The election…


The great trick in running an organisation is to figure out what’s important, find a way of doing it and get on with it.

The problem is corporate focus. There’s always the attraction of doing the next new thing. So much easier than fixing the tricky old things and that’s why they fester and become, too difficult.

There are three things that are heading for the NHS’ too difficult tray; workforce, debt and IT. We know all about the first two;

Recruiting and retaining the right number of well-trained, well-motivated staff is drifting beyond our reach.

Getting under the bonnet of healthcare finance giving it a jump start, would take determined leadership and there isn’t any.

That leaves IT… let’s be honest, it’s a muddle.

People are still buying kit-n-stuff that isn’t interoperable, there is far too much latitude in procurement and NHSDigital look like spectators, waving as a digital future disappears over the horizon.

Digital are too big, responsible for too much and bring all the operational inspiration of a bottle-washing factory.

If they were a commercial business they would be broken up. The component parts are worth more than the whole. Together NHS Digital is a confusing jumble.

Broken into discrete units with a clear mission would free them from the suffocation of the 60’s structures they endure and has seen some their best talent, leave.

That’s why we should give a cautious welcome to NHSX; the implementation department, broken out of Digital and repurposed.

Yes, it is the product of No18’s hobby and management by foible never ends well… but let’s see if it sticks.

X comes with the usual lofty mission blah… blah…

“Our single goal will be to improve the care that everyone in the country gets by making sure that both staff and patients have the technology they need….”

They’d hardly say they exist to make care worse and deny access to technology. Why do they bother? Anyway, putting that to one side, what do we want them to do?

We need some NHSXyrestic thinking.

Insist Trusts buy stuff that talks to each other would be a good start.

But, unless there is a change in the rules, NHSX will have no power to direct FTs to buy this or that… they are legally free to do what they want.

Nevertheless, it needs to be done. What to do? Change the regulations or deduct an equivalent amount of ‘unapproved TI spend’ from annual allocations, looks, to me, the only answer.

What else? Access to records? There’s a simple fix.

Do what they’ve done in Australia. Treat patient’s data like customer’s money in the bank. Give patients a pin-pin-number and let them decide who gets their money and who sees their records.

Apps, gizmo’s and gimmicks? Until you’ve fixed interoperability, with a crystal-clear explanation of what it means for hardware, software and data, declare a moratorium.

Otherwise, you’ll end up with a Tower of Babel. My guess is we are already building the foundations.

NHSX will need to be quick.

In the real world ICS are already buying and earmarking kit and systems for their patches. Frimley have just done it.

If these organisations sense new regulation is on the way, they will want to get-in, under the wire.

This will create villages of Babel. One village won’t be able to talk to the village over the hill.

The congestion could be added to by ‘the innovators’ and we need a carefull think, asking if more innovation is what we need right now?

• Innovators are often in love with their novelties and blind to reality.

• Innovation is not ‘doing what we do now’, on a screen. It has to be better than what we do now.

• Innovation championed by early adopters is no measure of ultimate diffusion and the potential for success.

NHSX runs the risk of becoming a marketing ploy to make No18 look busy and become the department of gimmicks

The acid test is can X make what we do now, easier, cheaper, safer and quicker.

They’re not in a hurry to get on with it, they don’t start until June.

After the election?

Have a good weekend.

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Reproduced at by kind permission of Roy Lilley.