NHSX and NHS Digital merger shakes up healthcare, IT leadership

In a move meant to accelerate digital transformation in healthcare, the two bodies responsible for NHS IT strategy and delivery, NHS Digital and NHSX, will merge into NHS England & NHS Improvement to help improve care for patients and provide leadership and support to the wider NHS.

The merger first came into focus after a leaked internal email from NHSX CEO Matthew Gould revealed that NHS Digital and NHSX would be incorporated into NHS England’s new Transformation Directorate, which will lead the digital transformation agenda for the NHS and social care at national and ICS (integrated care system) level. The UK government formally announced the decision hours later.

In the announcement, the health and social care secretary Sajid Javid also confirmed that the Health Education England (HEE) body responsible for education and training will fall into NHSE/I.

The changes at NHS will “better support the recovery of the NHS services, address waiting list backlogs, and support hardworking staff, all while driving forwards an ambitious agenda of digital transformation and progress,” according to the announcement.

The decision to bring NHSX and NHS Digital under the same roof as NHS England & NHS Improvement, which have worked as a single organisation since 2019, comes four months after former health secretary Matt Hancock ordered a major review into how the groups worked together. The independent review, which was carried out by former Tesco and M&S Group CEO Laura Wade-Gery, evaluated the critical capabilities and the digital operating model required to drive the digital system transformation as outlined in the government’s NHS Long Term Plan.

“This is not about centralisation — it’s about empowering the centre to have the mindset, operating model, skills, capabilities and processes to provide the right leadership and support to ICSs, so that together the NHS delivers improved citizen and patient outcomes,” said Wade-Gery in her review summary. 

Wade-Gery’s recommendations follow a £2.1bn investment from the Treasury, which promises to “support innovative use of digital technology so hospitals and other care organisations are as connected and efficient as possible” over the next three years, according to the October government budget report.

Digital transformation at the ‘heart of the NHS’

“To ensure our record NHS investment makes a lasting impact, I am bringing workforce planning and digital transformation into the heart of the NHS,” said Javid, in the announcement of the changes. “These reforms will support our recovery from COVID-19 and help us tackle waiting lists to give patients excellent care in years to come,” Javid said

He had earlier hinted at the structural change at the NHS Providers conference, where he said it was ‘odd’ that digital NHS leadership was split across departments.

NHSX CEO Matthew Gould added that the reorganisation intends to make digital delivery more coherent, and less siloed.

“For the past two years, NHSX has been making the case for digital transformation in the NHS, and for digital to be integrated within the NHS rather than kept in its own silo,” Gould said, in the press release announcing the changes. “This reorganisation is the culmination of that campaign. It is an excellent step — a more coherent structure that will allow us to accelerate digital transformation across health and care.”

Confusion between NHSX, NHS Digital and NHS England

NHS Digital was formed in 2013 as the primary delivery organisation taking charge of information, data and IT systems for commissioners and clinicians in health and social care across England, while NHSX was launched in 2019 to help local NHS and care groups digitise services, set standards and policy and connect disparate systems.

NHS England has to date largely been responsible for IT strategy and projects with larger capital costs, and for setting IT priorities, detailing programmes and commissioning these through NHS Digital.

Both NHS Digital and NHSX have won plaudits over the course of the COVID-19 pandemic, with a particular emphasis on introducing new digital technologies for remote monitoring and the roll-out of the NHS COVID Pass app, which has nearly 20 million users. Other notable achievements include the NHSX’s Data Store, which allowed the NHS to route ventilators and PPE to where they needed to be, as well as conduct research into COVID-19. On the flip side, however, NHS Digital’s controversial GP data sharing service, the General Practice Data for Planning and Research (GPDPR), was derided for invading data privacy.

Despite the various accomplishments, the cross-over between the organisations has caused confusion. As one CIO, who prefers to remain anonymous, explains, with both NHS England and NHS Digital being non-department bodies of the Department of Health and Social Care, and constituted differently under UK legislation, NHS England couldn’t manage NHS Digital, so NHSX was created to ‘commission’ projects from NHS Digital, ‘effectively as a budget holder’.

A 2020 report from the National Audit Office (NAO) spending watchdog also called out a lack of clarity on IT strategy and management.

A new CIO at NHS England

In the email from NHSX’s Matthew Gould which leaked the news about the merger, it was revealed that NHSX will “evolve into the strategy function” of the Transformation Directorate, and that NHS Digital’s interim chief executive Simon Bolton will be appointed as chief information officer for NHS England and Improvement.

Bolton, who will report into the group’s director of transformation Tim Ferris, said that the NHS needs “coherent, consistent leadership on tech if it is to survive and thrive” and admits that messaging in the past has caused “confusion and frustration”. The consolidation of duties, as he noted on Twitter, aims to improve agility, patient outcomes and reduce inefficiencies.

“One lesson from COVID has been [that] when we get policy, operations and tech aligned we move fast and effectively,” said Bolton on the social media platform.  “Creating a single, coherent centre that can provide consistent leadership on digital for the NHS is foundational.”

At the time of writing, it was unclear who will make-up Bolton’s immediate IT function, his core responsibilities, the timescales involved or what will happen to the NHSX CIO role currently occupied by Sonia Patel.

Patel joined NHSX last July, having previously been joint CIO at London North West Healthcare NHS Trust and The Hillingdon Hospitals Foundation Trust, and was the brains behind the ‘What Good Looks Like’ (WGLL) digital maturity framework, which was released this October. She also worked with UK government on the formation of a new architecture for NHS and social care, and led the authoring of key guidance to the NHS to ensure digital and data is embedded into the new system reform agenda.

Changes in IT strategy and leadership

Patel said that she is looking forward to being part of the new organisation.

“Our role of digitising health and care is recognised as being vitally important, and it makes sense for us all to be together where we can be most effective,” said Patel. “Whilst details are still to be worked out, that vital role will certainly remain, and I look forward to continuing to be part of it.”

When asked what the merger will mean for IT leadership and responsibilities within the NHS, NHS Digital said that it didn’t currently have anything further to add.

Industry commentators believe that the merger could break down organisational siloes, streamline duplicated duties, improve patient outcomes and enhance staff digital literacy, although one healthcare CIO cautioned that the structural change will only make the lines of demarcation clearer, ‘if the ambition is delivered’.

Gary McAllister, CTO at One London and former CTO at Guy’s and St Thomas NHS Foundation Trust, also believes that the move will bring strategy, transformation and execution into a single structure, but warns that the key challenges may still take time to resolve, particularly around obtaining the necessary skills and expertise to drive modernisation. He’s also unclear on what the changes mean for IT leadership.

“I suspect some roles may move to the transformation directorate and create more of a ‘digital, data, transformation and policy officer’ capability within NHS England and Improvement; transformation with a more collaborative approach between policy and delivery,” McAllister said. “It appears the CIO role, under the current operating model of NHS Digital, will be focused on technology delivery.”

Rachel Murphy, CEO of consultancy Difrent (becoming TPXimpact) and the former Digital Delivery Director at NHS Digital, believes the merger makes sense in the ‘next phase of digital transformation in the NHS’, and represents an opportunity to redeploy talent.

“There is an opportunity to redeploy much needed structured project management talent closer to the front line to help deliver and support the transformation that the health service needs,” Murphy said.