The impending departures of NHS England’s transformation director Tim Ferris, chief operating officer Sir David Sloman, and chief nursing information officer Natasha Phillips will leave behind a worrying power vacuum. By Rachel Murphy, Silver Buccaneer and former director of digital delivery at NHS England
Tim Ferris’s focus on the convergence of clinical systems left some perplexed, and there’ll be a sigh of relief from many who were keen to avoid entangling themselves in his enthusiasm for Epic. In times of upheaval, we want the centre to demonstrate leadership through simple action that avoids confusion. In recent months, some would argue, this had been in short supply.
It is unclear who will step into the vacant director of transformation role, if indeed it is to be filled permanently. Ideally, it will be someone with an inside understanding of the issues at play. It will not be easy: there are poisoned chalices, and then there’s this gig!
Power vacuum looms
The centre must take swift, decisive action on priorities and ensure that the funding materialises. While Tim works his notice, Vin Diwakar steps in as interim. Vin is known for being a reliable pair of hands and will no doubt look to keep things on an even keel.
However, the power vacuum over the coming months is concerning – and it is symptomatic of a tendency towards ‘interimitis’ within the NHS, where decisions are scarcely made, and responsibility is rarely taken. We can ill afford to lose the momentum for digital health that flourished during the pandemic.
The forthcoming general election renders decisive action less likely, as both main parties battle to appear the least offensive to the electorate. Labour’s plan for building an NHS fit for the future is clearly intended to be reassuring rather than revolutionary.
Sir David Sloman’s departure is a tremendous loss. He possessed intelligence, competence, and a wealth of institutional memory that is increasingly rare. He follows Tara Donnelly and Natasha Phillips on the way out, and undoubtedly, many more will follow suit. This includes the 9,000 individuals set to be lost by NHS England and those in integrated care boards which fall victim to demoralising budget cuts of 6%.
Brain drain could delay progress
In struggling organisations, talented individuals find it easy to depart – particularly when asked to make substantial cuts to existing programs within an atmosphere of mismanaged decline. Consequently, we face the possibility of an uncertain future with diminishing institutional memory and the looming possibility of having fewer people in the system with the power to effectively deliver.
The perils become evident when considering the NHS App, something personally close to my heart. Health leaders now contemplate adopting a native app approach without the valuable insights gleaned from conversations held since 2016, examining the app’s architecture and design. When I was digital delivery director at NHS England, we decided against this route for valid reasons. The failure to grasp this historical context, combined with the ongoing brain drain from the centre, brings with it a significant risk of reinventing the wheel, experiencing the same failures, and squandering billions of pounds.
Technical knowledge essential
There is, unfortunately, a deficiency in technical understanding within the NHS. Retaining individuals who can deliver is imperative, and technical insight is gold dust that the NHS cannot afford to let slip through its fingers. Otherwise, ill-advised decisions from well-meaning generalists will result in impulsive investments that repeat past mistakes.
On a positive note, health minister Lord Markham demonstrates a solid commitment to establishing priorities, regardless of who occupies the digital driving seat. He advocates for increased system leadership and is holding more meaningful conversations with the industry. This is an encouraging signal that the voices of those operating within the system will be heard.
Direct engagement of this nature is indispensable; otherwise, the NHS will continue to haemorrhage talent and undo the progress achieved in recent years.
Rachel Murphy is a former director of digital delivery at NHS England, an entrepreneur, and a Silver Buccaneer.