If digital leadership is truly to flourish in the NHS, do CIOs and CCIOs need to be on every board? In advance of a session at Digital Health Rewired, Adam Wright – senior policy officer at NHS Providers – considers the issue.
The NHS Long Term Plan centred many of its aspirations on digital transformation, within everything from primary care to outpatient services. One of the key milestones listed in the plan was for every local NHS organisation to appoint a chief clinical information officer (CIO) or chief clinical information officer (CCIO) to its board by 2021/22.
For NHS providers, this requirement throws up several questions. What does this mean for digital leadership more generally across boards? Do boards need a single digital leader to solely represent an organisation’s digital strategy or would this be better delivered, in the spirit of the unitary board, as a collective responsibility? And can only CIOs/CCIOs act as these digital leaders when the whole board will be held to account?
What is digital leadership?
Within the NHS, but also across other industries, organisations have been trying to define what makes a digital leader. Is it someone with a track record of leadership combined with a passion for digital? Or someone with stronger technical expertise who has a forensic understanding of where the digital agenda fits within a broader strategy?
Within NHS trusts and foundation trusts, there have been varying approaches. For some, digital leadership comes from the very top, driven by a passionate chief executive supported by a CIO/CCIO who has sufficient access and input into that individual’s thinking.
For others, digital expertise may come in the form of a non-executive director with a special expertise or interest in digital technology. Often finance directors, transformation directors or operations directors will have board level responsibility for digital and informatics within a wider portfolio. And in some trusts, a CIO may not sit on the executive board with voting rights, but instead feed into discussion via an executive committee and intermittent board attendance.
Whichever model providers opt for, it is clear the trust board as a whole will need the capacity and capability to assure itself that new digital strategies can be delivered.
Do we have the digital leaders to appoint?
If NHS trusts and foundation trusts are to appoint digital leaders to boards, we need to be clear on what should be expected. Part of this will require the NHS to think differently about digital and information technology.
As trusts look to implement the Long Term Plan, digital leaders will be at the forefront of transformation. Too often a CIO’s role has focused on reducing the costs of IT and supporting trust efficiency schemes. And while creating a more efficient organisation is an important task if we’re going to get serious about digital leadership, we need to invest in IT.
Equally important will be the ongoing professionalisation of the informatics community. The creation of the NHS Digital Academy, designed to develop new digital leadership within the sector, is an important step but represents only part of an ongoing process. Executive directors must demonstrate they have the right skills, qualifications and experience to lead.
Being on a board is about listening as well as contributing, to areas beyond a single portfolio or area of expertise. CIOs and CCIOs are arguably well placed to assume this role. Their jobs often involve managing competing priorities and strategising across large programmes: from innovation to operations to cyber security.
We must avoid tokenism
The digital maturity of the NHS regularly comes under scrutiny. But appointing a digital leader to NHS trust boards isn’t a panacea for the complex problems facing the sector. Crucially, our new digital leaders will need qualified, professional and valued digital teams to support them. The recent Topol Review made clear the importance of significant investment if we are to enable the workforce to develop new skills. Without sufficient funding, none of these changes can happen.
We have come along way already. The May 2017 WannaCry attack arguably focused the minds of every trust board. The informatics community showed strong leadership and resilience during a difficult few days. The appetite for digital leadership is there. And if we set the long term plan’s arbitrary deadline aside, it feels inevitable more trusts will be developing new, strategic approaches to develop digital capability for the benefit of patients and staff in the months and years to come.
Adam Wright is senior policy officer at NHS Providers, an official partner of Digital Health Rewired. Register now to attend the Rewired Conference and Exhibition, taking place on 26 March at London’s Olympia.