No more white knights please

The application of digital technology is central to addressing the challenges faced by the health and social care services, and, implementing the NHS Five Year Forward View, which talks of providing the “electronic glue” which enables different parts of the service to work together.

But we must be careful not to repeat the mistakes of the past, and we don’t need the kind of “exceptional” chief technology and information officer that NHS England is currently looking to recruit.

The real challenge

The challenges we face in effectively applying digital technology are not primarily technical, but rather questions of culture, governance and design.

My concern, shared by many in the health informatics community, is that these challenges won’t be understood, let alone successfully addressed, by someone with the skills normally associated with a chief technology or chief information officer, however exceptional they are, and particularly if they are from outside health and care or the UK.

There is a long history of appointing able people to the senior role in NHS IT with the naive hope that the latest messiah will achieve that which all those who have gone before have not. It really is time to stop this futile search for white knights and magic bullets.

In my view the health and social care community, which includes citizens, patients, carers, practitioners, academics, policy makers and vendors, already know most of the answers. The challenge is how to expose and apply this collective wisdom.

These challenges won’t be understood,by someone with the skills normally associated with a chief technology or chief information officer

The problems we face are complex and require a profound understanding across a number of domains which no individual is likely to possess. We need leadership that has a broad understanding of how health and social care operate at the front line with enough knowledge to critically appraise the advice they receive from various experts, many of whom have vested interests, and the humility and ability to foster cooperation and engagement of the community.

We have seen the appointment of Matthew Swindells to replace Dame Barbara Hakin as national director for commissioning and operations, but with a new job title that quietly, but significantly, adds “information” to the role.

Mr Swindells is unusual in having the experience and skills to guide a digital transformation and the ability to command respect from the community, he spent some time alongside his day job as chair of the British Computer Society Healthcare Group, where I served as his treasurer, and has the track record in the NHS, government and industry.

Most recently during his time with Cerner he has gained valuable global experience, The only concern can be that during his time in the US he has fallen under the thrall of “megasuites” but my impression is that Mr Swindells has changed Cerner more than Cerner has changed him.

Mr Swindells of course is no messiah and needs to build a team around who can engage with the collective wisdom of the community, drawing on the talent and experience that already exists in NHS England with a little new blood.

Chief clinical information officer

This team needs both expert engineers and designers, but most of all it needs something closer to a chief clinical information officer not a CIO/CTO. This individual needs to be a clinical informatician, someone who is a clinician, probably a medic, who understands how to make health and care data open, shareable and computable.

They need to be able to command respect in the senior level of the profession, but most importantly need to be a digital native able to engage with the community of young, innovative, clinicians and developers in the NHS hacker and app community. There are a number of individuals qualified for this role and I would be happy to share their names with Mr Swindells.

This individual needs to be a clinical informatician who understands how to make health and care data open, shareable and computable

Rumours abound in the corridors of power as to whether the proposed CIO/CTO will report to Mr Swindells or NHS England chief executive Simon Stevens. My proposition is that we don’t need at CIO/CTO but a CCIO but whichever they choose it is essential they report to Mr Swindells.

The last thing we need is another white knight new to UK health and care galloping on their charger into the void into which their predecessors have disappeared. Let’s build of what we have already got.

Ewan Davis has worked in digital health and care since 1981 in both the vendor and customer communites. Has twice been chair of the industry trade association, chair of the BCS Primary Health Care Group and is the founder of the not for profit HANDI set up to support health and care app developers. He now works as an independent consultant with clients including NHS England Code4Health, The Apperta Foundation and a number of local health and social care organisations. He blogs on digital health at woodcote-consulting.com/blog