Consolidation of NHS National Agencies and what that means for the Frontline

From the Frontline – a new semi-regular series of blogs featuring independent thought leadership and comment from a range of leaders that span the healthcare industry.

The consolidation of various NHS Agencies – NHS Digital, NHSX and Health Education England – under NHS England has the opportunity to bring digital transformation back into the heart of the Health Service, but will also see the loss of 30-40% of related positions. Andy Kinnear, former NHS CIO and now Independent Consultant, looks at the opportunities which this major restructure could bring to frontline service providers already busy implementing the change to the Integrated Care Board and Integrated Care System concepts ushered in by April 2022’s Health and Care Act. 

2023 – the year to make NHS structural changes work for patients

NHS Digital merged into NHS England on February 1st, 2023 as the Government implemented the recommendations of Laura Wade-Gery, Non-Executive Director at NHS England and Chair of NHS Digital. This followed NHSX, the body established to drive digital transformation and lead IT policy across the NHS, being brought under the NHS England Transformation Directorate. Health Education England (HEE), which is responsible for the education and training of the health workforce, will also be folded into NHS England from April 1st, 2023.

Any reorganisation brings both risks and opportunities. The latest restructuring definitely has the potential to drive improvements. The old multi-agency approach introduced boundaries, inconsistencies of approach at times and extra administration overhead. Cost and effort was needed to manage relationships between agencies which could have been focused instead on delivery for the frontline service providers and patients. The reorganisation offers the opportunity to both simplify and strengthen the national ‘voice’, and fast track proven digital solutions which can bring the rapid benefits to the frontline.

Change on top of change

These major structural changes come less than a year after the introduction of Integrated Care Board (ICB) and Integrated Care System (ICS) under the Health Act 2022. These were already some of the biggest changes in over 25 years to the way NHS England and the care sector would work together, which The King’s Fund noted was: “ establish a legislative framework that supports collaboration and partnership-working to integrate services for patients.”

ICS/ICBs aim to provide better, integrated, more comprehensive services to patients across a specific geography. This joined up approach to patient care should deliver economies of scale, standardisation and a better experience for people working in the sector, and therefore, better patient experiences. These changes are designed to drive collaboration and a move to digital can facilitate this ambition.

The importance of digital solutions to frontline delivery

As the mergers of the NHS National Agencies were announced, NHS England’s Laura Wade-Gery noted the importance of digital in meeting NHS goals and aspirations saying: “In the rest of our lives, digital has really changed how we live and we must now make this true in healthcare. The goal of my review is to equip the national centre with the right capability to support integrated care systems to deliver better citizen health. We need to have the culture, operating model, skills, capabilities and processes to put data, digital and technology at the heart of how we transform health services.”

When the reorganisations bed in NHS England should have a single national place that determines policy and strategy for digital healthcare. This has the potential for more consistency in the policy and strategy for digital solutions but remember, actual healthcare doesn’t happen in Whitehall or executive offices of NHSE. Simplifying the national organisations and ensuring ICS are focused on their local population is a good thing.

The agenda of frontline clinicians remains the same as organisation structures metamorphise around them, the care of their patients. The clinical workforce is only ever about improving the delivery of healthcare to the population they serve, including their family, friends, neighbours and people around them every day. This is a challenged environment of tight budgets, staff vacancies, industrial action and low morale. There’s never been a greater need for simple to use, easy to adopt, proven digital solutions to support the frontline.

Projects built for success

NHS England and the citizens which it serves desperately need the improvements which digital health solutions can bring. With ICSs and ICBs responsible for the population of a geography there is now the chance to create a local integrated healthcare system. A geography can take ownership of its own digital agenda and empower frontline organisations to act in a coordinated way to deliver better collaboration.

Key to this approach is the implementation of tried and tested systems which have been shown able to deliver quick returns to improve efficiency, staff morale and results for patients. The time for experiments and piecemeal implementations which don’t work together are past. The ICS/ICB approach will require frontline staff to be able to work across organisations. For example, a district nurse needs the same easy and reliable access to patient records and systems when on the road and when working from hospitals and clinics.

Today people just expect digital systems to be available everywhere at all times. Staff and patients bring these expectations into the healthcare environment and can’t understand why outdated ways of working can’t be simplified to speed up processes. Now NHS organisations are being directed to collaborate, there is the opportunity to quickly introduce digital solutions which will make it easy for staff to access systems and data and move between organisations without the need for multiple user IDs, different passwords and logon procedures, and separate digital identities.

Solutions designed for the future

To gain traction organisations must deliver rapid implementations and quick wins. However a longer term perspective is also needed. Successful digital implementations will require solutions which have demonstrated the ability to be impactful at the frontline and to be able to repeat these successes, working across organisational boundaries.

Solution providers must also be able to show how implementations can be phased. They must demonstrate mid and long term roadmaps of how the solutions will develop on emerging technologies and continue to deliver ROI year after year. Now is not the time to get locked into solutions which cannot expand and evolve.

Solutions like those offered by Imprivata can be implemented for digital identity and single sign-on in one department then be rapidly rolled out through and across organisations and wider across ICS. A next step might then be to bring in digital access to devices and for dispensing drugs. Then evolve to passwordless mobile access. As advances in biometrics, facial recognition and AI continue to appear these will be introduced bringing continuing benefits.

Proven digital solutions which can be implemented quickly, continue to evolve and go on delivering returns each year should be a priority for ICSs to seize the promise of digital transformation and the opportunities from collaboration.

To learn more about this topic, read Imprivata’s new whitepaper: What can a unified digital identity strategy bring to an ICS?

Imprivata provides a range of digital identity and security and identity solutions. For more information: