In February, health secretary Matt Hancock unveiled NHSX, a new body that would lead on the digital transformation of public healthcare nationwide.
"NHSX will combine some of the best minds from among the NHS, leading innovators and government into one unit to set national policy, remove red tape and create a culture of innovation to allow the best innovations to flourish," Hancock said at the time.
He later added that the "X stands for user experience" and that the unit had been set up for two reasons: to "bring together our tech leadership into one decision-making point" and "to bring the culture, the openness, the productivity, the speed of iteration of the internet to the way we deliver tech in health and care."
The announcement was met with a mixture of confusion over what this mysterious organisation would do, concern that it would take work away from existing departments, and hope that it could help solve the NHS' long-running IT issues.
Further details followed at the official launch in April, including the announcement of a CEO and two early initiatives, but the operations of NHSX remain opaque to most.
Here's what we know so far.
What will NHSX do?
NHSX was established to drive digital transformation and lead IT policy, implementation and change across the NHS, by bringing together teams from the Department of Health and Social Care (DHSC), NHS England and NHS Improvement into one unit.
The new body will oversee the IT strategy currently spread across multiple organisations. Its specific responsibilities are setting national policy and developing best practices for NHS technology, digital and data, enforcing IT standards, promoting interoperability, improving procurement, supporting new technologies, and developing digital skills and culture.
Further details on the plans were announced in April. They include recruiting a Chief Technology Officer to design and deliver a new internet-based technical architecture for all of the health and social care, mandating internationally recognised technology and data standards across the NHS, and teaming up with NHS England's cancer and mental health policy teams to identify how technology could improve the patient experience. NHSX will also scrutinise all significant spending on NHS technology transformation in England.
The unit opened in shadow form at the beginning of April before becoming fully operational on an as-yet unspecified date in July. The delay to launch is somewhat puzzling to Harry Evans, a researcher at healthcare think tank the King's Fund.
"I'm not entirely clear about why it's July and not now," Evans told Computerworld UK. "I can only imagine it's mainly because they haven't yet worked out exactly what NHSX is going to do and how the levers work."
This uncertainty has heightened concerns about the government's plans.
Taking digital control
NHSX is widely viewed as Matt Hancock's attempt to gain direct oversight of the NHS' digital strategy. It was therefore no surprise when Matthew Gould was chosen as NHSX CEO, as Gould had previously worked at the department of Digital, Culture, Media and Sport, where Hancock was a minister until his appointment as health secretary last year.
In his new role, Gould will report directly to Hancock, as well as to the chief executives of NHS England and NHS Improvement.
Gould previously served as British ambassador to Israel and held an array of roles in the civil services but had never worked in healthcare before joining NHSX. The appointment of an outsider suggests that significant structural changes may be coming.
NHS Digital, the arms-length body that provides information, data and IT systems for commissioners, analysts and clinicians in health and social care today, is one of the organisations that may have the most to lose.
NHSX will be the new commissioner for NHS Digital, and the new body is expected to take over some of its responsibilities. In April, Digital Health News revealed that a section of the NHSX website that claimed the new unit "will be funded through existing budgets, transfers of staff and savings from NHS Digital, which is currently restructuring" had been removed from the site, which DHSC officials claimed was because it had been published by mistake. A DHSC spokesperson told the title that "NHSX will bring together existing teams into one unit so no new funding will be required."
Digital Health News also reported that NHS Digital chief executive Sarah Wilkinson had emailed her staff to reassure them that while she expects NHSX to define the organisation’s future remit and "assume responsibility for a small number of areas that NHS Digital had previously led", its "book of work" wouldn’t change in the near-term, although there may in future be "strategic shifts that manifest in changes to the work that we are commissioned to deliver".
Gould will also have to work closely with NHS England, the Department of Health and Social Care, NHS Improvement, and the Government Digital Service. Keeping them all happy will be a tricky task.
In a pair of tweets announcing his appointment, Gould sought to provide some assurance.
Excited to become the CEO of @NHSX. I couldn’t ask for a more worthwhile challenge. We will have a single-minded focus on improving care, by giving staff and patients the tech they need. Looking forward to working w @NHSEngland, @DHSCgovuk & @MattHancock https://t.co/O27oAPYvEf— Matthew Gould (@matthewsgould) April 4, 2019
Key part of the new job will be to work with the huge talent already in the #NHS. @NHSDigital and the brilliant @SarahFWilkinson will be a massive part of this, and I’m looking forward to working closely with her and her team.— Matthew Gould (@matthewsgould) April 4, 2019
Evans believes the tweets suggest a certain distinction between the different organisations.
"You could imagine that, you want to work closely with DH and NHS England because technically you are responsible to them and they pay your bills," he said. "And then there's a separate thing about NHS Digital, which will be accountable to NHSX ... It seems to me that's then a different relationship to the one with NHS England. It doesn't feel like anything there has massively changed except for there is clearly a slightly different relationship being carved out with NHS Digital to the other national bodies."
Will NHSX unify or divide?
Hancock argues that NHSX will bring together the NHS' disparate digital teams, but critics worry that it will only add further disorder.
Niall Dickson, chief executive of the NHS Confederation, which represents organisations that commission and provide NHS services, warned that "creating yet another arms-length body at the centre, however innovative, will not in itself drive the technological revolution we all want to see," and asked "why is NHS Digital not taking this forward?"
“More importantly, if NHSX is to succeed it needs to draw on the expertise within the service and harness the fantastic work already underway as well as showing what is possible," he added.
“It is vital that we strike the right balance between support and control. The lessons from the past suggest that fewer diktats and more collaboration from the centre will bring about more effective change more quickly."
Evans has some sympathy with Hancock's aim to add oversight to a fragmented digital landscape, but has doubts about his strategy to do this.
"I think that there's still a remaining question for me about whether or not this is the most effective way of fragmenting the system," he said. "Traditionally, fragmentation occurs because there are too many organisations, so I'm not convinced the setting up another one is the way to unfragment it. But that doesn't necessarily mean that I don't agree that there's a problem. It's just, I think I disagree slightly on what the solution could be."