There has been growing interest regarding the potential of digital transformation to aid the UK’s health and social care system in its ambition to meet modern demands placed upon it. But what skills do different employees in this sector need – and is the infrastructure in place to support them? Here, Dr Alan Davies and Professor Angela Davies outline a new framework, developed with NHS England, to identify the skills and training needed by health and care workers.
- As technology and data play a larger role in health and care systems, the technical skills – and physical and digital infrastructure – must be in place to utilise them.
- A new framework allows healthcare workers to identify the skills required at their level, including those working across multiple disciplines.
- This framework should now be integrated across the NHS and medical training pathways.
Digital transformation in the health and social care sector is expected to help meet the growing demands placed on it in the UK. This includes the ageing population, complex medical needs, and new medical innovations (such as genomics and precision medicine). The system’s needs – and the potential for technology to meet many of them – is highlighted in the 2019 Topol review. The review’s recommendations are focused on 4 areas (genomics, digital medicine, AI & robotics, and the implications for education and training). The focus of these areas is related to patients, the workforce, and the wider health system.
Harnessing patient data is another potential area which promises benefits in the planning and provision of care and services, as the recent Goldacre review indicates. This can include the data from electronic patient records, alongside patient-generated data using technology like smartphones and wearable devices.
While digital transformation offers enormous benefits, it also involves implementing technologies such as artificial intelligence, robotics, and big data processing. Presently, the NHS lags behind many other industries in its use of technology. There are many reasons for this, including the size and complexity of the healthcare system, and the skills of the workforce and those it aims to serve – including people of all ages and digital literacy levels. Many of the areas where the NHS hopes to leverage digital transformation involve a spectrum of advanced digital skills that go beyond fundamental digital literacies. Moreover, the infrastructure needs modernising in many places to support these innovations; not just digital infrastructure, but also physical – including simple things like having enough power points, or appropriate space to implement solutions (such as robotics in surgical areas).
Who needs to know what?
The required skills represent an enormous spectrum, which threatens to expand the current digital divide. Some people will have little-to-no digital literacy, while others are embracing innovations that connect people and technology – such as implantable chips – and creating a new medical frontier. For health and social care professionals to act as patient advocates, they must first understand these technologies, and their advantages and limitations, to effectively advise patients and family, and subsequently use them for patient care and service improvement.
Frequent advances in medical technology and understanding make medicine (and healthcare) a demanding subject that requires life-long learning and continual updating of knowledge and skills. The added burden of doing the same for technology domains would not seem very practically feasible. To this end, the workforce needs to be guided in order to consider what they really need to know, and to what level; where the boundaries (and accountability) between different professions lie; and how they can work best with together towards the best outcomes.
How much of this digital talent and expertise should be developed by the NHS, and how much should be outsourced to industry, is also an open question. Even when outsourcing is used, we still need practitioners that can effectively translate and communicate with developers and industry providers to ensure the proposed digital health technologies are fit-for-purpose.
In order for people to start to answer some of these questions, a widespread set of more advanced digital capabilities is needed, building on the foundational digital literacy skills like being able to send emails and use basic software and apps, to the more advanced areas of health data, AI, and related digital health technologies.
The Artificial Intelligence (AI) and Digital Healthcare Technologies Capability framework
Our group was commissioned by NHS England, through the body previously known as Health Education England, to develop a capability framework for the health and social care workforce. Most capability and competency frameworks are targeted at specific groups (such as nurses, doctors, or informaticians). Given the variety and quantity of different roles in the healthcare workforce, and the fact that individuals can also hold multiple positions (for instance, a nurse may also work in an informatics team), we based the capabilities on a series of archetypes that can be used by managers or individuals to self-identify with.
Specifically, we used the archetypes of shapers, drivers, creators, embedders and users. Users of the framework may identify with different archetypes in different situations. For example, in some circumstances they may be users, whereas in others they may be shapers or drivers. The framework consists of 6 domains, 11 sub-domains and 195 individual capability statements. The statements are also presented in increasing levels (1-4), moving from lower order thinking skills (bottom) to higher order thinking skills (top).
Framework application in policy and practice
For the framework to be effective, advanced digital skills should be part of medical training pathways. Given the already highly condensed nature of these, digital skills could be included as cross-cutting themes delivered on other taught units; for example, using electronic patient records in a unit on prescribing, or obtaining and recording a patient’s medical history.
The main stakeholders who need to be aware of these capabilities include the Department for Health and Social Care (DHSC), regulatory and professional bodies, and those designing and delivering health and medical training pathways.
As a large portion of the workforce will be expected to upskill in these areas, workforce development plans must address this while accounting for variations in digital literacy (including among leaders). Policymakers in DHSC must work with digital and workforce teams within the NHS and the broader health and care sector to create, refine, and update these plans and ensure integration with the framework.
Careful monitoring of the workforce and its resource needs – along with horizon scanning to allow for the inclusion of rapidly changing and disruptive technology (for instance, generative AI such as ChatGPT) – must also be considered to mitigate potential disruption and identify training needs as early as possible. There is a role for the Department for Science, Innovation and Technology to work cross-departmentally with DHSC to highlight emerging technologies and trends.
The framework will also need to be updated regularly to maintain its relevance and reflect these changing needs. DHSC should ensure it is continually scoping, reviewing, and gathering evidence on emerging technologies and how they should be integrated into the framework.
Digital transformation in the NHS, and the wider health and care sector, has great potential to help meet the health challenges of the 21st century. Taking full advantage of this potential, however, requires a workforce with the right skills and confidence, alongside the physical and digital infrastructure to adopt new technologies.
The full team who contributed to authorship of the capability framework were: Dr Alan Davies, The University of Manchester; Dr Hatim Abdulhussein, Health Education England; Professor Angela Davies, The University of Manchester; Dr Mike Nix, Health Education England and NHS AI Lab; and Dr Annabelle Painter, Health Education England and the NHS AI Lab. More information about the authors and the wider contributors to the framework can be found here.
