Impact case study database

Cresswell and the eHealth Research Group’s evaluation of the National Programme for IT (NPfIT) offered robust evidence of fundamental problems of national IT strategy (3.1-3.4), arguing the need for increased local input in decision-making (3.6) and enhanced digital skills in the workforce (3.5). This evidence influenced 2016’s Making IT Work strategy for England (5.1), following which Cresswell and others developed and co-delivered an evidence-based solution – the NHS Digital Academy (NHSDA) – funded by NHS England. The NHSDA has built digital capability, confidence and skills across the NHS, which have proved invaluable during the COVID-19 ‘digital pivot’.

Policy impacts

Through the eHealth Research Group, Cresswell’s research influenced the English national health IT review Making IT work (2016), chaired by Professor Robert Wachter (5.1). The final report makes extensive reference to Cresswell’s research on the social dimensions of technological change in healthcare (5.1 p.23, p27, p30, p41, p50: Cresswell co-authored all of these referenced articles and led two as first author). Professor Wachter states: “ We often drew on [eHealth Research Group] work in our analyses and made reference to several papers from Edinburgh in our final report …Two of the eventual recommendations of my review were directly related to research findings from the University of Edinburgh eHealth Research Group’s evaluation of the introduction of electronic health records and electronic prescribing systems” (5.2).

The Westminster Government responded to the IT review with investments of at least GBP284,000,000 into digital training and engagement, including putting out a tender for the establishment of the NHS Digital Academy (NHSDA). The Edinburgh eHealth Group designed the winning bid in partnership with Imperial College London, and now co-deliver the NHSDA.

The NHS Long Term Plan (2019) specifically promises further investment in “enhancing the digital leadership of the NHS by further expanding the successful NHS Digital Academy programme.” (5.3 p.95; point 5.18) and the National Audit Office describes the NHSDA as “ a key element” of NHS future workforce development (5.4, p.38, para, 3.15). A 2020 review of the Digital Academy by Professor Wachter states: “ Clearly, the NHS Digital Academy has filled an important void. I was… very pleased to see that the NHS Digital Academy is playing a major role in addressing the fundamental goal of building digital skills and leadership across the NHS” (5.2).

Practice impacts

The NHSDA allows clinicians and managers from UK NHS hospitals to earn a postgraduate Diploma in Digital Health Leadership (5.5). The eHealth Group lead three of the five modules on health information systems and technologies, user-centred design and decision support and actionable data analytics (5.5). The course content of the NHSDA is underpinned by eHealth Research Group outputs, which are also used as teaching materials (e.g., 3.1, 3.2, 3.4, 3.5). Cresswell leads the module ‘Health information systems and technologies’ and 15 of her published articles (including 3.1, 3.6) are on the list of 54 essential readings for this module.

By November 2020, the NHSDA had trained 300 clinicians and managers from NHS organisations in all four nations of the UK in IT leadership and change management skills to support the digital transformation of the NHS, to improve the safety, quality and efficiency of care. The programme has been “consistently and significantly over-subscribed” and participants report individual benefits, benefits to their NHS organisations and (while early) anticipate benefits to the wider health system (5.6). An independent scoping evaluation found that, overall, NHSDA participants had “significant impact on their confidence and digital knowledge” (5.7, p.1). One clinician explained: “[NHSDA] has resulted in a huge change to what I bring to informatics meetings. My relationship with the IT Director and senior executives, as well as my influence over the direction of travel has increased dramatically” (5.8).

The NHSDA has supported its 300+ participants to use these new digital skills and confidence in workplace projects within their NHS Trusts/Boards. One Chief Clinical Information Officer (CCIO) implemented an online consultation software in every GP practice in Devon (131 practices serving a population of 1.2 million). The project increased from 1,500 eConsults used in March 2018 (NHSDA start) to 9,500 by Dec 2018, leading to a significant reduction in GP appointments (5.9). The CCIO states: “My learning from the NHSDA has really helped Devon during the current Covid-19 pandemic as GP practices in Devon were already more advanced in their willingness to adopt and implement digital change…The NHSDA has had wide ranging impact on my ability to function as a system leader in Digital health and I literally put this into practice daily” (5.9). The Officer has since been awarded GBP500,000 through the NHS Digital Accelerator fund to extend the project, with NHSE, via the Future NHS platform, recommending this approach nationwide to rapidly respond to the Covid-19 pandemic (5.9).

A GP from London created an ‘eHub’ model, a virtual hub that centrally directs eConsults from 11 GP practices (5.10, 5.11). Clinicians can work flexibly from a number of locations. The GP stated: “The NHS Digital Academy learning enabled me to understand the sociotechnical infrastructures involved, become skilled in process mapping the eHub, create a rich data source and create a continuous evaluation process to enable rapid change and evaluation” (5.10). By July 2019, the GP reported the eHub as having processed over 120,000 online consultations at a rate of over 3,000 a week (5.10). In reducing pressures for unnecessary face to face appointments, with around three-quarters of online consultations being closed off remotely (5.11), eHub freed up time for clinicians in the practices and created a route to retain GPs who would otherwise leave the NHS (5.10). The eHub model has been adopted in other areas of London (Brent and Lambeth) (5.10), with other UK Digital Accelerator sites to follow (Devon, Kent, Midlands).