Organisation’s annual accounts reveal major effort to deliver platforms to support booking of tests and vaccination

Credit: Raten-Kauf/Pixabay

NHS Digital’s work to support coronavirus response resulted in an annual funding increase of more than £160m in the 2021 financial year.

The organisation’s newly published annual accounts for the year to 31 March 2021 show that NHS Digital was given £695m in grant funding by the Department of Health of Social Care. This compares with £531m in the prior year, equating to an increase of 31%. The funding was supplemented by £45.3m the organisation generated via payments received for the provision of services such as training, data dissemination, and hosting.

The majority of the increase in central government backing can be attributed to £145m that was provided for “coronavirus-related delivery”. A little over half of the money from the DHSC – £364m – was allocated for “running and maintaining existing critical services”, while the delivery of “new and improved services” received £146m.

NHS Digital operates four via four delivery units, covering product development, data services, platforms and infrastructure, and IT operations and cybersecurity.

The product development arm’s work during FY21 included the development and delivery of the nationwide online systems through which citizens can book or order coronavirus tests and arrange vaccination appointments.

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Work on the digital service for booking tests began in April 2020 and, by the end of that month, a platform had already been launched through which key workers could order PCR tests.

“These systems were then integrated with NHS 111 online, allowing members of the public with symptoms to start to book tests,” the report said.

By June 2020, test results were automatically being sent to GP systems across the country and the test-booking service was integrated with the NHS Covid-19 contact-tracing app once it launched in September 2020.

As of the end of FY21 – by which point the public could order packs of lateral-flow tests – more than 110 million test results had been processed by the platform, with the daily figure “regularly reaching 1.5 million”.

The online system for booking vaccinations went live in early December 2020 and was used to process 30 million doses in its first four months in use.

“[Work] included the design and development of the patient-facing booking portal and integrating and managing services provided by third parties that allow NHS staff to call and recall people for vaccinations and record vaccinations when they have happened,” the report said. “NHS Digital also ensures that individuals’ vaccination information flows into their GP records and provides support to identify and address issues with data quality at vaccination sites.”

‘Digital front door’
As well as the delivery of new services, existing platforms experienced a surge in traffic and needed regular and significant updates as a result of the coronavirus crisis.

There were one billion visits to the NHS website during the year from users seeking information on Covid-19, while the social media channels run by NHS.UK generated 700 million impressions – a near-1,000% increase. 

The NHS App was downloaded 4.3 million times, equating to a threefold increase in overall users. A total of 9.7 million people had registered for an NHS login by the end of FY21, representing a rise of 107% over the course of the year.

The NHS 111 online service also saw a major spike in usage, with about 19,000 people per day using the platform to access medical advice.

“NHS 111 online has become a digital ‘front door’ to the NHS for millions of people, allowing users to check symptoms, determine whether they need in-person care and, through integration with NHS 111 telephony, receive clinical call-backs when required,” the report said. “In April 2020, traffic to 111.nhs.uk stabilised after peaking in early 2020 at nearly 95 times previous highs.”

NHS Digital’s data services function also face a significant workload in supporting pandemic response, including the collection of 10 new data sets to be provided the health service’s Data Access Request Service.

This included “GP data for pandemic planning and research”, as well as information on hospitalisations and prescriptions issued in hospitals, “vaccination status and adverse reactions… [and] Covid-19 ethnic category data”.

The Data Processing Service (DPS) run by NHS Digital’s IT operations and cyber unit, saw hugely increased usage during the year.

“In 2020/21, the DPS Core processed over 85,500 data submissions, comprising a total of over 128,000 million records and provided 114,000 data extracts,” the report said. “This is nine times as many data submissions and five times as many data extracts compared with 2019/20.”

During the year NHS Digital’s platforms and infrastructure division “supported connectivity upgrades for 350 NHS premises that needed more capacity to support their COVID-19 response… [and] delivered connectivity services to 150 vaccination sites”.

The unit also completed the rollout of the new NHS-wide Health and Social Care Network “ahead of time, under budget and in a way that has delivered more benefit than expected”, the report claimed. 

“A vibrant marketplace of 21 suppliers has been established, which is providing connectivity that costs, on average, 70% less than previous, equivalent services,” it added. “The value provided by the new HSCN marketplace has enabled health and care organisations to upgrade to far faster, more reliable connections that are better able to support their digital ambitions.”

Staff and supplier
The demands of responding to the pandemic saw NHS Digital’s annual wage bill for internal staff rise by almost 16% to £207m, while the £47.7m spent on secondees and temporary workers is double the comparable figure for the prior year.

Overall operating expenses rose by about a third to £296m. This increase was “driven by greater use of suppliers to support the increased scope of delivery… [and NHS Digital] also incurred significant transactional charges to pay for text messages to individuals about COVID-19 tests and for matching lab results to individuals’ records”.

Capital expenditure in FY21 increased by almost £40m to £137.7m. This included £99.3m spent on software development – compared with £52m in the prior year.

Money spent on software licensing, however, fell from £21.6m to just £3.8m.

In a joint foreword, chief executive Simon Bolton and chair Laura Wade-Gery claimed that the achievements of the year point towards the opportunities for the health service to better use technology in the longer-term. 

Such opportunities will benefit from the impending merger of NHS Digital and tech-strategy unit NHSX into NHS England, they said.

“The NHS had to use data and digital technologies differently because of Covid-19 and, in doing so, we saw their potential,” they said. “To make the most of these possibilities, we must work together. When the pressure of the pandemic was at its height, one of the shared experiences of staff at the heart of the action was that organisational boundaries tended to melt away. Projects involving complex groups of national, local and commercial partners became single teams focused on providing solutions. We want to keep that spirit as we build back after Covid-19. Looking forward, NHS Digital and NHSX will form part of NHS England and Improvement, bringing the key digital bodies of the NHS under one roof for the first time. Working together as one organisation, we will be able to step up the digitally enabled transformation of the NHS and focus our effort on what the system needs most.”