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Thought Leadership

Why it’s time for some plain speaking.

Debate is great, but when something needs to be said, being open and direct is best – here’s why…


Healthcare 3

James Seaman

Head of Advisory Services

This weekend, there was an article in the Sunday Times by Matthew Syed that made me sit up. It was about the NHS and took the view that we’ll never be able to improve or transform healthcare services in the UK until we stop deifying it.

Provocative. That statement alone causes an emotional response – or at least it should do. The NHS is an incredible institution and the envy of multiple countries. On a personal level, it makes me proud to be British and anyone who knows me will attest to the fact that I am a massive advocate of just how great our Healthcare services are; how much I love the NHS ethos; and how I am a number one NHS superfan.

However (and this may come as a shock to you), I totally and utterly agree with Matthew Syed and the pointpressed in his article.

For me, banging the drum, pots, pans and anything that makes a noise about how great the NHS is, is easy and for the most part, spot on. Being proud of NHS services, while understanding the weaknesses, is not mutually exclusive and although I am not qualified enough to talk about daily clinical issues, patient outcomes or front-line staff challenges evident in some, if not all Trusts – I feel I can provide a point of view about the daily IT challenges that get in the way of enabling NHS outcomes. As an ex-NHS employee, and having worked with the NHS in one capacity or another for around 15 years since then, I’ve seen there is a malignant issue that mirrors the points in the newspaper article.

The timing of Sunday’s article was uncanny and followed close on the heels of one of those ‘putting the world to rights’ conversations with a close friend of mine who happens to be a CTO within a large NHS Trust. Given our relationship, we regularly enjoy long rants to each other about our respective worlds of work. At this point, he and I are locked in a repeating cycle of mutually assured destruction, as we both know each other’s views and opinions on everything. However, beyond sharing (or oversharing) our rich opinions on most things, we ended up talking about technology, which is the thing we feel passionately about – and incidentally pays both our mortgages in one way or another. On this, a wet and cold Monday, the specific frustration that landed on both of us was the lack of reality – or acceptance of reality – we see in our peers across the NHS.

The NHS is amazing at publicising each and every quick win, such as a major clinical system procurement or deployment, but I rarely see honest reflections from across the NHS about the overall state of technology and technology platforms. We have both attended meetings feeling as though knowledge is not power but a curse – and that counteracts the messages of positivity shared by our peers and colleagues. We consistently hear leaders in technology across the NHS talk about how good things are due to a singular project or technology area, while knowing full well, that other Trusts (in some cases the same Trust) have had major cyber security issues; or are still running a sizeable proportion of services on Windows 7; or have limited backup and DR capabilities or… the list goes on.

Nurse ipad

Hold your horses

Just before we get too carried away, I want to make it clear that I am certainly not having a go at any individual or Trust, or saying everything is bad or wrong. Technology is an extraordinarily complex issue within a very complex system, and I appreciate the challenges around technology, people, process, funding and time, which influence and dictate that not every outcome in the IT space can be perfect.

My issues are not with the driving forces and pressures within the NHS IT space. It is a deep-rooted fear that if we do not accept the rough edges and discuss openly, we will never correctly address and fix them.

Whenever I hear news that more funding is available to the NHS for digital outcomes, or hear that a new national or regional initiative focused on a digital outcome is in the ‘offing’, I have two feelings. One of positivity and one of fear. The constant push for ‘new’ and shiny in the IT space, combined with years and years of underinvestment (people, technology and funding), means we may be building a house on sand if we do not remediate the issues of the past correctly.

Across the NHS there are standards, policies, training, academies, and governance. The same is true in IT. However – it is more standards led in IT. In the NHS, there is a tribal nature to IT, a fear to admit fault or issue, and a bravado that hides the reality of issues at the local level.

Digital services, IT infrastructure, applications and data are not fast becoming the bedrock of clinical outcome – they already are. Funding is improving with an amazing availability of innovative technology and the programmes and projects for better NHS service and patient outcomes are good.

However, the fundamental and foundational elements missing are:

- A fear of identifying and owning historic issues and failing.

- Lack of investment in the people charged with delivering digital into and for the NHS

'But what about the ongoing assessments?' I hear you ask...

Digital Maturity Assessments are useful, but not when the culture isn’t there to accept when things are not amazing. If there is no support to help remediate, with no structure in place that supports honest assessment, then no one will admit when things are bad. The carpet things get swept under will continue to bulge.

Setting standards at the core of the NHS establishment for IT security, operational matters, data, connectivity etc., are all incredibly positive but there needs to be more focus on the delivery against those standards. Money is only part of the answer – collaborative networks of peers within the NHS, suppliers and the marketplace can and should, be used to garner more honest sharing of problems and solutions. A cultural change is needed internally to help incentivise more honest reflection but also change the pressures from outside – from national bodies but also suppliers (don’t get me started on ISV’s warrantied environments! That is another opinion piece entirely!)

So what am I saying?

At any given time, things can be viewed as good, bad, on the right track or wrong – but rarely will they ever be perfect. We face a fluid situation, with ongoing change as the norm, so while the direction and aspirations can be correct, the reality of the here and now is vastly different depending on which side of the fence you sit. And that’s OK! If it is identified, faced, discussed openly, and addressed, not starting from a good place can be fixed.

However, no discussions or plain speaking means it never will be.