While COVID-19 has stress-tested the mothership NHS and revealed it to be surprisingly resilient, it has also exposed the frailty of the institution’s most junior satellite, NHSX, just when that unit might have been expected to come into its own as the main driver of policy and best practice for technology, digital and data across the service.

Health secretary Matt Hancock launched NHSX with a fanfare in April 2019. But it has been plagued ever since by the opaqueness of its role, which has been further exacerbated by a series of internal controversies and concerns about its procurement strategy, throwing its response to the pandemic into sharp relief, and raising questions about its fitness for purpose.

The speed of digital technology adoption across the NHS to address the immediate challenges of the crisis has been remarkable, with years of digital transformation apparently achieved in a matter of weeks. But that speed has also made alarm bells ring.

Even internally, apparently, doubts have been raised about the lack of compliance in hastily implemented applications. An email from CEO Matthew Gould to the leadership team was leaked to HSJ in which he acknowledged that launching non-compliant websites and apps was costing NHSX goodwill and credibility.

While the frontline has stepped up in the pandemic, the scattergun approach of NHSX as it has thrown funding at some hastily sourced applications while announcing other procurement projects long on ambition and short on budget has suggested an operation stuck in reactive mode.

Down and out

In March, for example, NHS England and NHSX issued a £12.6 rapid procurement for online consultation technologies, to support the total triage model advocated for all GP practices in response to the COVID-19 pandemic. Following a tender evaluation process of just 48 hours, 11 approved suppliers were given contracts.

Also in March, following strong endorsement from NHSX, NHS England and NHS Improvement approved funding for 12-month licences to be rolled out across secondary care for Attend Anywhere, including £20,000 per provider for any necessary hardware investment. The implementaton subsequently ran into teething problems that culminated in a major outage on 18^th May, prompting a public apology on Twitter from the application vendor and some observers to question the extent of pre-implementation due diligence.

The timing was unfortunate. Only three days earlier, the National Audit Office had published a report – Digital Transformation in the NHS – which questioned NHSX’s lack of clarity about whole-life costs and the benefits of different approaches to digital transformation at a local level.

It also identified possible tension between the two ambitions of achieving interoperability and increasing the number of technology suppliers to the NHS, which is likely to increase rather than lessen the amount of integration.

Among other conclusions, the report suggested that the expected technology plan for health and care includes an implementation plan with specific objectives and measurable actions that are required. This plan, it said, “should be realistic about the time and investment required.”

Time and money

Questions about time and investment have already been asked about an open procurement for clinical communications tools for NHS trusts, which was published on 4 May, scoped at £3 million across two years, with an admirable goal: to eradicate pagers, the time-sapping bane of life as a clinician, as quickly as possible.

But for such a critical programme that is clearly vital to its target users, the timescale and budget (around £1 per year, per NHS worker) hardly seems adequate. Furthermore, the investment required from any technology supplier in terms of data storage and security would make it prohibitive for many of the very innovators who might be best placed to help.

At the same time, as the progress of the COVID-19 contact tracing app stutters through testing from one controversy to the next, amid growing doubts that it will be ready for the launch of the government’s much vaunted national system on 1 June, this hardly seems the best climate in which to speed up the launch of another mission critical application.

Ben Moody, associate director of health and social care, techUK, said it would be wrong to position the open procurement for clinical communications tools as conflicting with the NHS COVID-19 response or the tracing app. “In fact,” he said, “clinical communication tools are a vital part of the arsenal allowing hospitals to effectively plan treatment and control the spread of COVID-19.”

Moody said: “techUK wrote to the Secretary of State for Health and Social Care, highlighting concerns about the use of digital tools in clinical settings that did not meet existing cyber security and data protection standards; or integrate with patient records.

“Our Manifesto for Matt [published in November 2018] cited research from the British Medical Journal that found that most doctors routinely used popular messaging apps to share sensitive patient information. Whilst convenient, the sharing of patient data in this way can be hugely problematic.

“As such, we welcome the creation of a national fund for clinical communications tools that meet the specific needs of clinicians and adhere to NHS standards. It is vital that world class NHS staff are equipped with world class digital tools.”

Nobody would disagree with that but until a coherent procurement strategy emerges from the very source that ought to be driving it, questions will continue to be asked about the role that NHSX was created to fulfil, and its ability to deliver standardised systems across the board.

NHSX was approached for comment, but had not responded at the time of publication.