Wanted: someone to lead on NHS IT

17 Apr 2008

The Department of Health appears to be having problems retaining its most senior IT and informatics leaders, and has not yet found replacements.

At the end of January Richard Granger finally departed as the head of NHS Connecting for Health (CfH), leaving some mighty big footprints to fill. And last month Richard Jeavons announced that he will quit as CfH’s director of service implementation.

The real surpise, though, came last week when Matthew Swindells announced he would step down as the Department of Health’s acting chief information officer, before his eagerly anticipated root and branch review of NHS informatics is published.

A former director of clinical services at Heatherwood and Wexham Park Hospital and head of IT for Guy's and St Thomas', Swindells, who been leading the DH’s Informatics Review, is seen as sensible and well-informed by many involved in NHS IT.

His departure to the private sector before his report is even published, and the DH’s confirmation that it is still seeking a high level chief information officer for England, to cover both health and social care, suggests that the review’s conclusions, in private at least, might not been well received.

Though not expected for another few months the review of NHS Informatics, is understood to have been completed and has been discreetly trailed at a number of events.

It is expected to stress that informatics is absolutely central to delivery of the strategic direction of the NHS as being pursued by the government. In addition to securing improvements in cost-effective patient care, key policies such as choice, competition and practice-based commissioning and payment by results all depend on the effective use of IT and information.

And although the department has repeatedly stressed that Swindells’ work is not a review of NHS CfH per se, the report is thought to have included an assessment of the NPfIT programme’s contribution to date, including the problems encountered. To not take in the £12.4bn programme in a review of NHS Informatics would have been tantamount to Swindells ignoring the 800lb gorilla in the middle of the room.

There have been some clear indications from early trails of the review’s findings that it would be critical of key aspects of the NHS IT programme and make appropriate recommendations. This includes a call for clear, consistent strategic leadership on informatics by the DH. There are also suggestions that the review will recommend setting a pragmatic course, giving more local autonomy on IT strategy and decision making.

With the NHS IT programme under pressure to respond to new policy imperatives the outlines of the Swindells review recommendations sound very sensible.

However, the problem that Swindells may have inadvertently run into is that NPfIT has not proved easy to re-direct or amend. This despite the NPfIT local ownership programme brought in last year and the contracts having been under almost continuous renegotiation.

The biggest stumbling block for the DH, though, would most likely be conclusions critical of the approach taken at acute trust level to electronic patient records. The DH has already sought to shrug off some pretty tough criticism of its track record on EPRs from both the Public Accounts Committee and Health Select Committee. What if an internal review has come to the same conclusions?

Despite many real successes, the central area covered by NPfIT - delivery of detailed care records systems - progress has proved slow and difficult. The jury remains out on whether the original contracts will be fully delivered, but DH shows no sign of abandoning them yet. In fact one of the attributes of the NPfIT programme to date has been the remarkable level of political support it has enjoyed.

But while Swindells heads off to the private sector, the DH is left with the challenge of finding credible new IT leaders – both a new departmental CIO and head of the NHS Connecting for Health agency - willing to stake their reputation on delivering an IT strategy and approach that is proving far tougher than was originally anticipated.

Jon Hoeksma

Reader's Comments

Pragmatic Course

17 Apr 08 16:53

'There are also suggestions that the review will recommend setting a pragmatic course, giving more local autonomy on IT strategy and decision making.'

I dont know who is suggesting this but who ever they are they dont understand a fundamental aspect of how the NHS works today. They obviously havnt heard of GP System of Choice or Foundation Trust status. Basically NHS Trusts and GPs are free to choose what ever computer systems make business sense for them. There already is local autonimy. Thats whey GPs are not moving off EMIS, unless of course they want to. It is amazing if those at the top of IT management have failed to grasp the nature of NHS management.

Wot? No Consultants?

20 Apr 08 11:38

Surely some consultant / free-lancer will come forward to fill this vacancy as they have filled so many CFH vacancies in the past?

Have I missed it?

22 Apr 08 14:42

I can't find the post advertised on EHI's jobs section!

Thank goodness!

25 Apr 08 10:49

"Despite many real successes, the central area covered by NPfIT - delivery of detailed care records systems - progress has proved slow and difficult." As we still don't know what a Detailed Care Record would look like - except that it is local and includes or replaces secondary, GP and Community records as a minimum - I'm inclined to say, we should be thankful for small mercies! It does seem that the effect would be not only to abolish GP records, but also any ability to move house - not only between England and one of the devolved nations but now between LSPs and even different localities within your own LSP! Still, whatever the benefits of the cradle-to-grave record, most comparable countries seem to have slightly better outcomes without them, so this could be a peripheraql benefit! ;->>

Pragmatic course

25 Apr 08 11:49

Back to the pragmatic course 'giving more local autonomy on IT strategy and decision making.'

Many years ago I did some work for the DoH (I think it was still the DHSS then) on an early attempt at a data network for GPs and dentists (yes they were still in the NHS then). Calculations of traffic and likely revenues were made and, for reasons too boring to go into here, the procurement was aborted and the contract offered to a company (better not name it) that already held a contract for some sort of government data network. Their method of charging for the government contract in no way suited the traffic patterns for the GP network, but never mind.

I had to give a little presentation to the contractor to explain what they were taking on. When I put up the traffic estimates they were quite pleased, in fact I could almost see the pound signs in their eyes. I felt, however, that it was my duty to inform them fully. I told them these were estimates, they said surely they are undertakings. I said no, GPs are independent contractors and can make their own decisions. I then spent half an hour drawing pictures of the (then) structure of the NHS and convincing them that it was not directed from the top down. They were amazed that it should be so.

I have been associated on and off with IT in the NHS ever since and have seen little if any improvement in understanding even amongst policy makers in government.

Wanted: IT Garibaldi (beard optional)

28 Apr 08 10:44

Hardly surprising that the DH is finding difficulty getting volunteers to swig from this particular poisoned chalice. The job of uniting the warring NHS IT tribes, challenging vested interests and entrenched fiefdoms is on a similar scale to the one undertaken by the great Italian hero. It's an intensely political role that is totally hamstrung by the dysfunctional relationship between the DH and NHS. The trouble is, most of the people who could apply, know an impossible task when they see one.