Topic 7.4 — Digital Skills & Capability Building

Digital skills are not an IT concern for a specialist few but a whole-workforce capability that determines whether new systems make care safer or more dangerous — so building them is a clinical-safety, equity and public-trust obligation, not an optional training line item.

Why this matters in health and care#

Most digital projects in health and care do not fail because the technology is broken. They fail because the workforce was never properly prepared to use it. A well-built electronic patient record, deployed into wards where nurses have had ninety minutes of e-learning and no floor-walking support, produces slower care, workarounds, frustration and — the part that should concentrate every leader's mind — new categories of clinical error. The technology works; the capability to use it safely does not exist yet. In this sector, an under-invested training plan is a patient-safety risk (see Topic 1.6 — Clinical Safety & Risk Management).

The scope of the challenge is larger than the digital and IT team, whose own development is covered in Topics 7.0–7.6. The people who most need digital capability are the clinical and care staff, operational managers and senior leaders who use digital systems every hour of every shift but do not think of themselves as "digital" at all. A radiographer, a community district nurse, a care-home manager, a receptionist booking appointments, a GP prescribing electronically: their fluency, or lack of it, is where digital transformation succeeds or stalls. Capability is only as strong as the least-supported user in the workflow.

There is an equity dimension too. Some staff are themselves digitally excluded — through age, disability, language, precarious employment, or simply never having had a device or protected time to learn. Social care is especially exposed: a fragmented, high-turnover, low-margin workforce, often without organizational email addresses, let alone laptops. If you design capability programmes only for confident, salaried NHS staff on hospital sites, you widen the very divide that shared care records were meant to close (see Topic 1.9 — Digital Inclusion & Accessibility, and Topic 7.6 — Workforce Equality, Diversity & Inclusion). And because capability shapes how safely and confidently staff handle patient data, it feeds directly into public trust: patients notice when the person in front of them is fighting the computer rather than caring for them.

Core concepts#

Digital literacy is the baseline: the capabilities that fit someone to live, learn and work in a digital society. In a health and care setting it means more than sending email — it spans information handling, communication, transactions, problem-solving, staying safe online, and the confidence to learn a new system without fear. It is not a fixed trait but a spectrum that everyone can move along with support.

The Topol Review — Preparing the Healthcare Workforce to Deliver the Digital Future (2019), led by Eric Topol for what was then Health Education England — is the sector's anchor document. Its central finding is the thesis of this topic: the rate at which health systems adopt technology is limited not by the technology but by the workforce's readiness to use it, so employers must invest in education, training and lifelong learning, and give staff time to adapt. It calls for the whole workforce to gain digital literacy, and for a cadre of specialists to go much deeper.

Health informatics — and its clinical, nursing and pharmacy sub-disciplines — is the professional field that bridges clinical practice and digital systems. The bridging leadership roles matter enormously: the Chief Clinical Information Officer (CCIO), Chief Nursing Information Officer (CNIO) and their allied-health and pharmacy equivalents translate between clinical need and technical delivery, and lend clinical credibility to change that a Chief Information Officer alone cannot.

Digital transformation fails or succeeds on capability, so treat capability as a design input, not a downstream afterthought. A capability (or digital-readiness) framework describes, in plain and assessable terms, what "good" looks like at each level and role — from basic digital literacy to advanced clinical informatics — so you can measure where people are and target investment at the gaps.

A skills gap is the mismatch between the capabilities the workforce has and the capabilities the work now demands. Closing it durably requires lifelong learning and a learning organisation culture — one that continuously develops its people rather than training them once at go-live and moving on. Professional development, apprenticeships and defined career pathways professionalize the digital, data and technology (DDaT) workforce and give clinical staff a recognized route into informatics.

The digital divide applies to staff as well as patients. Digital exclusion among the workforce — no device, no connectivity, no confidence, no protected time — is a capability problem you must design against explicitly, because the people it affects are often those caring for the most vulnerable citizens.

Best practices#

1. Treat capability as part of the system, and never deploy without a training and support plan. The single most reliable predictor of a failed rollout is a business case that funds the software but not the workforce change around it. Make it a rule — enforced at the spend-control or investment board — that no digital programme is approved without a costed capability and organizational-development plan attached (see Topic 7.5 — People & Organizational Development). This operationalizes the Topol Review's core finding and converts "we'll do some training" into an owned, funded commitment.

2. Assess the baseline before you design the programme. You cannot close a gap you have not measured. Use a recognized capability or digital-readiness framework to survey current capability by role, team and site, distinguishing confidence from competence, and surfacing the pockets of digital exclusion you would otherwise miss. Repeat the assessment after deployment so you can show capability actually rose, not just that attendance was recorded.

3. Embed training in the deployment itself, with floor-walking and super-users. Classroom e-learning weeks before go-live is largely forgotten by the time it matters. The evidence favours training close to go-live, in the real environment, with visible on-the-floor support — "floor-walkers" and local super-users (also called digital champions) who are peers, not IT strangers, and who stay embedded for weeks after launch. Budget for backfill so staff can actually leave the workflow to learn, and for the super-users' time, because unpaid goodwill is not a support model.

4. Grow the bridging roles: CCIOs, CNIOs and clinical informaticians. Appoint, fund and give real authority to Chief Clinical and Chief Nursing Information Officers and their allied-health equivalents, and build a pipeline of clinical staff into informatics through fellowships and formal training. These roles give change clinical credibility, catch safety issues that technologists miss, and ensure systems are configured around real clinical workflow. A digital programme led only by technologists, however skilled, will design for the system it wishes clinicians used rather than the one they actually work in.

5. Build career pathways and professionalize the DDaT workforce. Use apprenticeships (from digital-support technician to degree-level data and cyber routes), the recognized DDaT capability framework, and professional registration to turn ad-hoc digital roles into a profession with progression. This widens access — apprenticeships reach people who would never take a traditional degree route — and improves retention, because staff who can see a future stay. It also strengthens the talent pipeline your workforce strategy depends on (see Topic 7.3 — Workforce Strategy).

6. Make it lifelong, and build a learning culture. Capability decays and technology moves, so one-off training at go-live guarantees a capability gap within months, worsened by turnover. Protect regular learning time, normalize continuing professional development in digital skills, and reward the curiosity and psychological safety that let people admit what they do not know. A genuine learning organization treats every incident, workaround and near-miss as data about capability, not a reason to blame an individual.

7. Design explicitly for digitally excluded staff. Assume that some of your workforce — disproportionately in social care, domiciliary and bank/agency roles — lack devices, connectivity, organizational logins or confidence, and design programmes that reach them rather than the confident majority who least need help. Offer multiple formats, plain-language materials, one-to-one coaching, and basic-skills routes such as the Essential Digital Skills framework. Inclusion here is not charity; it is the precondition for the shared records and integrated pathways that only work if every part of the workforce can use them.

8. Develop leaders' and managers' digital capability, not just frontline users'. Boards and senior managers sponsor, fund and govern digital change, yet are often the least digitally fluent people in the building, which produces unrealistic timelines, thin support budgets and a rush to go-live. Invest deliberately in leadership digital literacy — enough to challenge a supplier, read a capability plan critically, and understand why floor-walking matters — through board development, digital-leadership programmes and reverse mentoring. Capable sponsors make the difference between a programme that protects learning time and one that sacrifices it to the deadline.

9. Measure capability and close the gaps you find. Define what capability means, baseline it, set targets, and track movement — completion rates, confidence surveys, competency assessments, adoption and proficient-use metrics, and reductions in error and workaround rates. Report capability alongside delivery milestones so the board sees it as a first-order outcome, and feed the gaps back into the next round of investment. What gets measured and reported to the board is what gets funded.

10. Tie capability building to change management and communications. Skills without motivation and clear communication produce trained-but-resistant staff, so run capability building as one strand of a coherent change approach (see Topic 8.1 — Change Management, and Topic 8.2 — Communications & Engagement). Use a recognized model — ADKAR's sequence of Awareness, Desire, Knowledge, Ability, Reinforcement is a useful reminder that Knowledge and Ability sit inside a wider arc. Capability is necessary but not sufficient; people also need to understand why the change matters and to see it reinforced.

Questions to discuss with your team#

1. Would our next major system go-live fail on capability rather than technology — and how would we know before it did? This question forces an honest look at the gap between your delivery plan and your capability plan. Trace a specific forthcoming rollout — a shared care record, an e-prescribing module, a new referral system — and ask whether the training, floor-walking, super-user and backfill provision is actually funded and staffed, or whether it is a paragraph of good intentions in the business case. Debate where your digitally excluded and hardest-to-reach staff are (often social care, community, night shifts, bank and agency workers) and whether the plan reaches them or only the confident hospital-based majority. Consider your leading indicators: baseline capability assessments, confidence surveys, super-user readiness, and protected-time commitments that you can check weeks before go-live rather than discovering the gap in a post-incident review. A good, honest answer names the specific groups at risk, points to funded and owned mitigations, and admits where the current plan is thin — rather than asserting that "training is covered."

2. Are we building capability that lasts, or training people once and moving on? Capability decays, technology changes and staff turn over, so a programme that peaks at go-live and then stops will have a fresh gap within a year — worse in high-turnover parts of the workforce. Discuss whether you have protected, recurring learning time or whether "digital skills" is squeezed out by operational pressure the moment a ward is short-staffed. Examine your induction: does every new starter, including bank and agency, get the digital capability they need, or do gaps compound with each hire? Weigh the tension between the immediate operational cost of releasing staff to learn and the slower, larger cost of workarounds, errors and disengagement when they cannot. A good answer describes concrete mechanisms — protected CPD time, refreshed super-user networks, digital capability built into every induction and appraisal — and evidence that capability is being sustained, not just an aspiration to a "learning culture."

3. Do we treat our own workforce's digital exclusion as seriously as we treat patients'? Digital inclusion effort in health and care overwhelmingly targets patients and citizens, yet a meaningful share of staff are themselves excluded — without devices, connectivity, organizational logins, confidence or protected time — and this is most acute among the social care and community colleagues who care for the most vulnerable people. Discuss who in your workforce is being quietly left behind, and whether your capability programmes assume a level of baseline access and confidence that many staff do not have. Consider the equity consequence: if only confident, salaried, hospital-based staff can use the shared record, integrated care fails precisely at the seams it was meant to join. Weigh practical responses — device provision, basic-skills routes such as Essential Digital Skills, one-to-one coaching, plain-language materials, reaching staff who have no work email. A good answer can point to who owns staff digital inclusion, how excluded staff are identified, and what is actually being done — not a general belief that "our people are fine with computers."

4. Do we have the clinical-informatics bridging roles — CCIOs, CNIOs and clinical informaticians — with real authority, or is our change led only by technologists? Digital change designed without clinical credibility tends to fit the workflow its designers imagine rather than the one staff actually work in, and it misses the safety issues that only clinical eyes catch. Discuss whether your Chief Clinical and Chief Nursing Information Officers (and allied-health and pharmacy equivalents) are genuinely appointed, funded and empowered — with time protected from their clinical duties — or whether the title exists on paper while decisions are made elsewhere. Consider the pipeline behind them: are you growing clinical staff into informatics through fellowships and formal training, or relying on a single overstretched champion whose departure would leave a vacuum? Weigh the tension between the cost of releasing scarce clinicians into informatics roles and the far larger cost of systems configured around technical convenience rather than clinical reality. A good answer can name the post-holders, describe the authority and time they actually have, and point to a route by which the next generation of clinical informaticians is being developed — not a job title with no mandate.

5. Is our board and senior-management layer digitally capable enough to sponsor this well — and would they know if they were not? Boards and senior managers set the timelines, approve the budgets and govern digital change, yet are frequently the least digitally fluent people involved, which quietly produces unrealistic go-live dates and thin support budgets. Discuss honestly whether your leaders could challenge a supplier's claims, read a capability plan critically, or explain why floor-walking and backfill matter — and whether anyone has ever assessed their digital capability rather than assuming seniority implies fluency. Consider practical development routes: board-level digital-leadership programmes, reverse mentoring with younger or more digitally confident staff, and exposure to the frontline reality of using the systems they sponsor. Weigh the awkward tension that the people who most need this development are often the least likely to ask for it, and that raising it requires psychological safety at the top. A good answer describes concrete steps being taken to build leadership digital capability and evidence that capable sponsorship is protecting learning time and support budgets — not a comfortable assumption that "the board is on board."

6. Are we professionalizing digital roles into real careers, or leaving them as ad-hoc jobs that people pass through and leave? Capability is not only built through training courses; it is sustained by a workforce that can see a future in digital, data and technology roles and therefore stays. Discuss whether you use apprenticeships, the recognized DDaT capability framework, professional registration and defined career pathways to turn scattered digital roles into a profession with progression — or whether digital posts are filled reactively, without a route from, say, a digital-support technician to a degree-level data or cyber specialist. Consider who this widens access to: apprenticeships and internal pathways reach people who would never take a traditional degree route, including existing clinical and care staff. Weigh the tension between the short-term ease of buying in contractors and the long-term fragility of a workforce with no home-grown pipeline and high churn. A good answer points to actual pathways, apprenticeship numbers and registration uptake, and to retention evidence — not an aspiration to "invest in our people" with no structure behind it.

In practice: a health & care example#

An integrated care system (ICS) spanning two acute trusts, a community and mental-health trust, five local authorities and roughly two hundred independent care providers is deploying a shared care record over three years. The first phase, into the acute trusts, goes reasonably well: hospital staff are salaried, on-site, and used to clinical systems. The second phase — extending access to community teams and care homes — stalls badly. District nurses on aged tablets with poor connectivity abandon the record mid-visit; care-home staff, many without individual logins or any prior clinical-system experience, either share a single account (an information-governance breach) or ignore the record entirely. Adoption in the settings that most needed integration is near zero.

The ICS pauses and rebuilds around capability rather than technology. It runs a baseline digital-readiness assessment across community and social-care partners and discovers the real problem: not resistance, but exclusion — no devices, no confidence, no protected learning time. It funds a package that pairs each cluster of care homes with an embedded digital champion drawn from the care workforce itself, provides devices and individual logins, and delivers short, hands-on, in-the-workplace training with weeks of floor-walking rather than a one-off webinar. A newly appointed CNIO ensures the record is configured around community and care-home workflow, not just acute needs. Crucially, the ICS makes a standing rule: no further rollout phase is funded without a costed capability and OD plan, and capability metrics are reported to the board alongside delivery milestones. Within two phases, adoption in care homes rises from near zero to routine use — because the workforce was, at last, designed to receive the system.

Sector lenses#

Startup#

A digital-health startup building, say, a remote-monitoring platform lives or dies by whether its NHS and care customers' staff can actually use the product, so capability building is part of the offer, not an afterthought handed to the customer. Design onboarding, in-app guidance and train-the-trainer materials that assume mixed digital literacy and minimal protected time on the customer side. Invest early in clinical-informatics credibility — even a fractional CCIO-style clinical adviser — because clinical fluency in your own team shapes a product that fits real workflow. Treat a customer's super-user network as a shared asset you help build, since your adoption metrics depend on it.

Small business#

An established small provider — a GP practice, a community pharmacy, a care home or domiciliary-care agency, a single-site clinic — carries the same information-governance and clinical-safety duties as a large trust but has no dedicated IT or training function and no slack to release staff for learning. Capability building here has to be lean and practical: lean on national resources rather than building your own (the Essential Digital Skills framework, Digital Social Care and Skills for Care materials, supplier-provided training), and grow one or two in-house digital champions from existing staff rather than appointing specialists you cannot afford. Because turnover is high and margins are thin, bake digital capability into induction and everyday routines so it survives when a key person leaves, and lean on your local ICS, primary care network or supplier for shared floor-walking and device support you cannot resource alone. The risk to design against is the shared login and the never-updated skill: with no protected time, staff quietly work around systems they were never properly supported to use.

Enterprise#

A large NHS trust or ICS is where full capability infrastructure belongs: a capability framework, a super-user and digital-champion network, funded CCIO/CNIO roles, an apprenticeship and DDaT career pathway, and a rule that every programme carries a costed OD and capability plan. The scale challenge is reach and consistency — tens of thousands of staff across many sites, plus independent-sector partners with weaker digital infrastructure and higher turnover. The board's own digital capability is a real constraint here, so invest in leadership development and report capability metrics to the board as first-order outcomes. Resist the standing temptation to protect the go-live date by cutting the training and floor-walking budget first.

Government#

A national body — NHS England, a devolved government, or a body carrying the legacy of Health Education England and NHSX — shapes capability as system stewardship, through levers it does not directly manage: capability frameworks (such as the Digital Capabilities and DDaT frameworks), the Topol programme and digital fellowships, apprenticeship standards, professional registration for informatics, and education commissioning. Its job is to set standards, fund pathways, and make national resources (e-learning, the Essential Digital Skills framework, digital-inclusion funding) available to a workforce it does not employ. The distinctive obligations are equity across the whole health and care system — including the under-resourced social-care workforce — and sustaining investment over the long horizon that capability building genuinely requires. National bodies must resist funding shiny technology while starving the workforce capability that determines whether it is ever used.

Common failure modes#

• Funding the technology, starving the training. The business case pays for licences and hardware but treats capability as a rounding error, so adoption stalls and workarounds proliferate. Make a costed capability plan a condition of approval.
• Big-bang e-learning before go-live. Training delivered weeks early, off the ward, in generic modules is largely forgotten when it matters. Train close to go-live, in the real environment, with floor-walking support.
• Super-users as unpaid heroes. Relying on the goodwill of a few enthusiasts with no protected time or backfill burns them out and collapses the moment they move on. Fund the role.
• Designing for the confident majority. Programmes built around salaried, on-site, digitally-confident staff leave community, social-care, bank and agency colleagues behind — exactly where integration was supposed to help. Design explicitly for excluded staff.
• Digitally illiterate sponsorship. Boards and senior managers who do not understand digital delivery set unrealistic timelines and cut support budgets. Develop leaders' digital capability too.
• One-and-done. Training once at go-live, with no refresh, induction coverage or protected learning time, guarantees a fresh capability gap within a year. Make it lifelong.
• Capability invisible to the board. If capability is never measured or reported, it is never funded. Baseline it, track it, and report it alongside delivery.

Maturity model#

Checklist#

• Every digital programme carries a costed capability and OD plan as a condition of approval.
• You have a baseline capability assessment by role, team and site, using a recognized framework, repeated after deployment.
• Training is embedded in deployment with floor-walking and funded super-users/digital champions, and backfill is budgeted.
• CCIO, CNIO and clinical-informatics roles are appointed, funded and given real authority, with a pipeline behind them.
• There are apprenticeships and DDaT career pathways that widen access and aid retention.
• Protected learning time and digital CPD exist, and digital capability is built into induction and appraisal.
• Programmes are designed for digitally excluded staff (devices, logins, basic-skills routes, plain-language materials, one-to-one coaching).
• Leaders' and managers' digital capability is developed, not just frontline users'.
• Capability metrics are defined, tracked, and reported to the board alongside delivery milestones.
• Capability building is run as one strand of a coherent change management and communications approach.

Key sources#

• Health Education England, The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future (2019) — the anchor: whole-workforce digital literacy, specialist informatics capability, and the finding that adoption is bottlenecked by workforce readiness, not technology.
• NHS England / NHS Digital, A Health and Care Digital Capabilities Framework — capability domains for the health and care workforce.
• NHS England, Digital, Data and Technology (DDaT) Capability Framework and Building Healthcare Software / DDaT profession resources — professionalising the digital workforce.
• NHS Digital Academy and the Topol Digital Fellowships — developing clinical-informatics leaders (CCIOs, CNIOs and beyond).
• The Faculty of Clinical Informatics — professional standards and registration for the informatics workforce.
• Lloyds Bank / UK Government, Essential Digital Skills Framework — the baseline digital-skills standard useful for reaching digitally excluded staff.
• NHS England, Digital inclusion guide for health and social care — for citizen and, by extension, staff inclusion.
• Skills for Care and Digital Social Care — capability and digital-skills resources for the adult social care workforce.
• Health Education and Improvement Wales & Social Care Wales, A Healthier Wales: Our Workforce Strategy (2020) — the "Building a Digitally Ready Workforce" theme and the rule that transformation carries an OD plan.

References#

1. Digital literacy — Wikipedia — https://en.wikipedia.org/wiki/Digital_literacy
2. Health informatics — Wikipedia — https://en.wikipedia.org/wiki/Health_informatics
3. Eric Topol — Wikipedia — https://en.wikipedia.org/wiki/Eric_Topol
4. Digital transformation — Wikipedia — https://en.wikipedia.org/wiki/Digital_transformation
5. Structural unemployment (skills gap) — Wikipedia — https://en.wikipedia.org/wiki/Structural_unemployment
6. Lifelong learning — Wikipedia — https://en.wikipedia.org/wiki/Lifelong_learning
7. Learning organization — Wikipedia — https://en.wikipedia.org/wiki/Learning_organization
8. Professional development — Wikipedia — https://en.wikipedia.org/wiki/Professional_development
9. Apprenticeship — Wikipedia — https://en.wikipedia.org/wiki/Apprenticeship
10. Digital divide — Wikipedia — https://en.wikipedia.org/wiki/Digital_divide
11. Health Education England, The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future (2019) — https://topol.hee.nhs.uk/
12. NHS England / NHS Digital, A Health and Care Digital Capabilities Framework — https://www.hee.nhs.uk/our-work/digital-literacy
13. NHS England, Digital, Data and Technology (DDaT) Profession and Capability Framework — https://www.england.nhs.uk/digitaltechnology/
14. The Faculty of Clinical Informatics — https://facultyofclinicalinformatics.org.uk/
15. UK Government / Lloyds Bank, Essential Digital Skills Framework — https://www.gov.uk/government/publications/essential-digital-skills-framework
16. Skills for Care / Digital Social Care — https://www.digitalsocialcare.co.uk/
17. Health Education and Improvement Wales & Social Care Wales, A Healthier Wales: Our Workforce Strategy for Health and Social Care (2020) — https://heiw.nhs.wales/workforce/workforce-strategy/