The outgoing chair of BCS Health and Care has said the organisational structures around NHS IT are confused and hindering progress on shared records.

Andy Kinnear, chair of BCS Health and director of Bristol Connected Care, told the annual Northern Yorkshire and Humberside NHS Directors of Informatics Forum (NYHDIF) conference in York yesterday that he believed “the jury is out on NHSX, so far”.

Looking back on his 29 -year career in health informatics, Kinnear said the current fragmentation of the NHS and multiple, constantly changing organisations and structures made shared records initiatives extremely hard to sustain.

Kinnear, confessing himself a geography graduate, illustrated the point through ‘fluvial geomorphology’, showing a picture of a bridge in Honduras that was left stranded after a hurricane moved the river.

“The job of a CIO, I think, is to try to build bridges that connect different parts of the NHS and enable records to be shared, quicker that the rivers shift,” said Kinnear, who is stepping down to take a career sabbatical next March.

“We have uncertainty ahead and, unfortunately, we have the worst political leadership you can imagine.”NHS IT

He said the NHS has CCGs slowly being abolished, Primary Care Networks being established, trust mergers and new Integrated Care Systems that don’t yet exist. “We have 14 in South West alone, which, so far, are barely functioning committees,” added Kinnear.

He urged the audience to leave organisation-centric thinking of the past behind them and think instead about the delivery of joined-up services focused on patients.

At the centre he said that the picture with NHSD, NHSI and NHSE was already confused, and into this has now been added NHSX, the new joint organisation responsible for digital, data and tech.

Kinnear was scathing: “Although NHSX has data in its tag line it doesn’t actually have responsibility for data. How can that possibly make sense?”

He added: “So I think the jury is still out on NHSX. I like Matt Gould [CEO of NHSX] and Hadley Beeman [Health Secretary Matt Hancock’s technology advisor], but come on – where is this really taking us?”

Despite these frustrations, Kinnear stressed that much had been achieved in recent years on developing health informatics into a recognised and accredited profession, with the creation of the NHS Digital Academy, the establishment of the FED-IP as the new registration body and new UK CHIME CIO certification programme.

Medicine has shown the way, said Kinnear. “What medicine did 200 years ago was say ‘we’re not going to tolerate poor practice and quackery’.”

He contrasted this with the position on health informatics. “We have still got people out there who make poor decisions because they are not true professionals.

“Even more worryingly, we have NHS organisations and financial directors who don’t believe in investing in individuals and teams to make them professionals.”

The profession needs to get to a place where it is recognised that you can’t do the job without having the qualifications, he argued, in the same as finance directors or doctors.

“I want us to get to a place where when you can tell your finance ‘until you have those badges, don’t try to tell me how to do my job.”

Despite that challenges and frustrations caused by constant NHS turmoil and re-organisation, the chair of BCS Health and Care said he was encouraged by the emergence of grassroots social movements and campaigns in recent years, including the CCIO and CIO Networks and Interopen.

“The CCIO and CIO Networks have gone from 5-10 blokes grumbling to 500 people gathering at a university each summer and 3,500 gathering online on Discourse and having a serious debate. That’s amazing, and came about without anyone telling us to do it,” said Kinnear.

He also cited Interopen, the collaborative group for interoperability standards. “Interopen is another example of that collective spirit developing a set of standards on interoperability. But, unfortunately, some at the centre now see that as a threat.”

On to develop a career in health IT, he said: “Despite all the problems and frustrations, it’s a really great place to be, we get to help improve the delivery of care to patients. Digital is simply the way for us to serve people better.”

Kinnear concluded: “So it’s the best place to be but parts of it are unfortunately so toxic and moribund your enthusiasm will die there, so choose your bed carefully.”