Dear NHS Digital, We Need To Talk About Intranets

The government has a new policy paper about its vision for digital services in the NHS and It’s well worth reading

The future of healthcare: our vision for digital, data and technology in health and care, published in October, is a positive and ambitious starting point for improving digital services across the NHS. Taking inspiration and learnings from improvements in standards made by the government digital service (GDS), the paper outlines the issues currently faced across hospitals, care homes, pharmacies and community care facilities where ‘technology systems don’t talk to each other’.

The vision sets out the intention for a collaborative development approach for digital systems and services. Given the size of the NHS, the government admits it doesn’t yet have all the answers and that this should be the beginning of an open conversation. In this spirit of openness there is a questionnaire for feedback with luminaries such as Ben Goldacre urging you to get involved. The openness extends to exciting innovations for improving patient care such as Genomics and AI but acknowledges that employees supporting this care are often struggling with outdated and under-managed technology. For one eye-popping example, there are currently 8000 fax machines still in use in the NHS

The vision is not a standalone paper. Digital transformation is being taken seriously via a standards team and other positive approaches including the recently published service design manual and guidance for moving to cloud services.

To move beyond the “narrative that it’s too difficult to do it right in health and care”< the vision introduces four guiding principles of:

• user need
• privacy and security
• interoperability and openness
• inclusion

As an intranet professional with NHS experience I was keen to see how this exciting new direction could benefit Internal Communications functions within Trusts and, in particular, intranets. I started by doing a word search for ‘intranets’ in all the above articles and anywhere else I could find including the NHS Digital website, their data and information strategy and brand identity guide.

0 results found  🙁

Nothing. Zilch. Nada.

Oh dear. But why is this important?

As part of a digital workplace, the intranet is often the first thing an employee sees when they turn on a computer. Used and managed effectively, it becomes an essential element of the employee’s digital experience and an asset to the organisation. Intranets enable staff to find each other, share stuff,  access key systems and seek out information that helps them do their job effectively. If the intranet is not managed well, trust is lost and people will look elsewhere for answers, with resulting cost and resource implications.

How many intranets are there across the NHS?

Caveat. The following numbers are not exact. In some cases a Trust has more than one hospital. Also a Trust is not always a hospital, neither is a CCG. It’s not easy to pin down and, frankly, I’m not an NHS expert but I had a go.

The NHS is the world’s fifth largest employer with 1.4 million people across 850 NHS hospitals in England, managed by

• 207 clinical commissioning groups
• 135 acute non-specialist trusts
• 17 acute specialist trusts
• 54 mental health trusts
• 35 community providers
• 10 ambulance trusts

There are over three hundred NHS Hospitals in Scotland led by 14 NHS boards and more than 100 NHS hospitals in Wales managed by three Trusts and just under 50 hospitals in Northern Ireland.

I make that more or less 1300 hospitals across the UK. The smallest Trust – in Weston-Super-Mare – employs 2000. The largest, Leeds Teaching Hospital, has 15000 staff.

And they all have an Intranet?

I would assume so (with reasonable confidence, I’ve been in this game a long time). There may well be some but I have yet to find research on the subject and get solid data. Details of the full scope of platforms and how many full time employees are devoted to intranets would be valuable so that a figure could be put on the amount spent, the amounts required to support people in doing their jobs, and where efficiencies could be made. This would align well with the aims of the policy paper.

Why are you interested?

As an intranet specialist I have spent the past 18 months running the intranet at Great Ormond Street Hospital in London. My first time working within the NHS, it was an honour to work with such committed and professional people.To see the amazing work the clinical staff do to save lives and heal sick children and how the non-clinical staff support the running of the hospital has been inspirational. I witnessed how having the correct information at their fingertips was so important for these people.

While working on the Intranet I did some low level research to try and establish if there were any common approaches and standards across the NHS that I could tap into. I found that intranet systems across the NHS range from low-cost open-source bespoke products, sometimes built in-house, to complex third-party agency designed SharePoint implementations and O365 integrations. Some have a shoestring budget and rely on the goodwill of committed staff, some spend hundreds of thousands as a one-off cost. There appears to be no general standards or guidance.

An argument against common intranet standards could be that Hospitals and Trusts all have differing user needs and requirements and that intranets should reflect this. My response to this would be to say that the NHS is one organisation and that hospitals generally have similar structures and objectives. Likewise, NHS hospital intranets, will be similar in content. There will be a homepage with news articles, links to a People Directory and key systems, possibly some social feeds and a navigation menu linking to relevant content etc.

What would improve things?

Although creating guidance on which technology system to use for an intranet and broader digital workplace would be a significant and longer term piece of work, establishing common standards for data and management for intranets would be a more straightforward exercise, drawing on the principles and learnings that the vision sets out. Standardising content management, governance, policies, navigation, search, and people directory profiles could bring benefits in time and resources spent in development. It would also make it easier to share content across the NHS and reduce instances of content duplication.

A set of common standards could work as a toolkit for Trusts to use without going through expensive discovery and workshop processes. It could show the big spenders that large scale complexity is not always necessary and the small spenders could use it to optimise for efficiency.

Why has nobody done this before?

I don’t know. 1.4 million people helping to save lives using 1300 intranets deserve an excellent digital employee experience. The common standards and design principles outlined in the policy paper, if implemented across NHS Intranets, could potentially create large savings on hardware, design and implementations and lead to more digitally enabled employees. If clinical staff can quickly find each other and the information they need to perform their roles better, more time can be spent on saving lives. And non-clinical staff are able to support the smoother running of the hospital ultimately leading to improved patient care.

There are many conversations to be had about NHS internal digital communications (digital literacy, ownership models of digital workplace etc) but as a starting point, the policy paper sets a most relevant position. So do fill in the questionnaire and provide comments and feedback on it. Anyone with an interest is welcome to share their views.