What should be top of mind for the new NHS CIO?

The NHS is looking for a new chief information officer, and the Highland Marketing advisory board has been considering what should be on his or her ‘to do’ list.

Following the merger of NHSX and NHS Digital with the NHS England transformation directorate, and the departure of some high-profile digital leaders, the NHS is looking for a new chief information officer.

In the middle of March, NHS England announced that it had appointed John Quinn, the former head of the Medicines and Healthcare products Regulatory Authority, as interim NHS CIO. But there’s no indication when a permanent replacement for Simon Bolton will be found.

The uncertainty has contributed to health tech being – as one member of the Highland Marketing advisory board put it – “in a bit of a mess right now.” Against a paralysing backdrop of elective recovery, demand, financial pressure and strikes, providers and suppliers are trying to work out what the IT strategy is meant to be – and where the resources are going to come from.

As Andy Kinnear, a former CSU CIO who now works for Ethical Healthcare Consulting, put it: “We’re trapped between two worlds. We’ve got this exciting new world of digital that we see in other areas of our lives. And we’ve got this stale, old world of patching critical infrastructure and running after programmes that are run by people who feel a long way from the frontline.”

Quinn, and the new CIO when they are appointed, will have a lot on their desks, and the advisory board highlighted five of their biggest challenges as being to:

Reboot frontline digitisation: The frontline digitisation programme has been billed as an opportunity to complete the roll-out of electronic patient records to hospitals that was started 20 years ago by the National Programme for IT, while encouraging ‘convergence’ on infrastructure and core systems.

However, the Health Service Journal has reported that more than half of the £2.2 billion that was found for the programme in last year’s Autumn Statement has been clawed-back. And there is concern that, in some areas at least, the focus on convergence is skewing priorities in the direction of clusters of trusts adopting the same EPR from a single supplier.

Ian Hogan, chief information officer at the Northern Care Alliance NHS Foundation Trust,said: “NHS England is saying there are about 30 trusts without an EPR but, due to the reduced funding envelope, it looks as if not all will be funded for one. Where does that leave the rest?

“And if we can’t support 30 trusts to get an EPR, how can we support the other trusts to converge on one or two systems? You can make a case for convergence being the right thing to do, but at the moment it is just causing more confusion.”

Pick a future for the NHS App: The NHS has made a considerable investment in the NHS App but has seemed uncertain about what to do with it. Should its developers create their own information and transactional functionality? Or should they focus on providing identity and access services for third-parties?

Or should the NHS let the app become one of many digital access points? The current health and social care secretary, Steve Barclay, seems keen to see the app widely downloaded and used as a ‘digital front door’ to the NHS; and advisory board members thought he should push on.

Neil Perry, a digital health consultant who was, until recently, the director of digital transformation at Dartford and Gravesham NHS Trust, said: “The NHS App had something like 30 million downloads during Covid, so there is clearly an opportunity to build on that. And it should be a digital front door, ideally a nationally provided patient portal, from which the economies of scale would drive down cost and create standardisation. But more than a patient portal, key apps should be integrated and funded nationally, such as AI assisted diagnosis & symptom checkers that can reduce the overall burden on GPs, UTCs and emergency departments. All this would democratise patient facing tech across the UK.”

Advisory board chair Jeremy Nettle is passionate about this agenda. “I remember thinking, years ago, when we first heard that the ‘information revolution was coming’, that it was more likely to come from the public than the NHS,” he said.

“To some extent, that is happening, with the spread of GP apps and remote monitoring. But we need it to happen faster, because so many people are still ending up in hospital when they could be better treated elsewhere or staying in hospital when they could recover at home.”

Secure the med tech revolution: Medical technology is a hot topic. The government has just published the first-ever strategy to give UK patients access to safe, effective and innovative equipment ranging from syringes to medical scanners and from test kits to home dialysis machines.

Many of these devices will be connected to NHS networks or the public internet in one way or another, and Neil Perry argued there is an urgent need to think about how to regulate and secure them. “The med tech space is really important, but it is a hotch-potch at the moment,” he said. “There’s no consistent adoption, and the NHS needs to invest in making sure these devices are connected, data insights utilised and are made fit for purpose. This can really improve safety, efficiency, and effectiveness, reducing communication errors, increasing accuracy, and enabling faster diagnosis and escalation. I’d argue investing in a med tech Strategy or ‘smart hospitals’ would have a greater impact rather than refreshing a PAS and/or an EPR.”

Stop the talent drain: National leadership for NHS IT has been in flux since the merger of NHSX and NHS Digital was announced. But Andy Kinnear pointed out there have also been some high profile departures from integrated care boards and trusts.

At the same time, the NHS continues to lack the workforce and IT strategies that might help it to secure the digitally savvy clinicians, IT innovators and data analysts it will need in the future. Ian Hogan said: “This is one of the things that keeps me awake at night – alongside the old data centres, and the cyber security.

“The health service has had a cadre of IT leaders who are NHS through and through – I am probably one of them. But there’s fewer and fewer of us. Even when we recruit people, they do the job for a bit and then go somewhere else. It’s not just the money, or the hours, or the complexity. It’s the workload. You do 100-hour weeks to try and stay on top of it, and it’s just not sustainable.”

Reconnect with the frontline: This leads to the question of who the next, substantive NHS CIO should be. In some ways – the board argued – it might not matter. The present government will, almost certainly, be out of office within a couple of years. NHS England looks as if it will spend a good chunk of that time re-organising to cut costs and headcount.

Most of the national capital funding for NHS IT has been earmarked for frontline digitisation and then cut, so only small sums may be available for projects. Probably those that catch ministerial attention, like digital follow-up, or virtual wards, or bed management and patient flow systems – which are suddenly ‘the ‘solution’ for next winter.

As Andy Kinnear put it: “The political forces may be so huge that whoever takes on the job will have virtually no room for manoeuvre.” Even so, members felt it would help if the NHS could find a CIO with frontline experience.

“I think we need somebody who has been at the coalface; somebody who has a proper connection with what it is like to do the job in an acute environment,” said Ian Hogan. “Because it is just tortuous at the moment, and we need somebody who can bring a bit of realism to what is being demanded by the centre and what is possible.”

Pulling IT all together  

The advisory board was divided on whether the merger of NHS England, NHSX, and NHS Digital will be a good thing in the end. Cindy Fedell argued it would be because “we do need IT to be blended with operations” and also “when NHS England says something, chief executives sit up and take note.”

However, entrepreneur Ravi Kumar reiterated that, for the moment: “It feels like the whole digital agenda is on hold. Plans are announced, but nobody backs them up. And the leadership has gone, so nobody fights for that money. Instead, it feels like a culture of survival has taken hold.”

Andy Kinnear argued that while the hiatus continues, the best thing ICB and trust CIOs can do is “crack on” and “use the space to do things locally” – although he wondered where innovation would come from, with SMEs and start-ups finding it so hard to get a toehold in the market and at risk of take-over by bigger players.

Looping back to his opening point, he said: “There is the fourth industrial revolution going on around the NHS, and there is the moribund state of things within it. For me, what the new CIO needs to do most is to provide challenge about that, and to work out a way to get from one world to another.

“They need to start by acknowledging that the past five years have achieved very little, and they need to engage regional and local leaders to be part of the way forward.”