John Quinn has been appointed as the NHS’ new CIO and will lead the organisation’s digital transformation strategy. It’s a big job with huge demands from across the healthcare system.
Our Partnerships Director, Andy Kinnear, sets out what John’s priorities should be and how he can make a real difference in moving the digital healthcare agenda forward.
How we got here
There have been repeated attempts to digitally transform the NHS in the last two decades. Despite some pockets of success, digitisation has yet to be truly realised at scale across the entire NHS footprint. The problems, and in many cases the solutions, are very well understood so the question is why have we not done this yet?
There are many reasons for that but, in the end, it boils down to leadership.
Political leadership endorsement has been inconsistent, sometimes flimsy, or soundbite driven, often matched by policy and approach. The political “we will be paperless by [pick random future date just after next election]” mantra is well rehearsed now.
The calibre of leadership at national level – including technical, administrative and clinical – has changed too often, revisiting the strategy question time and again when it is delivery that counts.
At local level, Boards have been painfully slow to recognise they need professional digital leaders in their midst and even slower to grasp the opportunity digital transformation presents. If that wasn’t enough, the funding has been uncertain, slow, insufficient and complex. Frontline CIOs have had to become experts in creative accounting treatments and fantastical benefits realisation to secure any funding from the Centre.
Far too much time has been spent on writing and rewriting strategies to commemorate each new leadership arrival. A grand document to signal the new era but, in reality, the mission has hardly changed this century. So, while the CIO might be new, the vision and challenges are pretty familiar.
Almost there once…
There was one period when we came close to getting it right.
At that time, the national leadership consisted of professionals with a pedigree in frontline digitisation. We had a:
- Deputy Head of the NHS being a former frontline CIO
- National CIO being a former frontline CIO
- National Clinical CIO who was a clinician and frontline CEO who had implemented a huge EPR project
- National Public-Facing Lead who was an expert in the digital app sector and consumer-facing technologies
This period saw the creation of a national target architecture, the launch of digital exemplar investment schemes, launch of the NHS App and associated public-facing initiatives. It saw the publication of seminal works like Making IT Work, a review led by Professor Bob Wachter that called for investment in the creation of a profession in digital health, especially for clinicians. I look back on my 30 years and genuinely feel this was the moment when I thought we would do it.
Familiar challenges
The sad reality is that decades of work have not moved the NHS far enough with its digital transformation agenda. As a result, the three main challenges for the new CIO are largely what we have faced before:
- Get rid of the paper – Complete the digitisation journey across the NHS and ensure that all patient information is being captured digitally so that the fundamental baseline benefits of efficiency, sharing and safety can be realised.
- Share information – Create the standards, contracts, architecture and vendor buy-in to information sharing. The NHS has one of the most complex technical architectures of any sector and interoperability cannot be achieved without consistent standards on sharing.
- Empower patients and the public – Give our public the same consumer experience in health that they enjoy in all other aspects of their lives.
So, what do I think they should do?
The new CIO needs to do five things to get the digital agenda moving forward and at pace.
1. Get more money
Digital transformation is impossible without investment. The last 13 years of austerity have bitten hard on the NHS and other public services, and digital services have taken their share of the pain. But the stark reality is transformation needs investment capital so the new CIO must find a way to secure funding for the long term. Use this money to invest in leadership, resources and the digital platform, funding teams not products.
2. Ensure interoperability happens
True digital transformation will not be achieved without interoperability, and that takes consistent standards. If necessary, the new CIO should seek to create legal levers to ensure the technical and information standards required are adopted across the NHS and vendors alike. We have had decades to do this voluntarily and failed, and we all know why. Time to make this less optional.
3. Target frontline benefits
An unrelenting focus on realised frontline benefits is required to demonstrate the impact of digital transformation. Every single project proposed nationally, regionally and locally should be required to describe its frontline benefits and be held to account on delivering them. And by frontline benefits, I mean to our patients, our public and crucially our tired and broken frontline care professionals who deserve so much more of us.
4. Develop truly professional leadership
Ultimately, the failure to digitally transform the NHS has been a leadership failure. The new CIO must invest in the professional development of capable and professional digital leaders and not allow organisations to badge people without the skills in key roles. CNIOs, CCIOs and CIOs and their teams should be professionally certified; organisations who fail to do this should be penalised.
We have created all of the necessary infrastructure for a mature profession, including professional register, education programmes, professional bodies, certifications and accreditations, so now it’s time to make them happen. Imagine if a trust could fail its CQC because it had not invested emotionally and financially in professionalising its digital transformation team. I daresay it would happen then!
5. Be consistent
No more new policies. No more fancy strategies. No more headline-grabbing announcements. Just turn the wheel again and again and again. Digital transformation is a long walk, and I know about long walking. It’s a slog, one sorry step after another but in the end, you begin to look back and see the immense distance travelled.
Progress on the NHS’s digital transformation journey has been slow. Really slow. But, in a way, it has to be. We’re trying to get 1.4 million people and thousands of individual organisations to fundamentally change the way they work.
Professor Wachter’s review described this walk as an ‘adaptive change journey’ and one that takes time. It is going to take a million steps so let’s just keep walking.
If you’re interested discussing opportunities for collaboration in the healthcare sector, please contact Matthew Roberts at matthew@ethicalhealthcare.org.uk.