In our last column of 2021, Joe McDonalds reflects on Christmases gone by and why Matt Hancock’s ‘Tech Vision’ cannot be forgotten. 

The first Christmas I recall was 1966 – I can remember the smells of the tree, sausage rolls in the oven, Imperial Leather soap (Santa doesn’t come to dirty children), fresh cotton jimjams, the coal fire and not forgetting the glass of Glenmorangie and the mince pie next to Rudolph’s carrot.

The ritual was set in stone, bathtime, the reading of “The Night Before Christmas” and then Dad would recite a diluted version of George Sims Victorian monologue, “Christmas Day In The Workhouse”, of which I can only recall the following:

“…up stood a grimy pauper with a face as bold as brass ‘you can keep your Christmas Pudding and stick it up your……..jumper”.

We fell about laughing because Dad nearly said “a**e” which was a very rude word in 1966.

Flash forward 25 years to another Christmas Eve – I have three children under five, I am doing my first consultant job and I have had a terrible year.

I am one of a team of three consultants in the hospital, demand has outstripped supply so badly that my two colleagues have been on “long term sick” for months and I have been covering their caseloads and on-call in return for a promised 10% uplift in my salary.

I’m exhausted by a nightmare year but I’m summoned to my manager’s office so I walk across the frosty car park, my breath crystallizes in the sodium-lit night air. Once there, I’m informed that times are tough and the 10% uplift is now unaffordable and it won’t be forthcoming.

I am incandescent with rage and resign on the spot, “you can keep your Christmas pudding and stick it up your a**e” I bellow to my somewhat bewildered boss as I exit the building.

Driving back over the Tyne Bridge a few minutes later I feel triumphant, liberated and relieved. However, as I walk up our garden path I see my three children through the warm glow of the living room window, dressed in their clean cotton jimjams with stockings ready to be hung by the chimney and the Glenmorangie and the carrot on the fireplace. It dawns on me that I will have to tell my wife I’ve no job to go to and likely no reference from my boss because of my ill-judged, anatomically tricky Christmas pudding profanity. Doh!

So dear friends, spare a thought for our colleagues at NHSX who go into Christmas facing an uncertain future, maybe no future in digital health at all.

I guess X’s future was in doubt the day Matt Hancock resigned as it was his brainchild. Older readers may recall my theory that the NHS operates on  the “Lava Lamp Model” of continuous organisational churn and, let’s call it, “NHS IT Central” (aka “NHS Alphabet”) is not immune to that model.

I probably won’t win many friends by saying I will mourn the passing of NHSX – at least the idea of it – because I felt that it was at least an acknowledgement by Hancock that NHS IT Central had a problem and needed shaking up with a few new ideas and a few new faces.

The early promise of NHSX for me was the publication of Matt Hancock’s “Tech Vision” with it’s long awaited commitment to open platforms and acknowledgement that there was a way forward other than by the procurement of American megasuites.

Hancock’s Tech Vision at least acknowledged that the NHS IT ecosystem was unhealthy.

I have previously written about the requirement for NHS IT Central to have longer than two years before the next restructure and somehow we have to find a way to distance NHS IT from politics and to create institutions which are not ministerial fiefdoms but communities which can endure a change of minister and indeed government.

Matt Hancock was my 15th health secretary and the average length of stay is 22 months. I recently spoke at the 500 year-old Royal College of Physicians, established through Royal Charter by Henry the Eighth. Yes. Henry the Eighth.

It is an organisation which is independent and unaffected by politics as wee as being open and funded by it’s members.

In my recorded session, I spoke about the history and future of NHS IT and I offer it to the new regime as both induction material and a plan to change from a rigid hierarchy to the kind of liberated team of communities who delivered us 30 million NHS App Users. And to deliver Matt Hancock’s perfectly decent Tech Vision. Please, let’s not start over.

To my friends in NHSX – Merry Christmas, when I found myself jobless on Christmas Eve all those years ago, things looked grim but by January the second I had a new and better job. Back yourself, you’ll be fine.

To all readers, Merry Christmas.

And Merry Christmas Mr Hancock, you can keep your Christmas pudding….but we’ll keep your Tech Vision.

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