NHS Digital, the organisation charged with improving the use of information and technology across the National Health Service, has seen a number of leadership changes in recent weeks – right at the top of the organisation.
The changes include senior people leaving and new leaders being brought in (along with some familiar faces).
In November of last year it was announced that then CEO Andy Williams was set to retire after over two and a half years of service. In April it was revealed that he would be replaced by the Home Office’s Chief Digital, Data and Technology Officer, Sarah Wilkinson, whom has a strong reputation in government digital circles.
Furthermore, this week NHS Digital Director Beverley Bryant – who has headed up a lot of the NHS’ key digital programmes – announced that she would be leaving to join private sector health software supplier System C, with no indication if a replacement will be sought.
Finally, Matt Edgar, a consultant that focuses on helping organisations grow their service design and digital capabilities, also announced that he would be joining NHS Digital as the new Head of Design.
Whilst we are yet to form an opinion on the extensive changes – it’s too soon to tell what the impact will be – it’s worth noting that they come at a critical time for NHS Digital, which faces an uphill challenge in implementing change across a hugely complex organisation.
Wilkinson has a good reputation for driving change, with her time at the Home Office spent focusing on restructuring the technology and digital functions, as well as being responsible for large-scale programmes that include e-borders.
At the time her appointment was announced, Wilkinson said:
I am thrilled to be joining an organisation that has such a major role to play in supporting health and care organisations to provide preeminent services.”
Digital and technical capabilities and the fast-evolving market in platforms, software, devices and analytics, are transforming the ability of the medical profession to prevent, diagnose and treat diseases. To be asked to work at the forefront of delivering these capabilities is hugely exciting.
A major draw of the role is the opportunity to work with and alongside an incredibly talented team of medical practitioners, technologists and other specialists. It is a huge privilege to be asked to be part of this community.
The more surprising announcement is this week’s departure of NHS Digital Director, Beverley Bryant, who had been building up a profile as a key player in the organisation, engaging in a number of public speaking announcements that revealed her plans for driving change.
Some of Bryant’s key initiatives included responsibility for making the NHS paperless by 2020 – a long running ambition that has seen successive setbacks under previous leadership – and creating more personalised online services for citizens, via the better use of data. She also negotiated the spending review settlement to deliver the NHS and social care digital strategy.
Bryant will take up her new role as COO of System C & Graphnet Care Alliance, which focus on hospital electronic patient record and shared record systems.
Commenting on her new role, Bryant said:
The System C & Graphnet Care Alliance stand out for me because they work across the whole health and social care economy. They have real drive, a substantial user base and an excellent delivery record.
I am really pleased and excited to be joining the supplier community to help drive real change at such a critical moment.
Bryant recently struck a chord with stakeholders in technology deliver across the NHS, where she admitted that previous approaches had been too top-down and that future change programmes needed to be carried out in collaboration with clinicians and local users. It has been argued that one of the primary reasons for the colossal failure of the £13 billion National Programme for IT, was that it didn’t take into consideration local requirements. Bryant recently said:
Our vision is to make health and care better by harnessing the power the power of technology. What we really mean there is to partner with the local authorities and the NHS to help them transform care. We’ve been too national, too ivory tower in the past, and now our role is to step out from the centre and help the NHS, help local users, clinicians, to actually do this for themselves.
Finally, new head of design, Matt Edgar, who has worked with the Government Digital Service (GDS) and DWP Digital Academy on developing and delivering courses for hundreds of civil servants, wrote in his personal blog that the temptation to work alongside people delivering “such important service” outweighed his “trepidation at the scale of the challenge”. He added:
For one thing, there’s the impact of the stuff this organisation is delivering to meet user needs. Patients, service users, families and carers have a visceral need for information about their health and care; it’s about them personally. At system scale, small changes can make a massive difference.
Secondly, I’ve found it hugely rewarding in previous roles to help designers develop their practice into a strategic capability for the whole organisation — making visible what’s valuable, and supporting creative leaps to deliver better service.
And further, I have long held a hunch that the practices of co-creation and co-production emerging in health and social care will be the foundations for the next phase of people-centred service design. If we want to transform the relationship between citizen and state, we should start by understanding the changing dynamics between patients and practitioners.
A mighty challenge
Many have tried and many have failed at delivering technology change across the NHS – those stepping up to the plate should be commended for taking it on. I know plenty of very smart, very capable people that have always said to me that they wouldn’t go near it with a bargepole, claiming it to be a poisoned chalice.
The effects of the failure of the National Programme for IT are still felt across the industry, given how much money was lost and how little was gained from the venture. There were many factors at play, including the poor management of the contract by the public sector, and the poor performance of the private sector suppliers involved. But ultimately, it was a lack of understanding of user need and requirements at a local level that gave it the kiss of death.
And in a way, we should be grateful it failed (although not suggesting the waste of money should be ignored). The National Programme for IT was a big bang project that would have implemented a platform that would have aged quickly, particularly within the context of the rapidly changing IT industry.
More agile approaches need to be introduced, with a greater focus on driving innovation from the ground up – introducing modern technology and techniques that suit local needs. This can be met with a drive from the top by setting standards, guidance and objectives. Incentives need to introduced, so that digital innovation is linked to funding.
Equally, the NHS needs to have an honest conversation about how it uses data. Previous projects to make better use of data have failed, because of sensitivities around protection of patient information. However, if we want to continue having free healthcare the point of delivery, we need to make the NHS smarter – and better use of data can do that. Public consultations and open planning can help ease concerns.
We’ve been hearing positive noises from NHS Digital along these lines, but I’ve also been told that the organisation suffers from an enormous amount of pressure and that people tend to think that the only way to get things done is through intimidation, rather than collaboration – so it will be interesting to see if that changes over time.
Equally, it’s important to note that an influential Select Committee recently said that there is a worrying lack of strategy for digital within the NHS. It noted:
The Department of Health at both the political and official level is failing to think beyond the next few years. There is a shocking lack of long-term strategic planning in the NHS. This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.
In other words, plenty of challenges ahead. However, the people taking on the challenges are credible and the opportunity to deliver something valuable for the whole country is huge. We will be following this closely.
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