Dr Tim Ferriss’ impact assessment on NHS IT

With the news that Dr Tim Ferriss is departing as NHS England director of transformation in September, Jon Hoeksma, editor-in-chief of Digital Health News, considers what his track record has been for digitizing the NHS and what we can expect next can do.

The past two years have seen huge uncertainty and turmoil in NHS IT at a national level, with the abolition of NHSX in 2022 and the demise of both NHS Digital and Health Education England in early 2023. The current waves of job cuts at the massively expanded NHSE are set to remove 30% of staff.

Over the same period, we have seen massive political instability, with Secretaries of State for Health coming and going in rapid succession.

More parochially, we have seen a succession of NHS IT leaders depart: NHS Digital CEO Sarah Wilkinson in 2021, NHSX CEO Matthew Gould in 2022; Simon Bolton, interim CEO at NHS Digital in 2023.

A constant on the NHS IT landscape during this period has been Tim Ferriss as National Director of Transformation at NHS England.

digital as part of the transformation

Despite not having digital or IT as part of her job title, Ferris has done the national brief for digital over the past two years, making a significant impact on the direction of travel.

As a practicing physician with an impressive career in clinical leadership at Massachusetts General, one of the world’s top health institutions, Ferris has been influential, effectively using digital and data to modernize healthcare Provides thoughtful leadership and insight into the many thorny issues of doing. ,

His experience is in stark contrast to the most recent NHS national digital leaders, who were involved variously from the Home Office, the Foreign Office and manufacturing.

In public speeches and blogs, he has argued that it is cultural factors, such as local NHS leadership and organizations’ appetite for risk, that are as important as ensuring digital transformation as a national investment is serious in duration. limited in form. He has also been a strong advocate of population health management and the power of data.

Ferris has certainly been a director of change during a period the NHS has been under enormous demand and financial pressures, with a dire need to find ways of using technology to curb growing waiting lists.

It has made more headline friendly initiatives on virtual care, as well as announcements every few months about the NHS app.

A period of relative calm on digital targets during massive upheaval

But in an era when Secretaries of State for Health come and go so quickly they barely get a brief, there have been relatively few new NHS targets on digital.

And this relative calm – which has previously been a restless series of breathless goals and a bewildering array of initiatives – has arguably helped provide an opportunity to focus.

The biggest target came in February 2022, courtesy of Sajid Javid, when he said he wanted 90% of NHS trusts to have EPRs by December 2023.

While few believed the target when it was set (and it will surely be missed) it has at least served to draw attention to the rapid provider digitization of digitally mature trusts.

Focus provider under Ferris is completing digitization

This has been a key digital focus for Ferris over the period: completing provider digitisation, particularly in acute trusts, bringing all hospital trusts onto a baseline of EPR capability, implementing overlapping initiatives on digital maturity, convergence and leveling-up through a series.

We have started to focus more on supporting front-line digitization through knowledge transfer from NHS England and best practice in areas such as EPR optimisation.

In many ways the leveling-up agenda reverses the earlier Global Digital Exemplar program from 2016 to 2020, which also aimed at provider digitisation, but which targeted national investment in the most digitally advanced hospital trusts.

The aim under Ferris is to support the third or so number of trusts (estimates vary) without modern EPRs, which first develop the business cases and then procure and implement the EPRs, often jointly or collaboratively. .

There have been twists and turns along the way and the promised funds have come and gone, but overall the focus has been on bootstrapping less digitally mature providers.

A veteran NHS CIO told Digital Health News he thought Ferris’ approach to leveling up had been “sensible and sustainable”, and believed it was likely to continue after his second term ends .

Focus on a small number of EPR suppliers

As part of this approach, NHS England has steered trusts towards obtaining EPRs from a small number of proven suppliers. Sometimes it looks like Epic and Kerner’s promotion of the American monopoly.

The propensity to buy from fewer suppliers that has gained momentum under GDE has accelerated significantly in the last 2-3 years, especially as ICs, taking their cues from the NHSE, have driven convergence on the EPR.

A London NHS CIO told Digital Health News: “It seems that we have made real progress on provider digitization over the last few years. I worry that suppliers have fewer options, but we are accelerating on digital maturity “

connection with epic

In fact, one of the biggest criticisms of Ferris is that he has at times been perceived to be too close to one supplier in particular: Epic, advocating and supporting the system used by the organization in which he is going on his second trip. Partners Healthcare of Boston.

Given that Ferris has returned to work regularly during his second stint at Partners Healthcare, Epic is the system he uses personally. And he talked about how this single system has tied the partners together into a cohesive organization.

From the start of his time at the NHSE there were strong rumors that Ferris intended to strike a national deal for Epic across the NHS; And for this he had several meetings with Judy Faulkner, the CEO of Epic.

Ultimately, plans for an NHS-wide deal failed to materialise, believed to have been scuttled by the Treasury, but by the Wisconsin-based EPR supplier NHS England even after it appeared to liaise with trusts on business matters and procurement Works.

This perceived market bias has caused widespread dismay among other suppliers critical of the US supplier’s extremely high costs and dire warnings of the costs of a monopoly market and the consequences of supplier lock-in.

Champion of Federated Data Platforms

The notion of having a preferred supplier that can do no wrong has also been a major criticism of the other major digital program during Ferris’ tenure: the controversial £480m Federal Data Platform (FDP), where existing Palantir was widely preferred supplier. is seen as .

Although responsibility for the FDP rests with Ming Tang, Tim Ferriss, NHS England’s director of data and analytics, has been the senior board executive sponsor and champion for the FDP, giving it top-level support and providing information about the US AI and analytics spyware company. I am seeking to refute the concerns. is a suitable partner for the NHS.

Ferris’ departure in the autumn will coincide with a critical period in the FDP’s procurement and could potentially undermine NHSE support for the controversial project as the next general election approaches.

Too much focus on rapid provider digitization

But perhaps the biggest disconnect of the past two years has been the lack of alignment between the NHS Long Term Plan transformation goals, the development of Integrated Care Systems and supporting the national NHS IT strategy.

a CCIO told Digital Health News. “I work in a DGH and recognize that provider digitization needs to be accomplished, but yet too much attention and investment has been placed on acute, not nearly enough on the rest of the health system, and almost none on social care. nobody is here. “

With Integrated Care Boards (ICBs) now in charge of digital strategy and funding, the future direction on the NHS digital strategy must be determined far more locally, rather than focussing on leading the long march of provider digitization in the true sense On providing integrated care and how to use data, AI and analytics far more effectively for research, population health and patient engagement.

Inadequate focus on development of digital capabilities of ICBs

But while the current mood is about musical divergence and local ICS decision making, it remains delicate and very quick. A recent HSJ report found that only half of ICBs had digital strategies in place yet and the prospect of 30% staff reductions and mergers is not an auspicious start.

Without significant additional support many ICBs may still prove too weak and poorly resourced to effectively formulate and deliver a truly transformative digital strategy.

The focus under Ferris on baseline provider digitization for the digital disadvantaged was less welcome, needed and long overdue. But it may in many ways be the necessary completion of the foundation needed before a more far-reaching and ambitious transformation of health and care underpinned by digital and data.

Change may have to follow Ferris

Ferris’ lasting legacy may prove to be a focus on getting the work of frontline digitization done that will ultimately enable his successors to focus properly on achieving real change.