Digital-First

Digital First – what exactly are we trying to transcend?

Just over 18 months my colleague, Andy Wilkins, and I finished a report for the Department of Health Innovation Health & Wealth programme team on ‘Digital First – the delivery choice of England’s population‘. In essence, the report was a call to action for the NHS in line with other areas of the public sector which had already undergone their own digital growth spurt (more commonly known as Digital by Default). If you haven’t read it, I’d place you in the majority as it’s not the sort of report that has had substantial airing by anyone beyond those closely involved with it’s definition and production. Which is a bit of a shame, not because as an author, I’m proud of it and feel it should get some airtime, but because it is actually a fundamental building block for helping the NHS to move towards a digital future.

Why is it so important, then? Foremost, in a world where technological development moves at a ridiculously fast pace, behemoths like the NHS can easily be left behind and in such a world where trends in how the public are using technology and devices are outstripping even the least conservative expectations the gap between what the NHS is willing to do and what the public might expect is going to keep growing.

And the NHS can’t just take a leap of faith to fill that gap, nor can it expect a massively strategic shunt to come from the centre to align everybody and make the NHS a fertile and low risk market place for digital SMEs to finally generate a sustainable income. But what Digital First set out to do in it’s initial form was to encourage the NHS to look inwardly and do a few things that make a lot of sense, serve the nascent concept (at that time) of being patient (or user) centred and de-risk a lot of the barriers that get wheeled out whenever someone mentions digitally empowering patients.

In some ways, the report itself was a de-risked version of something much more substantial which we wanted to express, but which was considered too ‘strategic’. Which was this: that the NHS needed and still needs a roadmap for going digital. Such a roadmap needs to define for local and regional implementation a set of significant step-changes to fundamentally move the culture towards a viable and sustainable future state – underpinned by digital. And I think it is achievable if we can ensure that each step-change incorporates changes to both how users experience service delivery as well as how those services can sustainably ameliorate their digital capability and functionality.

And this gets down to the guts of what I believe (along with others of notable responsibility within the healthcare system), that Digital First, through it’s inception as a call to action for the NHS is really a driver for culture change. And this is where the rocks still need to be banged together, because for the minority of those who have even seen, let alone bothered to read Digital First, initial perceptions are that this is about technology change. It’s not and never will be. If we in the industry can collectively help the NHS to see digital as a cultural shift towards user centred service delivery, personalised care and an understanding that health is a system not a process, they will get to see the true opportunity that digital offers.

Coming away from Health2eu a fortnight ago, it struck me that what is missing for the NHS and the digital industry is a common language. And whilst I appreciate the time that NHS England’s technology directors put into turning up at such events to evangelise about a coherent future working in partnership with us on this side of the fence, I lack faith that they have sufficient ideas on how to achieve it. Certainly developing a centre of excellence is more of a knee-jerk reaction than a thought out plan and will probably cost a lot of money and achieve very little – the money might as well be put in the dirty paws of a bunch of developers who can be told to go away for six months and come up with something interesting.

As a parting shot, here’s a thought for everyone to consider. When the Inland Revenue kick-started a programme to transform their public services, they approached the Treasury for a £350m loan because they could see a few billion pounds of benefit downstream. Even though Digital First came up with some comparable numbers detailing the benefit from basic digital improvements, the argument has not moved forward and there is no business case in sight that might give the SME sector a sense that there could be a plan out there that could be used to underpin their own business intentions.


This post has also appeared on my own personal blog, Keep Banging The Rocks Together.