Leaked NHSE review warns of ‘severe’ lack of nurses with digital skills

A leaked NHS England review has warned of a “severe shortage” of nurses and midwives with digital skills despite an ambition to deliver tech-enabled healthcare.

The Phillips Ives review – seen by HSJ – recommends creating a national board to bring together “professional leadership and national bodies” and oversee the upskilling of the nursing and midwifery professions.

It says the roles and functions of nurses and midwives – which together make up the largest group of the NHS’s workforce – will “need to change” over the next two decades to “fully realise the benefits of technological developments”.

It also recommends: 

• Giving nurses and midwives a digital “passport” which shows their level of “competence and capability in delivering person-centred, digitally enabled practice”;
• Addressing an “urgent need” for digital nurse and midwife leaders to provide expertise to integrated care boards; and
• Significantly expanding digital skills training for student nurses and midwives.

Health Education England, which merged with NHSE last year, commissioned the review in 2022. It was led by former NHSX chief nursing information officer Natasha Phillips and Jeanette Ives Erickson, chief nurse emerita at Massachusetts General Hospital in the US.

The year-long review was due to be published in spring 2023, but NHSE has not released it and declined to say why. HSJ understands the review is unlikely to be released any time soon. 

New skills needed 

The review said the English NHS’s estimated 370,000 nurses and midwives all need new skills and competencies in evolving areas such as genomics, artificial intelligence, data science, research and innovation. Currently, these competencies are “poorly understood” and an “education gap” exists for a “large proportion of the workforce”.

The review recommended that “digital learning” should be integrated into curricula for pre-registration nursing and midwifery education so the professions are “prepared to practice in a digitally enabled healthcare environment”.

This would include students accessing a standardised simulated electronic patient record system, undergoing clinical placements with digital nurses specialist teams, data teams and virtual wards, and learning principles for using AI, digital technology and data.

Digital passport 

The review also recommended its proposed national board roll out a “competency framework”. This framework could then potentially be used to establish a digital passport setting out every nurse and midwife’s digital abilities, offering employers “clarity of current competency level[s] and inform[ing] training needs”.

The review also urged policymakers to consider the “unique role” nurses and midwives can play at the intersection of care delivery and operational management.

It highlighted that nurses “remain the most trusted profession” in the NHS and are therefore “perfectly positioned” to support, educate and empower patients to make decisions about the use of their medical records and population health initiatives.

Sharing expertise  

The review also highlighted an “urgent need” for digital nurse and midwife leaders to share their expertise at the ICB level to “inform systemwide digital transformation plans and data sharing policies”.

In the medium term, it recommended there should be an “established and well-embedded digital nursing and midwifery team throughout each [integrated care system], rather than situating practitioners solely in acute trusts”. The long-term vision would then be for every nurse and midwife in the health and care system to be “digitally enabled, as system-based digital solutions and data sharing become commonplace”.

It warned that “digital transformation for nurses and midwives cannot come soon enough” as the pace of technological developments shows no sign of slowing down in areas such as genomics and AI.

The review predicted that – within five years – nurses and midwives will be offering genetic counselling more routinely for individualised health concerns and referring people to specialist screening programmes.

This means there will be a longer-term need for nurses and midwives to know how to access genomic family history data from EPR systems to “inform their shared care decisions with people”.

This can be achieved by giving nurses and midwives a “broad understanding” of genomics in the context of personalised medicine, family histories and referral pathways, with genomics training made mandatory for registered nurses and midwives as part of their practice.

The review flagged the importance of current and future nurses and midwives being “confident” in integrating AI technologies into their practice, with AI principles also included in pre-registration training and education.

NHSE declined to comment.