My Lords, I am very grateful to the noble Lords, Lord Hunt of Kings Heath and Lord Clement-Jones, the noble Baroness, Lady Thornton, and my noble friend Lady Cumberlege for bringing these amendments for debate before the Committee today.
Once again, we are dealing here with an important set of issues. First, Amendments 26 and 35 would ensure that integrated care boards appointed a director of digital transformation. The Government fully agree with the spirit behind the amendments, ensuring a strong local focus on digital transformation. However, looking at the pros and cons, we must balance the desire to go further—which we all want—with the important principle that I have articulated before: that the provisions in the Bill should not be too prescriptive when it comes to membership requirements. As we have discussed, it is an essential principle of the Bill that there must be local flexibility to design the board in a way most suitable to each area’s unique needs.
4.15 pm
As your Lordships will be aware, local areas can, by agreement, go beyond the legislative minimum requirements to appoint individuals with the necessary experience and expertise to address their needs. As such, prescribing particular roles in these provisions is not necessary. What I can say is that developing the digital capability of local health and care services is one of the areas that we would expect ICBs to prioritise. It is an area of significant investment centrally, as I shall come on to explain in a moment, and of similar investment by local commissioners; it needs good local leadership, undoubtedly.
To buttress this investment, the NHS has been set a very clear set of expectations in relation to digital transformation. This set of expectations is even called What Good Looks Like, and it will be the benchmark for integrated care boards. It sets the criteria against which they will be assessed for their effectiveness in using digital technology to support improved outcomes for patients.
The first measure of success is that the local system has a clear strategy for digital transformation and collaboration, with the right leadership. Integrated care boards are expected to have digital expertise and
accountability in their leadership arrangements, but, as the noble Lord, Lord Mawson, brought out so well, we also expect a general development of digital competence in the board, and investment across the local system in expertise in building digital capability. That process certainly could be assisted through a chief information officer and other roles.
We will provide resources, including a non-statutory assessment framework for organisations to measure their level of digital maturity against the characteristics set by What Good Looks Like. It will help identify gaps and prioritise areas for local improvement. Assessments will be repeatable annually so progress can be tracked year on year.
We are not just setting expectations; we will be testing progress. This is obviously where the strength would lie in any expectation-setting process, rather than whether or not it was in statute. The Committee may like to know that my right honourable friend the Secretary of State and my noble friend Lord Kamall have regular meetings with NHSX, NHS Digital and NHS Transformation about the safe and ethical sharing of data and appropriate ways to break down silos. Ministers are in no way distancing themselves from those important issues; quite the reverse. Data Saves Lives is the name of the draft strategy that we published, and it is a title that vividly reminds us of what is at stake here.
I just say to my noble friend Lady Cumberlege that I am also especially pleased that we are in the process of appointing the first ever patient safety commissioner for England. The role is currently open for applications until Tuesday 25. As she knows, the patient safety commissioner will be responsible for promoting good practice, for calling the healthcare system to account and for identifying and monitoring potential problems across the system.
While on the topic of digital transformation, let me turn to Amendments 84, 134 and 140, which seek to place a duty on ICBs to promote digital transformation, accompanied by the publication of a five-year plan for digital transformation, with an update at least once every five years. The use of digital technology has been crucial to meeting the demands which Covid-19 has placed on health and care services. It has given renewed impetus to an area which in the past, as the noble Lord, Lord Hunt, will know from his considerable experience, has been problematic for the NHS.
Leading the process of digital transformation locally is a significant role for the integrated care board, but this should be part of its general duties rather than a separate duty. I am afraid that I do not think it would be proportionate or effective to have a stand-alone statutory duty, as it would require the creation of a separate planning and reporting process, which we do not think is necessary. As I have made clear, we will test the progress of ICBs in this area against the expectations we set.
There is a broader point, which my noble friend Lady Harding brought out cogently: digital transformation is most effectively done as part of wider service and pathway transformation rather than looked at as a separate activity. Integrated care boards will be required periodically to produce strategic plans, which we would
expect to include digital transformation and its interaction with other aspects of planned transformation. A separate statutory duty is therefore unnecessary and risks misalignment between digital transformation and wider service transformation when we would want them to go hand in glove. Rather than risking this, I ask the noble Lord to agree with our approach of placing digital transformation at the heart of the ICB’s general duties.
Of course, any efforts to promote digital transformation must be incentivised through effective funding. Amendment 160 would ring-fence 5% of NHS organisations’ spending to be dedicated to digital transformation. The noble Lord, Lord Clement-Jones, asked about the amounts of money that we are earmarking for this. Over the next three years, we are investing centrally £2.85 billion in capital, with £2.9 billion of revenue on top of that. Within this, more than £2 billion has been set aside for digitising the front-line NHS, in addition to local investment by commissioners. However, noble Lords will understand that we have a long-standing and well-tested principle of not ring-fencing investment in the NHS. It is fundamental to the flexibility of local commissioners and to the principle of local, clinically led decision-making. We would not want to tie the hands of local trusts specifically to spend a certain amount of money in one area and not in other areas, nor would we want to be prescriptive about whether NHS organisations should use capital or revenue spending to deliver digital transformation, particularly as the market is in the process of moving towards revenue-based products.
I can also inform the noble Lord, Lord Hunt, that consideration has been given to whether a minimum tech investment policy for NHS organisations could helpfully support digital transformation. The conclusion was that such a policy would face practical challenges, including difficulties in monitoring and enforcing compliance, and could cause a range of unintended consequences, including encouraging organisations to focus on hitting the target rather than maximising value from appropriate investments in digital technology. We also felt that it would not address many of the underlying causes of low levels of digitisation. Instead, we would advocate a flexible approach, giving local organisations the ability to spend the money in the areas which are urgently needed. This must be accompanied by clear national standards defining what a good level of digitisation is and guidance and support, including for local skills development, so that organisations are supported to invest effectively. If local NHS organisations fail to meet the required standards of digital transformation, there are other levers at our disposal to enforce compliance, including the oversight arrangements used to manage organisations’ operational performance, financial sustainability and the safety and quality of care delivered.
Amendments 70 and 73 specify that patients should be involved in decisions relating to the provision of information about the deployment of new treatments and technologies, and the provision of this information to enable patients to make a choice with respect to aspects of healthcare provided for them. I believe that the Bill, as is, achieves what the noble Lord and noble Baroness seek to achieve through these amendments.
An integrated care board, in the exercise of its functions, must promote patient involvement in decisions relating to their care and treatment, and this would likely cover providing information about available new treatments and technologies where there is an impact on the care received. The Bill also includes duties to promote research and innovation on matters relevant to the health service and the use of evidence obtained from research, so I believe that the Bill will allow local NHS bodies to best engage and involve patients and the public, supported by national guidance.
Turning to Amendment 78, the first part of the amendment requests that integrated care boards review all innovations. I completely appreciate the intentions behind the amendment, but it is unclear to me what additional benefit such a review would produce. As noble Lords know very well, the National Institute for Health and Care Excellence already plays an important role in ensuring that patients have access to promising new innovations by making recommendations on whether health technologies represent a clinically and cost-effective use of NHS resources. Where NICE makes a positive recommendation, NHS commissioners are under statutory obligations to fund the technology. This requirement will carry over to integrated care boards.
The second part of the amendment seeks to appoint a dedicated innovation officer to each board and develop and maintain a system to keep up with innovations. The Accelerated Access Collaborative, or AAC, the umbrella organisation overseeing the health innovation ecosystem, is working with NHS partners to look to embed research and innovation objectives within the new statutory ICBs. For example, as articulated in their job descriptions, a clear requirement will be placed on ICB chief executives and chairs to foster a culture of innovation. We also have existing reporting tools at our disposal to monitor the use of innovative medicines and medicinal products. This includes NHS Digital’s innovation scorecard and the AAC scorecard. Finally, alongside work that is under way to strengthen our ability to monitor progress, the AAC is scoping the development of an overarching innovation metric to help identify and address unwarranted variation.
Against that background, I hope that I have said enough to persuade my noble friend to move her amendment when the time comes for it to be called and to persuade the noble Lords, Lord Hunt and Lord Clement-Jones, not to press theirs.