Challenges in moving to a permanent digital delivery model for health

Following the publication of Northern Ireland’s Health and Social Care Digital Vision and Strategy, the Department of Health’s Chief Digital Information Officer, Dan West, discusses prioritisation, finance, and workforce capacity.

Identifying a major obstacle to the delivery of a permanent digital delivery model in health and social care in the shape of a projected £540 million overspend in the budget, West says a further challenge will be the need for more streamlined policy direction.

Northern Ireland is unique in the UK and across most of western Europe in having a fully integrated health and social care system with a funding scheme that comes to “provider organisations that have both halves of the health and social care equation”.

The overarching strategy is the Digital Strategy for Health and Social Care, published in May 2022, which he believes has benefitted from the digital innovations which were made during the Covid lockdowns, although there are further challenges to be tackled.

West explains that the Department of Health has been focused on the development of an implementation plan, developing further engagement, and prioritisation.

Drawing on the lessons from the feedback, he further states: “We need to get better at using digital technology, better at using data, and using research and innovation. All of those things are good, but people are concerned about our ability to execute.”

Departmental policy priorities

West believes that there are too many overarching priorities from the various health strategies which have the potential to cause confusion among staff and patients, which will potentially further curtail the progress made on the digital side.

“If you are trying to do everything, and everything is treated as a priority, then nothing is truly a priority and it is very hard to do the small number of impactful things which will set us on the way through this journey. We need to get better at prioritising what we are asking of the service, what we are asking of our population, and what we are asking of our staff over the next few years.”

“We need to get better at prioritising what we are asking of the service, what we are asking of our population, and what we are asking of our staff over the next few years.”

Strategic investment

West says that there is a need to prioritise current investment more strategically if a digital transformation is to be achieved.

“The capital plan for the HSC includes the digital strategy strand of the investment portfolio. It thinks as much about how we build hospitals and build capacity, resulting in a problem with capital availability due to the number of conflicting strategies and aims and objectives.

“Within that portfolio is evaluation of some of the things which worked during the Covid crisis, such as agile delivery and smartphone apps. All of that needs to be part of our plan going forward, and maintained whilst learning from some of the difficulties that we faced in and beyond the Covid pandemic.”

There are further challenges with funding, West states: “We have to recognise the current funding with the broad political context in which we sit and think about health and social care and its budgets for this year. We are £540 million overspent in our budget for 2022.”

West states that the funding gap needs to be rectified if the digital transformation is to take place. “It is further difficult to maintain focus on transformation so that we can hand the health and care sector to our children’s generation without it being bankrupt.”

Workforce capacity and immediate priorities

The digital transformation will require a change in the direction received among all staff, as well as clear departmental guidance.

“Our digital capacity is really important, ensuring that we have the people with the right skills, the right number of people to deliver the programmes, and also asking how we build the digital capability across the whole workforce and how do we deliver these tools and capabilities so that staff are able to use and embrace them and give staff the ability to use them at the top of their licence.

“We also need to think about the broader workforce size and capacity in how we deliver health and care and how we can optimise use of the clinical and multidisciplinary resources in delivering the best care outcomes, whilst training new doctors and nurses – even if we do not have the money to do that – is something that is going to take some time.”

West further states that undergoing this transformation must work in tandem with the task of enduring the predicted winter crisis in the health service, given the rise in flu, Northern Ireland’s higher per capita level of respiratory illness than most European countries, and the again-increasing levels of Covid.

“We cannot just focus on transformation; we have to keep the lights on in our organisations and keep delivering high quality care and clinical services to our patients and those who need it most. Doing that is hard and doing that whilst doing transformation is hard.”