Where should the £2.1 billion NHS capital funding be prioritised? Why has the funding been released before ICSs are made a legal entity? Will Sir Jim Mackey’s Elective Recovery Report pose real value and make a difference? These are some of the questions pondered at our latest Silver Buccaneers Advisory Board meeting. Read on to get the full insights from Hassan Chaudhury, Yasmin Stinchcombe, Lloyd Price, Sam Shah and Jon Hoeksma…
The £2.1 billion funding to improve IT and digital technology in the NHS was announced amidst a huge fanfare and much back-patting. There were assurances that this was indeed “new money” and not just a politicised “smoke and mirrors” exercise. So, with £2.1 billion up for grabs, we asked some of our Silver Buccaneers where they would like to see this money go?
£2.1 billion is not enough
They agreed that there is widespread opinion that £2.1 billion just isn’t enough. That, while it sounds like a large figure, the reality is that the NHS needs significantly more to bridge the gap left by years of woeful underfunding and that it is core revenue, rather than capital investment, that will make the difference.
The funding has been earmarked for IT and digital technology, but it is in fact the people using the technology that we need equal investment in. While technology helps the workforce to work smartly, we now need to be thinking about what our future workforce should look like for the next ten years. What are the training requirements needed to generate and upskill the workforce? And what funding needs to be made available to support fulfillment of the training places? We need to remove the thinking that having a ‘digital nurse’ is enough, and embed digital into everyone’s way of working.
Bridging the digital gap
Currently, there are huge disparities in the digital capabilities of staff and this digital gap is growing. There is a disconnect between the training that junior doctors receive, which is primarily paper based, and their experience when they are on hospital wards, faced with navigating digital solutions. Then there are the experiences among the wider health and social care workforce which are further disconnected.
We need to be thinking now about what a digitally enabled workforce looks like in five years time, and then in ten years time, and we need to act now to prepare for that. In some instances technology has skipped a generation and staff are expecting voice recognition and touch screens. The £2.1bn isn’t going to unlock this but if spent wisely, it could help.
The fear is that the funding may not be spent wisely. We are already hearing of rushed funding bids submitted by trusts simply keen to get a piece of the pie, as opposed to well thought-out funding submissions that add long-term value. Big, well established companies will no doubt be supporting the bid writing, automatically placing such companies in the line of favour. This creates the very real danger of stifling innovation that is associated with smaller companies and start-ups as they lack the same resource and support.
Deck chairs on the Titanic
There is a huge question mark as to why the funding has been released before the Integrated Care Systems have become a legal entity in April, limiting scope for ICSs to benefit. By releasing the funding ahead of the ICS digital costed plans, funding bids will no doubt centre around acute care rather than the wider needs of the system across primary care, mental health and community care.
Many of our Buccaneers were in agreement that they would like to see the money invested in mental health and in social care to level up the foundations for digital transformation, rather than just areas such as AI and robotic process automation. While these are undoubtedly part of the future of care, there is still so much to do to implement more fundamental technologies. They were also clear that staff need to be prioritised, advocating that we need to see investment in mental health training and resilience for staff to help prevent burnout. After all, we can’t deliver better care through the use of technology if there are no people to deliver the care.
Ultimately, there was a call for clarity on how people get the money, what it’s for, and what the restrictions are. The many funding pots that have been created over the past year have been useful, but we’re hearing that trusts are finding the need to keep bidding for different slices of the Unified Tech Fund relentless. It will be interesting to see if this continues to be a sustainable model for funding allocation and if different ‘pots’ will be created based on the ‘What Good Looks Like’ plan.
Elective Recovery Report
One issue that is sure to be front and centre of mind for every acute trust CEO when it comes to using digital, is how to tackle the elective care backlog. Sir Jim Mackey’s report is expected to be published in the next couple of weeks against the backdrop of all key metrics declining, and a political view that the system needs to ‘get on with it’ post-COVID. We asked our Buccaneers if they are expecting the report to be a revolution, or offer more of the same.
There was a desire that through the report, Sir Jim would place the backlog responsibility firmly with the ICSs, to empower them to deliver care on a regional level that responds to their population health needs. However, there was a sense of pessimism that this will occur, and that in reality the focus will remain on acute care with community and primary care remaining on the periphery.
Similarly to the situation with the release of capital funding ahead of ICSs becoming established, the Elective Recovery Fund submissions were due at the end of October in advance of Sir Jim’s report. So submissions are being made without the strategic guidance and direction from the elective recovery report, risking a scattergun approach that lacks impact. It is another case of putting the cart before the horse!
If there is to be any level of success, then the report must set the central expectations, and funding must be available to deliver against these. There must also be a high degree of flexibility for each ICS to determine the best way of achieving these expectations, according to their individual local context. Will the government deliver on this? Only time will tell.
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