Bridging the growing digital divide between NHS England’s hospitals

Policymakers worldwide now recognise that digital transformation is fundamental to the creation of high-reliability health systems and there is now, as a result, very considerable global investment in health information technology and data science capability.¹ The English Global Digital Exemplar Programme, launched in the aftermath of the dismantling of the highly centralised National Programme for Information Technology,² arose from the recognition of marked differences in digital capability between early adopters, digital-ready hospitals and those deemed not yet ready for digitisation.³ Twenty-three relatively digitally mature hospitals received substantial short-term funding to become Global Digital Exemplars. They were paired with slightly less mature Fast Follower hospitals that would benefit from their experience, including through the creation of best practice models (‘Blueprints’), which would, it was hoped, subsequently be disseminated across the wider National Health Service (NHS). Our ongoing independent evaluation has shown that the Global Digital Exemplar Programme has accelerated digital maturity and transformation in these select sites through the competitive allocation of funds, reputational benefits and a raised profile of digital transformation among hospital leadership.⁴

There are, however, growing concerns about the digital capability divide among English hospitals, which needs to be bridged if we are to avoid creating a two-tier secondary care sector. The announcement by the Secretary of State for Health and Social Care of the Digital Aspirant Programme aims to respond to this divide.^5,6 These efforts to promote digitisation in less digitally adept hospitals are, however, only likely to succeed if they maintain and build on the knowledge sharing and networking established during the existing Global Digital Exemplar Programme (Figure 1).

Figure 1.

Proposed model to drive forward system-wide digital transformation.

The Global Digital Exemplar Programme has delivered a boost to digitisation through external (and matched internal) funding and through securing senior hospital leadership engagement, resulting in alignment of effort and clinical buy-in. However, competitive allocation of funding tends to favour already well-resourced hospitals (thereby accentuating unevenness). A supporting framework is required to promote the spread of experience and expertise across the NHS by incentivising knowledge sharing and networking. This can be facilitated through strategically building on organic relationships, regional links and common technological platforms.⁷

Less digitally mature hospitals are typically struggling on many fronts, including leadership, capacity building, finances and staff recruitment/retention. In view of these challenges, central government is likely to feel compelled to closely monitor deployment of national resources, and compliance checks and/or penalties are therefore likely.⁸ However, such programme assessment must avoid reporting requirements that might overlook local priorities or stifle innovation. Moreover, there is increasing recognition that continuous digital transformation needs to be a central pillar of safe, efficient and high-quality care, as reflected by the fact that the Care Quality Commission (the independent regulator of health and social care for England) is planning to incorporate digital infrastructure as a key part of its national safety and quality assessments.⁹

As a result of the Global Digital Exemplar Programme, a select group of English NHS hospitals is making substantial progress in digitising its hospital infrastructure. A large number of less digitally mature hospitals are, however, left behind. The forthcoming Digital Aspirant programme and the broadening of Care Quality Commission inspections are welcome developments that should help to bridge this gap (Figure 1), but given the overhaul these hospitals will need to make, it is imperative that the Department of Health and Social Care both maintains and incentivises Global Digital Exemplar and Fast Follower sites to engage with Digital Aspirants to share their hard-earned lessons and help catalyse the spread of digital maturity of hospitals throughout NHS England.

Acknowledgements

We gratefully acknowledge the input of the wider Global Digital Exemplar Evaluation team: Professor Bryony Dean Franklin, Dr Marta Krasuska, Wendy Lane, Dr Hajar Mozaffar, Kathy Mason, Sally Eason, Dr Susan Hinder, Dr Hung The Nguyen, and Dr Henry W. W. Potts.