tool. This is partly due to public concern about the wider programme in summer 2021, which led to commitments, from the Minister at the time, that data would only be uploaded using the system once the following was in place:
Privitar has undergone penetration testing as part of the wider IT security review within NHS Digital, with the report being submitted to NHS Digital in May 2021.
Resources were in place, however the programme has paused due to external factors (see summary above). We are currently looking at how best to respond to the concerns raised.
While implementation of the commitment has been delayed, the use of GP patient information (also known as GP data) for planning and research has the power to transform our understanding of what causes ill health and, importantly, what we can do to prevent or treat it and provide better care. It is also used to support better care for patients, planning and running of NHS services, and research.
However, this can only be achieved where we have the trust of the public and professions. In order to ensure this programme will only move forward where the following conditions are met:
The commitment to be able to use data from GP systems to support the NHS and to enable research remains.
As set out above GP patient information is an important resource. The commitment to improve secure and appropriate access to GP data for the benefit of health services, and the care and treatment it provides, remains appropriate. However, we are considering – working with stakeholders – the best way to realise that commitment whilst also addressing concerns and meeting the tests outlined above.
Commitments 1 and 2 under Policy Area 3 refer to the same programme of work. The written evidence below applies to both commitments. Given that we are dealing with both commitments together, we have also provided a summary of the programme for ease:
The Expert Panel requested the following evidence (further details are outlined below):
Whilst the committed under Policy Area 3 specifically refer to the procurement frameworks we are adopting, it is also worth highlighting that we are working collaboratively across a range of areas to support companies develop and deploy health-technologies (please note these are not specific deliverables against the workstream/commitment in question). This includes the:
A first iteration of the NHS digital framework recommendations has been published, which has consolidated routes to market. This part of the commitment has been met overall and new objectives have been set for further consolidation. However, it is important to note that this is an ongoing piece of work, as the framework landscape is constantly developing (as agreements expire and new iterations are let). The dynamic marketplace ensures new technologies have a route to the NHS buyer.
We will continue to work with framework authorities to ensure these frameworks are the most appropriate to use at all times and where necessary, support new or modified routes to market to replace any current frameworks that do not continue to meet required criteria.
Trusts are well briefed on our recommendations, and we are receiving significant feedback, clarifications requests and request for further information from buyers, which indicate the recommendations are a consideration pre-procurement in new tenders across the system.
As more spend data becomes available (as well as resource to analyse it recruited), more consolidated/aggregated procurement activities will become possible. However, the focus on our recommendations are to achieve better value for money (improved patient care), less expense for vendors (fewer frameworks to apply to), and simplified routes to market for the NHS buyer (more efficient procurements, fewer local checks needed, i.e. standards).
Specific funding arrangements were made to support the implementation of the commitment. They were made to actively manage the framework landscape for this spend category, to engage the marketplace and framework authorities.
No additional funding (other than recruitment) was sought.
The framework should have a positive impact on patients and service users. The vision is a simplified framework landscape, reducing costs for vendors and resource requirements for procurements, leading to better value for money/reallocation of savings.
There will be indirect benefits; the work we are reporting on involves enabling buyers to better access the market for digital products and services, rather than any specific buying activity. We expect buyers will be reporting these benefits against specific areas of digital spend.
All patients will benefit from the procurement of fit for purpose, well specified digital solutions. As above, our work has been to ensure that buyers are able to access the market in a more consistent and value-added way.
Yes, this will provide a meaningful improvement in efficiency benefiting the wider system.
The scope of the commitment is wide enough to match the pace and complexity of the marketplace, which is constantly evolving.
Whilst the commitment refers specifically to standards, this is only a small part of overall workstream – the focus is on better routes to market, simplification, and reducing overheads for suppliers and buyers, leading to better value for money and improved patient care.
The Expert Panel requested the following evidence (further details are outlined below).
o will provide a digital learning offer that includes accessible training and online resources over the next 3 years. In March 2022, we published a digital skills framework alongside a collection of digital skills training resources for social care staff. We are finalising the framework and implementing a self-assessment tool to sit alongside. Social care staff will be supported via digital skills training such as the NHS Digital Academy
o are working in partnership with Skills for Care, the National Care Forum, Digital Social Care and Cosmic, this year we have delivered 2 free training programmes to support social care professionals to develop their skills and help drive digital transformation and change across the sector. We are now working to formally evaluate the training to help shape a scaled-up future digital learning offer
We are progressing these well and are shortly looking to also begin some additional eLearning development, development of two small qualifications, the discovery for the self-assessment tool and a small piece of research for regulated professionals.
The original commitment was set out for DDaT professionals only and is for March 2023 – whilst it is tied to the wider workforce plan and digital readiness more broadly, this commitment focusses specifically on the Digital Workforce programme. Due to contextual and operational factors which have delayed work, we are now working to deliver an interim Workforce Plan in April 2023, with a subsequent full plan and framework by September 2023.
Impact of Covid-19 Response on Targets
As noted in the summary, re-prioritisation during Covid and the response to its impact has led to delays in developing the workforce plan.
Impact at Trust/Patient Level
The commitment is well understood and well received at the regional, ICS and provider levels. ICSs and providers are very keen for help and guidance to be able to better attract and retain people with specialist skills. In June/ July 2022 we ran a short survey across the CIO community in healthcare to get an indication of the current vacancy rate across Digital, Data and Technology roles within their provider organisations. While current records do not allow us to know the total DDaT workforce in the NHS, at the time of surveying, the indicative vacancy rate was 3,500 FTEs. The reasons given for this vacancy rate were to do largely with a difficultly in attracting candidates (due to pay, career opportunity and the fierce competition with industry), and a fundamental shortage of potential candidates in the pipeline. Furthermore, in the report ‘Data Driven Healthcare in 2030....’ published by Health Education England in 2021 forecast that by the year 2030 the sector would require an additional 32,000 FTEs in specialist Digital, Data and Technology roles to meet the demand stimulated through digital transformation.
Yes - the Digital Workforce programme has £1.1 million of funding to deliver the workforce plan and graduates/apprenticeships schemes, and small elements of the Skills framework development.
The originally proposed funding level is deemed as sufficient to deliver the workforce strategy/plan but is also dependent on wider factors.
It is too early to tell what impact this commitment has had on different groups of patients and service users. However, proxy evidence shows that, during cyber-attacks, Trusts that had a more optimal digital, data and technology capacity, were better able to tackle the breach at the pace required and to implement contingency measures that helped to continue business as usual care delivery.
The commitment is likely to bring about an indirect impact for patients and services users. The outcomes of the Digital Workforce Programme enable other transformation programmes to deliver on their patient related outcomes. Through ensuring there is sufficient Digital, Data and Technology skills and expertise to implement and optimise the use of the digital tools in provider organisations, it means that patients, service users and staff are more likely to experience the benefits in terms care delivery and health outcomes. An example of this is Frontline Digitisation – with £2bn investment). It is critically important that in order to generate the benefits from this digital investment and hence the ROI, the EPR solutions Trusts need to be able to deploy the right resource capability to implement these complex solutions, to optimise them for usage that meets the needs of the organisation and pathways, but also, to ensure adoption across the staff. This requires a rich mix of specialists in many digital, data and technology roles, including clinicians with an informatics specialist to help with the change management, configuration and adoption activities.
Yes, the commitment was addressing an identified need, as outlined in the Topol Review. The commitment is likely to achieve meaningful improvement for service users, healthcare staff and the healthcare system as a whole; sustainable digital transformation cannot be achieved without the workforce. Both in terms of digital literacy, but also in terms of capacity and expertise to deliver and optimise the digital investments made.
The commitment has been emphasised in:
The commitment is wide enough in scope as it spans all of the job families in the existing five Government Digital Services (GDS) DDaT Capability Framework, plus additional 5 job families required to meet the domain- specific needs of the health and social care sector.
The commitment is specific enough as it focussed on devising a plan of action and framework for addressing the skills gap for the Digital, Data and Technology Workforce in health and social care.
The level of ambition as expressed by the commitment is reasonable but in light of Covid and resulting impacts, some of the timelines have had to be extended.
It is too soon to identify how this commitment has affected other aspects of care (or if the system had the relevant tools to support the change). However, at present, there have been no unintended consequences from this commitment.
The Expert Panel requested the following evidence (further details are outlined below).
The Workforce Strategy/Plan will be key to meeting the target by 2030. We are on track against the revised timelines of an interim plan by April 2023 and a final plan in September 2023.
Yes - please see response to this question under Commitment 1. As part of the wider £1.1m budget for Digital Workforce, £0.5m will support the delivery of the DDaT Graduate scheme for FY22/23.
Please see response to this question under Commitment 1.
It is too soon to measure a meaningful improvement on outcomes, however operationally the scheme has performed as follows:
Please see response to this question under Commitment 1. The commitment is still the right one, as highlighted by the report: Data Driven Healthcare in 2030: Transformation Requirements of the NHS Digital Technology and Health Informatics Workforce. This report was commissioned by Health Education England’s Digital Readiness programme to identify the capacity and capability challenges facing the NHS digital technology and informatics workforce (the ‘digital workforce’) in the next 10 years. Information from the exercise was used to model projected demand, and data from the NHS Electronic Staff Record used to model projected supply, for the digital workforce for the period 2020 to 2030. Particular attention was paid to workforce demand and the job roles and skills needed in a scenario called the Data Driven Future. Highlighted areas of change across workforce planning, workforce development and professionalisation and workforce supply; all of which the commitment in question seeks to address.
Through the research carried out by Health Education England and the recent vacancy surveys across the system, plus insights gathered from large EPR suppliers, we have a clear idea of the DDaT roles that need more focused attention.
Rules to support the system with this change will be set out in the Digital Workforce Strategy/Plan.
 As part of the standard inquiry, we understand the Committee has shown previous interest in remote technologies, streamlining the regulatory appraisal process and workforce development, as well as the need to upskill the primary care workforce to make better use of IT services.
 All findings detailed here from the NIHR funded evaluation of the rollout of the NHS App in England are subject to peer review.
 An observational study of uptake and adoption of the NHS App in England. Salina Tewolde, Céire Costelloe, John PowelI, Chrysanthi Papoutsi, Claire Reidy, Bernard Gudgin, Craig Shenton, Felix Greaves. medRxiv 2022.03.16.22272200; doi: https://doi.org/10.1101/2022.03.16.22272200
 In response to the COVID-19 pandemic, NHS England and NHS Improvement supported all GP practices in England with the rapid implementation of a ‘total triage’ model using telephone and online consultation tools. Total triage means that every patient contacting the practice is first triaged before making an appointment. Many GP practices disabled appointment booking via the App to prevent patients from booking appointments directly so that they could deliver their triage model.
 All NHS App services are accessible through the NHS Website via NHS Account, ensuring parity in access regardless of device preference.
 The University of Oxford’s qualitative research (conducted as part of the NHIR funded evaluation of the NHS App) took place in four case study sites (GP practices in the South East, East Midlands, North and North West) and comprised: four focus groups with 22 patients; one-to-one interviews with 25 patients, 20 healthcare staff, 14 stakeholders; and ethnographic site observations. The findings from the research are due to be published in December 2022. All findings are subject to peer review.
 All findings detailed here from the NIHR funded evaluation of the rollout of the NHS App in England are subject to peer review.
 Information Governance Framework: Shared Care Records - NHS Transformation Directorate (england.nhs.uk)
 Patients have the options to opt-out of Summary Care Records and Summary Care Records with Additional Information. Weekly views have increased from 150,000 at the start of 2019 to 300,000 per week in 2022
 A plan for digital health and social care - GOV.UK (www.gov.uk)
 A plan for digital health and social care - GOV.UK (www.gov.uk)
 De-identification is the removal of personal identifiable information about individuals from a dataset.
 GPDPR launched successfully in May 2021 but was paused in July 2021 due to the conditions set out in the letter for Jo Churchill https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/general-practice-data-for-planning-and-research/secretary-of-state-letter-to-general-practice
 Data Driven Healthcare in 2030: Transformation Requirements of the NHS Digital Technology and Health Informatics Workforce | Health Education England (hee.nhs.uk)