Conscious digital transformation across healthcare and the NHS is gradually happening but significant challenges are afoot

During the past decade, there have been numerous attempts to implement digital transformation initiatives across the NHS.

In 2014, following the introduction of the government’s ‘Cloud-First’ policy, the NHS set out to achieve a paperless scenario by 2018. Due to legacy technological infrastructure, a lack of digital skills, complex governance arrangements and limited budget, the NHS missed its target. The goal was reset in the NHS Long Term Plan 2019, then, in 2020, the NHS faced a crisis like never before as the pandemic pushed it to the limit.

For all its negative consequences, the pandemic introduced a renewed sense of urgency around the need for digital transformation. It fostered a fresh innovation culture, giving healthcare technologists the autonomy to implement technology and complete digital projects in a matter of weeks.

The NHS now aims to deliver a ‘core level of digitisation’ by 2024, but this will come at a significant cost with the NHSEI estimating that over £8.1 billion of investment is required to deliver against this goal. This sheds light on the sheer scale of transformation required to alleviate the current digital challenges across healthcare.

Progress towards the NHS Long Term Plan has improved over the past two years, but it is vital that technologists within healthcare do not lose sight of the overarching challenges faced across the sector and seek to address them in the most appropriate way.

Old story

Healthcare’s most prevalent digital challenge is widely accepted as legacy technology. The NHS relies heavily on ageing IT applications and paper-based systems – these systems have formed the technological backbone of the NHS since its creation. It makes digital transformation and cloud adoption complex, or impossible in the case of implementing emerging technologies like AI.

Legacy technology should not automatically be dismissed because it isn’t ‘fit for cloud’, especially as there has often been heavy investment in these systems. Healthcare technologists, however, need to understand that their reliance on systems that cannot support the interoperability of data may hamper the NHS’s ability to reach its digital transformation goals.

A ‘cloud strategy’ freedom of information (FOI) request found that more than 40% of healthcare respondents cite legacy technology as a significant challenge, and intend to keep approximately 70% of their apps, data and workloads on-premises.

In addition to this, more than 69% of NHS Trusts report that they do not have a cloud strategy, with just 11% of NHS Trusts forecasting a plan to have more than half their infrastructure in the public cloud within 12 months.

This number is in stark contrast to the 67% of organisations in central government who intend to move to a public cloud, highlighting the disparity between central government’s expectations and the reality within healthcare.Interoperability

Interoperability is a key aim for the NHS. It can mean powerful analysis of national data, leading to earlier diagnosis, treatment and development of preventative medications, ultimately improving patient care. The data exists, but better unification is where the true power lies.

Health data remains difficult to access and share in a secure manner. The sensitive nature of the data, public consent and the need for immediate access in life-threatening circumstances ensures that achieving interoperability is complicated, requiring large-scale implementation of cloud technologies.

The ‘cloud strategy’ FOI request found that many NHS Trusts highlighted data security as a key concern with using cloud technologies, with 48.8% reporting data privacy concerns, 39.87% recognising offshoring and data residency as an issue and 21% stating that data classification was a key challenge.

With NHS Trusts opting to keep 70% of data on-premises, planning for interoperability will require substantial change to policies and procedures to implement a UK-wide government data fabric.

A sprawling array of applications is a governance nightmare for any organisation, but especially when those systems are vital to delivering patient care. Of the NHS Trusts who responded to the Solar Winds FOI request in 2018, 61% cited security and compliance as the biggest barrier to the adoption of new technologies such as cloud.
There is a disparity, however, between the NHS national plans and the expectations that organisations such as NHSX have on local Trusts to implement them.

In its 2020 report the NAO states there is “currently no governance mechanism to make existing data and technology compatible with national plans” across NHS Trusts. While the NHSX has outlined approaches that Trusts can take to develop systems inline with national ambitions, it fails to provide transparent cost information. This ‘hands-off’ approach has contributed to the proliferation of inefficient legacy systems, lack of governance and leaves local and national strategies out of sync.

Digital watch

One of the most significant challenges for NHS Trusts at a local level is the vast spectrum of digital skills available within healthcare. Disparate systems, nuanced Trust requirements and the monetary draw of the private sector are impacting the availability and dissimilarity of skills across the NHS.

In the ‘cloud strategy’ FOI request, 41.53% of more than 400 respondents reported a lack of in-house skills as a barrier to public cloud adoption. When the NAO asked digital and technology leaders why this skills gap exists, 78% blamed ‘external market conditions’, 67% limited supply, 58% procurement constraints and 50% organisational culture.

NHS Trusts who have started their cloud migration journey have predominantly moved applications to cloud-based versions of their existing software, suggesting that technology professionals feel most confident migrating the tools which have a lower impact on vital health services.

For example, 88% of healthcare organisation respondents have moved ‘Office productivity’ tools such as Microsoft to the cloud-based systems such as Microsoft 365 or their public website (63%).

The skills gap, meanwhile, is recognised by the Government as a significant challenge. Its Digital, Data and Technology (DDaT) function was launched to help cross-government professionalisation of technology roles and drive consistency.

For NHS trusts to accelerate their digital transformation and address the issues of legacy technology, lack of governance, data interoperability and digital skills challenges, we believe it’s time to critically review digital estates, infrastructure and strategies.

There is a growing movement for the public sector to become conscious of their cloud transformation. The pandemic has been a huge catalyst for digital transformation in the NHS, but now is the time to maintain momentum and join a conscious transformation revolution that drives the nation’s digital ambition.

Russell MacDonald is Chief Technologist at Hewlett Packard Enterprise. Go to