What happens to all the big digital commitments after the election?

Well isn't this just the question of questions. Clients are asking me, it's coming up in passing discussion etc.

Not following? OK, let's take ourselves back to the rainy a**ehole that we called Spring 2024, Jeremy Hunt made a huge albeit rather unqualified promise about the new dawn of digitally enabled productivity:

£3.4bn in capital funding between 2025/26 and 2027/28 was also announced at Spring Budget 2024, for digital and technological transformation and to support an NHS productivity plan.        

Whilst about as wishy washy as a training session with Mr Miyagi, and as vague and conjecture inducing as you can get. £3.4bn isn't a number to sniff at, and in this barren financial landscape everyone hungrily wanted to know where it was going and for what.

Beyond the £3.4bn a number of huge, and some contentious, national initiatives were laid in front of us like delectable cakes in front of Paul Hollywood, along with a few that were melted underbaked monstrosities with very soggy bottoms. But I'll leave you to guess which would and wouldn't get the Hollywood Handshake in my book.

Needless to say many across the NHS, in the market, investors and potential importers were very hungry for something edible, and salivating.

Then expected but surprisingly early an election was called and all the big plans and promises largely stop where they are and the various forms of civil service stop in their tracks.

A veritable no mans land. Projects become like a collection of Schrodinger's cats - both dead and alive at the same time.

So are they dead 🙀 or alive 😺?

Let's indeed delve into this.

I'm trying not to make this article political as I'm aware my other ones are going to be ramming my political musings down the throats of people who signed up for intel, ideals and tips around digital and the NHS.

But I can't answer the question (and many others right now) without looking at the politics here.

Because one political administration made a bunch of promises that have not been actioned before a big vote for a different administration or the incumbent to come back in. They control the next NHS financial year (FY2025/26)

So it comes down to two elements:

1. Technicalities and levels of progress.
2. Likelihood that it would get carried forward (whether as continuity or rebranded as a brand new thing as happens in the political world).

Let's look at some of the projects we're talking about:

• The Spring Budget's £3.4 billion digital productivity drive.
• The future of the highly problematic, intervened and opaque Frontline Digitisation Programme after 2024/25.
• The other, contentious FDP - Federated Data Platform - with everyone's favourite company Palantir.
• The Digital NHS Health Check (due May 2024)
• National plans to offer tangible commercial support for 'contingent digital health technologies' incl. a centrally driven framework.
• The Tech Innovation Framework
• Future commitments around the NHS App.
• Specific policy drivers and strategies that include digital focus such as the Major Conditions Strategy.
• What other biggies have I missed? Let me know in comments. 💌

I have been squirreling information over the last month on these, but I'd like to be clear that there's lots that's unclear and I don't have all the answers, and given that I get a lot of my intel via WhatsApp and grapevines 🍇 I may have some stinky intel.

If you know it's stinky then send me a confidential DM with the right intel and I will duly upgrade (if you're not able to comment).

For a number of the above the future is uncertain and they are neither dead of alive, but let me outline what I know in the typical Liam's Logic way (which may be illogical)...

ONE - If it's in contract then it's a goer

So the Federated Data Platform, the new Electronic Staff Record and the future of NHS Mail are fine. Yes there may be some wiggles and small changes, and yes, a new government may be able to exit from commercial arrangements if clauses allow, but I would say these are in the bank.

TWO - if it's a promise for something to start in NHS FY 2025/26 onwards it's in the wind

So yep, that budgetary commitment for £3.4bn digital productivity is entirely at the discretion of the new health secretary so theoretically it's tomorrow's fish and chip paper from a technical perspective.

Expect that Labour will fully review this (officially) in August and then in greater detail in the run up to April 2025

...but I'll return to this one presently.

THREE - If it's a particularly politically driven policy a new party will likely wish to stamp it out

So as a headline concept the Major Conditions Strategy and 'a plan for digital health and social care' but produced by DHSC for their [then] current political landlords, will likely become irrelevant in their explicit current form, to be replaced with something basically the same...

... wait, I'm veering into point four...

FOUR - New emperors like new clothes, even if they're the same clothes.

Whilst a new party does not wish to be seen to carry forward the legacy of their former opposite numbers (that they've criticised at the dispatch box), the legacy can often be VERY helpful.

Anyone who has been in the NHS knows that the new thing is an old thing in new wrapping, and I think this is where we come back to THE £3.4bn.

Whilst Labour will unlikely carry forward the exact programme, Jeremy Hunt has effectively given them £3.4bn of capital investment that they don't need to cost up and promise in their manifesto (because it has already been promised), but can stick it in their budget line.

After the election, after the spending review, Wes Streeting will NO DOUBT spin this as new money from a benevolent new administration during the first 100 days, but I'd expect that whilst technically the £3.4bn is blowing in the wind, the Labour manifesto basically echoes it: driving productivity, data connectivity, CT scanners, AI to support the workforce. Less about basic plumbing and EPR foundations / minimum standards, but they're often pre-requisites or obvious necessities.

Now of course Labour may seek to divert some of the capital allocation away from digital and towards reducing the waiting lists with private partners, a bonus love letter with cash in it to NHS staff, or something else that drops over the coming weeks.

FYI... if this doesn't make sense - you need to know the following!

Capital - one off spend, within year (non-recurrent) to spend on stuff.
Revenue - recurrent longer term commitment.        

So it's not in the bag, but since the SOS in waiting has made lots of noise about tech, it wouldn't make sense to divert the whole shebang then have to find money elsewhere for the digital shinies.

TLDR - we'll likely see something very similar to the £3.4bn announcement that is of course totally different to the last copy.

FIVE - Less political things in train are great chances for early wins

So a month ago I was moaning that NHS England had a bunch of stuff that could come out but the whole possie had effectively downed tools around pressing the big green button because it was too close to the election. Now everything has changed because they literally can't put them out, but there's a library of more NHS England driven things that are relatively ready to roll.

The Digital NHS Health Check - not hugely publicised and much came from an independent review in 2020-21 - it's a health economic win and makes sense to push through a national offer so expecting to see it come out in 2024.

National plans to offer tangible commercial support for 'contingent digital health technologies' incl. a centrally driven framework - from what I've heard it's a bloody logical starting point, and hasn't been heavily publicised so very much expecting Streeting to shout "look what we came up with and did really quickly" after the summer. Keep your eyes on the prize.

The Tech Innovation Framework - again all the work has basically been done and lesser known early adopter programme in situ, so expecting this will get traction after the election.

SIX - erm Frontline Digitisation 🤷

God knows - I've hunted and hunted but nobody knows. As a programme it has been a bit of a poisoned chalice and useful pot to dip into for the Conservatives. But given what it covers we'll likely see more stuff like this, but hopefully done much better than what, at least from outside appearances and public complaints from providers, has been a dogs dinner. A brand new iteration is probably a good idea!

...and finally on a different note...

SEVEN - Local projects = down but not out

There are a lot of local digital projects and announcements that will be on hold that would have been moving forward. Naturally local leaders will wish to see what the new SOS will be asking them to do, and if it's different, but given all indications are that there isn't huge material change for local systems and providers, most projects that fell into the ditch will be hauled back out to continue after August.

That said, momentum really is a thing and some all but agreed projects may find themselves stuck in the ditch. Sadly.

SUM

I'm hearing loud and clear that the levels of consternation, stress, rumour fatigue and general feeling of helplessness is high right now for those pitching digital stuff into the NHS.

On one hand, I hugely emphasise and know how hard it is.

On another, this was entirely predictable and all that's happening was always going to happen, other than the timing, which surprised us all.

But at least in the short term, I think whilst the narrative and ownership, and self-crediting will shift, as will policy papers and buzzwords, a lot of what is here isn't lost, just destined to be re-packaged.

Yes, we're waiting like the proverbial surfers in the Guinness Advert (dum dum dum dum dum dum), but these are the inches and blockers that come with the territory in the NHS. Time to prepare for what comes next.

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Liam Cahill is a trusted adviser to frontline providers and national bodies on all things digital, with nearly two decades experience of doing tech stuff in the NHS. He has mentored and advised some of the best known names in Healthtech, and they've usually said some nice things about his work. He regularly posts content, ideas and advice on LinkedIn. Check out his other numerous articles and videos here, and subscribe to his LinkedIn newsletter here.