The director of the Great Northern Care Record (GNCR) has said that the culture that led to the failures of the national programme for IT (NPfIT) is being carried into NHSX.
Speaking at the Northern, Yorkshire and Humberside NHS Directors of Informatics Forum’s (NHYDIF) annual conference in York, Professor Joe McDonald suggested the key cultural lessons from NPfIT had not been learned and it remained very difficult for local NHS IT leaders to have honest conversations with the centre on NHS IT.
“I think NHSX is the right idea, pulling the strands together, but I’m not sure it’s working, and that the negative culture that stymied NPfIT is unfortunately alive and well,” McDonald said at the event on 7 November.
Prof McDonald – who was “let go” a decade ago as a clinical lead for NPfIT for “career limiting frankness” on Lorenzo – also said he “was worried that NHSX may lose the dressing room before they get their team on the field”.
He added: “There’s lots of money out there, but an incoherent funding arrangement and a confusing NHS alphabet soup.”
Prof McDonald called for fundamental cultural change, far greater honesty and for budgets to come out to the frontline.
“There has to be a massive change in culture; we need to have the honest conversation about what needs to happen,” he said.
The culture needed is one willing to listen to dissenting voices and alternative perspectives, McDonald stressed.
“One of the signs of being in a culture that stamps down consent is that the real conversations happen in Whatsapp groups, but not with government,” he said.
Speaking about the development of the Great Northern Care Record (GNCR), Prof McDonald spoke about the pressure to “torture truth” by signing up to artificial targets set by NHS England and NHSX.
He said that unwillingness to commit to such targets had cost GNCR Local Health and Care Record Exemplar (LHCRE) funding.
“We’ve not yet got LHCRE funding and may miss out because we have a real problem with the phoney milestones set by the centre,” Prof McDonald said.
“If you have to torture truth about what is achievable on phoney milestones – we don’t want to do that, we want to be a trustworthy and truthful.”
The issue was rooted in organisational culture, McDonald argued.
“The culture is not great, and it’s really wearing to operate in culture in which any form of dissent is seen as disloyalty to the programme. But my loyalty is not to ‘the programme’ but to my patients and colleagues.”
McDonald also argued that local leaders must feel that they were able to speak truth to the centre and push back on projects and ministers chasing the latest technology hype.
He added: “In the North East I have three trusts in my region who don’t even have an EPR, they are just going to be dark on data sharing and their patients will not see the benefits.
“To be spending £250m on AI first, rather than sorting out the basics, is just bonkers and we need to be able to say that.”
The former chair of the CCIO Network said that it was a key dimension of NHS IT leadership to “have a duty to be talking back to the centre,” but added this was really gruelling and contributing to key local leaders leaving the NHS.
16 November 2019 @ 14:26
What are the issues? What are the phoney targets? Is this just bad blood because the NCR hasn’t gotten any money yet. This is article takes a swipe at NHSX with nothing real to explain why. Matt Gould has made some good improvements already, halting the NHS app programme and stating clear priorities. The LHCRE programme, creating STP wide platforms with an ability to allow innovations to be plugged in once per region should prevent the hairball of apps, IOTS and data quality issues that will be inevitable otherwise. They will also accelerate region wide population health, condition plans, patient access and understanding of care gaps.
As for AI it’s really starting to show promise and could save huge time and money (particularly in areas of diagnostics). Money that can be ploughed back into healthcare. Let’s face it many trusts are already spending money on this without the scale or ability to understand that a central group could bring to bare. Why should this money be frittered away on hospitals that aren’t willing to spend money on the basics?
Come on digital health. If we’re making accusations like this let’s have more depth and put in some evidence. This says little more than NHSX are bad because someone hasn’t gotten his money yet and doesn’t like them.
18 November 2019 @ 08:58
Steve, back to basics. If the processes are broken, ad hoc or non-existent, all the AI, SW and HW in the world will not fix it, Read any article on digital transformation and you will get the same message, Processes first, products (technology) is support for them. The reverse, bolting technology onto bad processes is a recipe for disaster
This is an immutable law of IT projects.
18 November 2019 @ 10:18
Hi Steve — the news report is from a conference presentation Joe gave at NYHDIF that spanned the history of NPfIT up to current-day. Within this context, I think it is notable (and worth reporting) that a leading figure like Joe is warning that the culture needs attention.
Personally I’d argue it needs constant vigilance, as it is so hard to get right and the default of government agencies too often reverts to wanting to accumulate power, and exert control of any money and decision-making.
15 November 2019 @ 19:07
I have recently commenced in a new CCIO role and feel fortunate that the trust wants to focus on staff engagement as a priority. This is so important as we need staff to shape and transform services using the right technology.
I really feel that the focus needs to be on training and staff engagement with technology and funding of the right tools. Financial deficits and struggles with funding makes it difficult for organisations to move forward whilst fire fighting
18 November 2019 @ 12:05
Thanks Terry, you’re absolutely correct, people and process are vital. I’m not saying otherwise.
Thanks Jon, thats helpful but still very generic. Any examples of how we believe they are inappropriately controlling?
8 November 2019 @ 16:02
Interesting developments. I have worked in healthcare 50 years, 40 years as a doctor, and know from experience how the system has been industrialized from a professional environment into a manager’s run operation, Hospitals are like Disney Land. That said, it is logical that healthcare workers resist yet other hypes and other disruptions. Resistances have been studied extensively, see f.e. Why hospitals don’t learn from failures (google search). To me, the logical thing is to start over and do it right this time. Start at the patient’s workflow, follow through at the doctor’s workflow, the nurse’s wokflow etc. Throw all IT that not facilitates workflows in the shredder. After that major task, begin thinking about diagnostic support, because that is far more complex than workflow facilitation. To end in an upbeat: The Pople-Meyers model of working together proofed, in the 70ties, that programmers and doctors can work together very well. The future of dyads of domains is bright.
15 November 2019 @ 19:54
Spot on Hans. I’ve been ranting on for ages about ‘Processes precede Products’ (technology) and I find another disciple. If we can get Matt Hancock to repeat these words, the NHS might be saved from ‘death by technology’..
8 November 2019 @ 06:21
Right now it seems like the wild west. A gold rush of ideas and work, mostly great in their own right, but all pulling in very different directions.
7 November 2019 @ 17:34
I suspect this might be connected to some of the same players being carried over into the new team. At an NHSX event I attended some months back Dr Eccles put on a performance that was worthy of Richard Granger circa 2003 (although huskies were not name-checked).
But when you get down to the details, there are some major differences: to begin with at least NPfIT was focused and clear about it’s objectives and it had a budget to back it up; NHSX is the polar opposite of that.