On the day of NHSX’s formal launch, Antonio Marino explores how it can make an effective and lasting impact.

Today, NHSX, the health service’s shiny new technological innovation unit, goes live. In preparation, Matthew Gould – headhunted to lead it and already a close ally of Matt Hancock – has embarked on a ‘month of listening’ and set the tone for his new organisation with a string of eye-catching policy announcements. The organisation is still a work in progress, although Gould will hope that it is somewhat more than a minimum viable product.

Guided by the Department for Health and Social Care’s tech vision, the new unit has assumed extensive responsibilities: from cyber-security, to the creation of system-wide standards, to digitally upskilling a 1.2 million-strong workforce.

However, as NHSX takes on the charge of implementing the health service’s dauntingly ambitious digital transformation agenda, it will need more than a new-age name to succeed. Amidst real frustration at the level of political energy and attention it has consumed, many will inevitably wonder whether it is up to the task or if it is instead destined to join its predecessors in the NHS’s infamous graveyard of acronyms and quangos.

With these sceptics circling, NHSX will have to fight for survival right from its formal launch. Its success in this regard will hinge on three factors:

1. Setting a tone of realism

Conscious of the need to drum up positive publicity and goodwill, NHSX’s interim leadership will no doubt already be on the look-out for quick publicity wins. However, it must avoid overstretching itself in the pursuit of gimmicky initiatives that promise all things to all men.

Resisting this temptation will be a key challenge. But NHSX has put a good foot forward, with Gould’s first announcement signalling a significant scale-back of the NHS App, a move that will have prompted an audible sigh of relief in many quarters.

Although the NHS App set out with laudable intentions to house other programmes and applications, it soon became clear that its ever-expanding, rather ubiquitous nature would make this difficult. Concern grew that certain firms would be closed off from cooperation because their technology did not fit the NHS mould.

The decision to reduce the number of functions fits much better with the tech vision’s credo and its heavy emphasis on harnessing the expertise of the market.

More importantly, though, it signals a level of self-restraint that predecessors to NHSX have lacked. A more grounded, piecemeal approach to digital reform will in the long term endear NHSX to the change-fatigued technology community.

2. Establishing a functioning partnership with existing bodies

Quite how NHSX will fit into the current landscape is unclear.

Though we know that it will sit above and have oversight of a reformed NHS Digital, it is not yet apparent how the latter’s responsibilities will be affected. Nor is it known how NHSX will cooperate with the Transformation workstream, now without its architect, Matthew Swindells.

This ambiguity will need to be rapidly addressed. As NHSX is inserted into various organograms, there is a high risk of unnecessary disruption or duplication to valuable institutional memory and expertise. It was a shrewd move to appoint experienced figures to NHSX’s interim leadership who will be wary of institutional turf wars, but following a path that adds value instead of treading on toes will be challenging.

Locally, meanwhile, it remains to be seen how NHSX, the self-proclaimed ‘front door’ for innovative technology developers, will work alongside AHSNs, who have hitherto done much of the heavy-lifting in introducing innovative digital tools to frontline staff. If NHSX is the front door, then AHSNs should not be locked out. Digital innovators are unlikely to be concerned about who they deal with, as long as they get the help they need. Better to slowly and organically build up functional working relationships and align them to the centre’s strategy.

3. Heeding lessons from a troubled past

NHSX’s interim leaders freely acknowledge that the National Programme for IT, the much-maligned flagship digitalisation project of the 2000s, looms large over current thinking. Memories of its over-centralisation and insensitivity to frontline views should offer a useful corrective to anyone wanting the centre to exercise far-reaching powers when it comes to digital reform.

The Global Digital Exemplar programme was the antidote to this, offering a ‘middle-out’, decentralised approach that empowered a small group of trusts to lead their own digitalisation projects. Despite some successes, the mood music has turned against the programme, amid reports that its budget is soon to be cut.

Gould has since announced that the GDE programme will remain, albeit with a greater focus on less advanced trusts. This, again, will be viewed positively. As the Nuffield Trust has recently shown, people like the more collaborative environment of the GDE programme and there is an opportunity to make improvements through incremental change to reporting requirements and targets.


Progress on these three fronts will set NHSX in the right direction. Ultimately, though, whatever choices it makes, the final guarantor of success will be the continued political patronage provided by Matt Hancock and his ability to twist the ear of colleagues in the Treasury.

The next Spending Review will determine technology spend in the NHS for the foreseeable future. If local trusts do not receive the sustained, ringfenced uplift that successful digital transformation requires, progress will be very difficult. NHSX will be hoping that Mr Hancock can act as the crusading champion it desperately needs.