Seeing digitisation as part of a bigger picture

In 2018, leaders at Nottingham University Hospitals Trust launched a new strategy to set the future direction of the organisation. One of the current plans to support the delivery of the strategy is Tomorrow’s NUH. Tomorrow’s NUH is based to some extent on new plans for the organisation’s estate – the trust is part of the national health infrastructure plan for new hospitals – but programme director Phil Britt says it goes far beyond that.

“There’s a significant case for change around our clinical model,” he explains. “We don’t work in the most effective way across our two big hospital sites. But then we’ve also got some significant estates issues that we’ve been grappling with. So the Tomorrow’s NUH programme is really taking [the question] of how we look at our clinical model plus our estates issues together, and looking at how we address some of those problems over the next 10 years.”

Digital, he says, underpins much of this conversation. “We’re very much looking at a digital roadmap: what are the areas of digital transformation that we want to deliver? So that we’re not building a hospital and then thinking: ‘Well, what are the digital bits we then need to add into it?’”

The trust benefits from already having an electronic patient record in place, and the same system across both sites (not a given, since the organisation was formed through a merger).

In that regard, it is ahead of some other organisations. A move from paper to digital notes is not complete at all trusts, as reflected by a new national impetus to implement EPRs. In February, at the HSJ Digital Transformation Summit, Sajid Javid set a target for 90 per cent of NHS trusts to have an EPR in place by December 2023 and the remaining 10 per cent to be in the process of implementing one.

But for Mr Britt, having an EPR in place is not the same as making the most of it. He instead characterises it as one digital “foundation” – along with “having digital infrastructure, having Wi-Fi, a good network infrastructure”.

“I think it’s fair to say that there’s a big opportunity around digital at NUH. We’ve got some of the basics in place, some of the foundation bits. Our journey now is how do we take that solid foundation and really layer on top the transformation and innovation opportunity that the solid foundation gives us.”

He believes the ability to do so lies in seeing digital as part of the bigger picture. “To take your digital foundations to transformation and innovation, [you have to have] your clinical model and your estates strategy as well. So it’s those three things for me which come together, which enables us to have everything in place to move forward.

“It’s more than just having the digital foundation,” he stresses. “We’ve spent quite a lot of time in our programme over the last kind of 18 months on getting all of those foundations in place. So we can then say, actually how does our digital transformation and innovation now align and support that clinical model transformation we’re trying to achieve.”

He also emphasises how central workforce is to capitalising on such opportunities. “It’s almost a bit pointless changing our services, putting them into shiny new buildings and giving fancy new bits of kit, if we don’t support our staff to work in a different way as well,” argues Mr Britt.

“So our people plan which wraps around it all is probably more important than anything else, and that’s everything from having the right staff in the right place at the right time to deliver the care, all the way through how are we supporting our staff to develop their skills. How does our digital strategy support staff to be in the right place at the right time to deliver the care we want to achieve? And how does digital transformation support our staff to work in a different way? How do we make learning, education, training and development more accessible through technology?”

Part of answering those questions is conversations with a broad range of staff, including those who sit outside the boundaries of the trust. The Tomorrow’s NUH programme very intentionally has a GP lead “who gives us dedicated time to work with us on the development of our clinical model and everything that sits around it, and brings a different perspective”.

“Whether it’s our digital transformation, whether it’s our EPR, whatever it might be, we can’t do that in isolation anymore. And that’s not specific to Nottingham, that’s every system. Having a strong system plan is really, really beneficial.”

While there may be a national target focused on acquiring an EPR, then, it is likely best viewed as a mere step along the way to digital transformation – one for which preparation is required, and which will require subsequent work in a variety of contexts.

As Mr Britt puts it in describing the situation at his organisation: “We’re on a journey. We’re not right at the start, we’re not at the bottom of the mountain, but we’re definitely not at the top. We’re making our way.”