Chief Executive, NHS Digital
A traumatic shock to an established system has destructive power, but it also has the power to transform and reinvigorate.
When the COVID-19 pandemic arrived last year, it was clear that digital and data services within the NHS would be critical to the response. In order to meet the demands of the crisis, we would need to transform numerous aspects of our approach.
New services were required, and fast. These included systems for testing and tracing, for scanning the population for clinically extremely vulnerable individuals so they could be shielded, a digital infrastructure for vaccinations, data dashboards for multiple audiences and many more.
Existing services had to be scaled, and dramatically. The peak utilisation of our 111 online services in March last year was 95 times its highest ever previous peak. We were sprinting to stay ahead of the surge in demand and, on more than one occasion, the waves hit us and we had to recover quickly.
Responding to increased demand
Clarity of requirements, radical acceleration of service design, product design and build phases, a near-elimination of bureaucracy and intense hard work were essential to meeting increased demand.
Risks were taken that were well beyond those we would normally accept: systems went live without extensive testing, without a good understanding of how they would perform under scale and without automation of many of the service operations processes.
We were sprinting to stay ahead of the surge in demand and, on more than one occasion, the waves hit us and we had to recover quickly.
Compromises were made. In the normal course of business, we consult extensively with all our stakeholders and the public on the use of patient data, whether for direct care, for planning or for clinical research. During a public health crisis there is little time for this and there is specific legislation that allows for the sharing of health data quickly, without consultation. This increases the speed with which we can react, but it also increases the responsibility to act on the behalf of all those constituents in ensuring all data use is appropriate, proportionate and secure.
Maintaining this focus, amid the clamour for data, was one of the greatest challenges.
From collaborations to partnerships
Loose collaborations were forged into cast iron partnerships. Unity of purpose, the intensity of interactions and a dense history of heart-felt problems and victories written throughout this last year have created new trusted pathways within the complex network of the NHS.
Mean reversion is strong in large bureaucratic systems. The challenge ahead is to rethink how we deliver digital and data services, based on our pandemic-era experience.