Creating a new NHS Scotland Application: FOI release

Information requested

1.  the content of all assessments and documents considering whether to create a new NHS Scotland  app from scratch, or whether it would be possible to adapt the NHS England app.

2.  any cost estimates and timeframes for either option.

Response

I enclose a copy of some of the information you requested from the Digital Front Door Full Business Case and Digital Front Door Outline Business Case.

We have extracted and provided the relevant sections that fall within scope of the request as  appendices in this response.

Appendix 1

Pages 94, 95 and 96 extracted from Digital Front Door Full Business Case

4.11.7 Shortlist SWOT analysis

4.11.7.3 Re-use the NHS England App as the basis for Digital Front Door

Page 94

Strengths Proven at scale in England Makes use of investment already made within the wider NHS Supports health and social care use cases Available as a web application on device Accessibility - aligned with GDS Service Standard for UI/UX design Provides digital front end for capabilities which are required for DFD – referrals and hospital appointments management, digital communications, GP health records, linked profiles & proxy access Integrated with NHS Notify as a comms channel but we note that use of NHS App is expected to require additional discussions/costs to also use Notify The aggregator model used for the NHS App will reduce the level of change needed in the public-facing digital service

Weaknesses The NHS App hasn’t been designed and built to be deployed in another territory; it has been built for the needs of NHSE Changes to the digital service and the aggregator would be needed for DFD:  Integrating with CHI Integrating the Health & Care Record Using ScotAccount Integrating NHS 24 Scottish specific content NDP investment still required for services such as identity, demographics, digital comms, appts, health & care record. The overhead of adopting NHSE code; as shown by the time & cost for NHS Wales to deploy a Welsh version of the NHS App The time likely to be required to obtain agreement in both NHS Scotland and England for code to be shared The NHS App is not designed for social care.

Opportunities Creation of services that improves the public experience in cross border scenarios e.g. moving from England to Scotland or vice versa Builds on the strategic goal of the 4 nations approach to health data standards and sharing Adoption of capability already built within the NHSE App, albeit requiring significant change to be deployed in Scotland, for example digital prescriptions, register with a surgery, waiting times

Threats If the code is not forked for Scotland, and is maintained as a product, then Scotland could become a junior partner impacting the ability to drive change Complexity, cost and time overruns if the code is maintained as a product with a single code base from the complexity of working across both Scotland & England The challenges of deploying the NHSE App in Wales for DHCW may engender a lack of confidence in this solution Political optics of adopting an English solution

4.11.7.4.3 Re-use the NHS England App as the basis for Digital Front Door

Page 95

Reusing the NHS England App offers advantages in the digital and technology space by building on an already proven and scalable digital platform, compliant with good practice in the GDS Service Standard and plugging into an existing flexible communications channel in NHS Notify. From a public perspective it offers the opportunity to improve the experience in cross border scenarios such as moving from England to Scotland, and builds on the strategic goals of a 4 nations approach to health data sharing.

The NHSE App, however, has not been designed or built to be used in other territories and large changes would be required to the platform, as well as continued investment in NDP-Like services such as authentication and more. Any programme to adopt the NHSE App would come with high levels of risk from creating a tartan version of the App or maintaining a single code base across both Scotland and England.

4.11.8.1.2 Re-use the NHS England App as the basis for Digital Front Door

Page 96

Using the NHS Patient App to underpin DFD has been deemed an inappropriate choice. It could be tempting to see this option as a short cut to the delivery of DFD, but the weaknesses and threats outweigh the benefits that would be gained from the strengths and opportunities. Whilst the NHSE Patient App offers a comprehensive digital service that could inform the future of DFD, significant changes will be required to the App to bring it in line with Scottish functional needs and the Scottish healthcare systems landscape and to build NDP or NDP-like services. Choosing whether the code is forked and given to Scotland or maintained as a single product has significant implications. In the case of the former effort will need to be expended by both NHS England and NHS Scotland to hand over the code to a Scottish team, after which significant engineering changes will still be needed to bring it in line with DFD needs. For the latter choice, there is significant risk that Scotland will be the junior partner in the wider program, and DFD specific changes will have to be sequenced with NHSE changes impacting the DFD timeline and Scottish needs/outcomes.

In either case the experience of Digital Health Care Wales (DHCW), who have undertaken a substantial programme to adopt the NHS England App and deploy it in a Welsh context, suggests that this is not a viable option to meet the imperative to deliver an initial solution rapidly. Given the above, and that the

NHSE App has been designed and built specifically for the complexity of NHS England rather than with the aim of being re-used in another territory, this business case determines that re-use of the NHS Patient App is not an appropriate technology selection given that DFD initial delivery is scheduled for 2025.

Appendix 2

Pages 93, 94 and 95 extracted from Digital Front Door Outline Business Case

2.4.7 Shortlist SWOT analysis

2.4.7.3 Re-use the NHS England App as the basis for Digital Front Door

Page 93

Strengths Proven at scale in England Makes use of investment already made within the wider NHS Available as a web application on device Accessibility - aligned with GDS Service Standard for UI/UX design Provides digital front end for capabilities which are required for DFD – referrals and hospital appointments management, digital communications, GP health records, linked profiles & proxy access Integrated with NHS Notify as a comms channel but we note that use of NHS App is expected to require additional discussions/costs to also use Notify The aggregator model used for the NHS App will reduce the level of change needed in the patient facing digital service

Weaknesses   The NHS App hasn’t been designed and built to be deployed in another territory; it has been built for the needs of England and the complexity of NHSE Changes to the digital service and the aggregator would be needed for DFD: Integrating the Health & Care Record Using ScotAccount Integrating NHS 24 Scottish specific content NDP investment still required for services such as identity, demographics, digital comms, appts, health & care record. The overhead of a DFD team adopting the NHSE code; as shown by the time and cost for NHS Wales to deploy a Welsh version of the NHS App The time likely to be required to obtain agreement in both NHS Scotland and England for code to be shared

Opportunities Creation of services that improves the  patient experience in cross border scenarios e.g. moving from England to Scotland or vice versa Builds on the strategic goal of the 4 nations approach to health data standards and sharing Adoption of capability already built within the NHSE App, albeit requiring significant change to be deployed in Scotland, for example digital prescriptions, register with a surgery, waiting times

Threats   If the code is not forked and passed to Scotland, and is maintained as a product, then Scotland could become a junior partner impacting the ability of DFD to drive change Complexity, cost and time overruns if the code is maintained as a product with a single code base from the complexity of working across both Scotland & England The challenges of deploying the NHSE App in Wales for DHCW may engender a lack of confidence in this solution Political optics of adopting an English solution

2.4.7.4.3 Re-use the NHS England App as the basis for Digital Front Door

Page 94

Re-use of the NHS England App offers advantages in the digital and technology space by building on an already proven and scalable digital platform, compliant with good practice in the GDS Service Standard and which plugs into an existing flexible communications channel in NHS Notify. From a patient perspective it offers the opportunity to improve the experience in cross border scenario’s such as moving from England to Scotland and builds on the strategic goals of a 4 nations approach to health data sharing. However, the NHSE App has not been designed or built to be used in other territories and large changes would be required to the platform, as well as continued investment in NDP Like services such as authentication and more. Any program to adopt the NHSE App would come with high levels of risk from creating a tartan version of the App or maintaining a single code base across both Scotland England.

2.4.8.1.2 Re-use the NHS England App as the basis for Digital Front Door

Page 95

The use of NHS Patient App has been deemed an inappropriate choice to underpin DFD. It could be tempting to see this option as a short cut to the delivery of DFD, but the weaknesses and threats outweigh the benefits that would be incurred from the strengths and opportunities. Whilst the NHSE Patient App offers a comprehensive digital service that could inform the future of DFD, significant changes will be required to the App to bring it in line with Scottish functional needs and the Scottish healthcare systems landscape and build NDP or NDP-like services. A choice would also need to be made as to whether the code is forked and given to Scotland or maintained as a single product. In the case of the former effort will need to be expended by both NHS England and NHS Scotland to hand over the code to a Scottish team, after which significant engineering changes will still be needed to bring it in line with DFD needs. In the case of the latter, there is significant risk that Scotland will be the junior partner in the wider program, and DFD specific changes will have to be sequenced with NHSE changes impacting the DFD timeline and Scottish needs/outcomes. In either case the experience of Digital Health Care Wales (DHCW), who have undertaken a substantial program to adopt the NHS England App and deploy it in a Welsh context, suggests that this is not a viable option as it will not fit with an imperative to deliver an initial solution in a rapid timeframe. Given the above, and that the NHSE App has been designed and built for the complexity of NHS England and has not been designed and built with the aim of being re-used in another territory, this business case determines that re-use of the NHS Patient App is not an appropriate technology selection given that DFD initial delivery is scheduled for 2026.

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